Polypharmacy guidance: realistic prescribing
Identify the need for adding/intensifying drug therapy in order to achieve therapeutic objectives:
- To achieve symptom control
- To achieve biochemical/clinical targets
- To prevent disease progression/exacerbation
Step 4: Are therapeutic objectives being achieved?
- Check treatment choice is the most effective to achieve intended outcomes
- If this is not the case, the possibility of patient non-adherence should be investigated as a potential explanation. Otherwise, the need for dose titration may also be considered. 50% of patients taking four or more medicines don’t take them as prescribed. (World Health Organisation).
If therapeutic objectives are not achieved:
Consider intensifying existing drug therapy
- Laxative - Constipation
- Antihypertensives - BP control
- Antidiabetics - HbA1c control
- Warfarin - INR control
- Rate limiting drugs - Heart rate?
- Respiratory drugs – Symptoms?
- Pain control
For patients with the following potential indications:
Consider if patient would benefit from the specified drug therapy
- (see NNT section)
- CHD - Antithrombotic, statins, ACEI/ARB, beta blocker
- Previous stroke/TIA - Antithrombotic, statin, ACEI/ARB
- LVSD - Diuretic, ACEI/ARB, beta blocker
- AF - Antithrombotic, rate control
- DMT2 - Metformin
- High fracture risk - Bone protection