Assessing the harms of polypharmacy requires careful interpretation and consistent definitions

摘要

The article by Payne and colleagues [1] concludes ‘Assumptions that polypharmacy is always unsafe or harmful, … need to be reconsidered in the clinical context of the conditions for which those drugs are being prescribed’. Given the large body of evidence that polypharmacy is associated with many harms, especially in older populations [2], the conclusion can be misinterpreted when translating to clinical practice, and the contribution of polypharmacy to hospitalization, and other clinical outcomes, should not be dismissed. This study demonstrates that use of ≥10 medications (or ‘hyperpolypharmacy’ [3]) was consistently associated with an increased risk of hospitalization across patient groups with any number of comorbidities. For those with multimorbidity, the relative effects of medications on hospitalization may be diminished by the effects of the diseases themselves [4]. This study adds to the evidence that in those with multimorbidity, following clinical guidelines for all of a patient's comorbidities has undesirable effects [5].