Case Scenario: Polypharmacy List Review

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KS is a 79-year-old female. She states that she takes too many pills and would like to try to reduce some. Here’s her list.

  • Aspirin 81 mg daily
  • Clopidogrel 75 mg daily
  • Pantoprazole 40 mg daily
  • Valsartan 80 mg daily
  • Metoprolol 25 mg BID
  • Amlodipine 5 mg daily
  • Mirtazapine 15 mg at bedtime
  • Famotidine 20 mg BID
  • Trazodone 50 mg at bedtime
  • Sertraline 100 mg daily
  • Flonase 2 sprays in each nostril daily
  • Ibuprofen 400 mg PRN
  • Docusate 100 mg BID
  • Pramipexole 0.5 mg at bedtime
  • Cyclobenzaprine 10 mg BID
  • Tramadol 50 mg BID PRN
  • Melatonin 5 mg at bedtime
  • Claritin 10 mg daily

One of the important items that I notice initially is all of the medications she is taking that are sedating. Mirtazapine, trazodone, melatonin, and cyclobenzaprine all have significant sedative properties. I would recommend attempting to reduce some of these medications for insomnia. Having a past medical history as to when these medications were added and the exact indication are two of the first items to investigate.

A pain assessment is going to be very important in this patient. She has ibuprofen, tramadol, cyclobenzaprine, and pramipexole (likely for RLS). Acetaminophen would be a much safer choice for her instead of the ibuprofen or tramadol. I would definitely inquire about the prior use of acetaminophen.

I do like to review allergy medications in an attempt to reduce polypharmacy. Asking the question if she requires both the loratadine and the fluticasone would be another opportunity to lower her medication burden.

She is on aspirin and clopidogrel and is at higher bleed risk. This makes the ibuprofen a little scarier. Coupled with that, she does have two agents that reduce acid. Reviewing the benefits of famotidine and pantoprazole to see if both of these are necessary would be another opportunity to reduce medications.

What else would you inquire about?

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Written By Eric Christianson

November 3, 2019

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