Managing Polypharmacy in Non-Communicable Disease Patients

Introduction to Medication Management

• A comprehensive medication review should be performed at least annually for all patients on multiple medications for non-communicable diseases to optimize therapy, reduce adverse events, and improve outcomes, as recommended by the American College of Physicians 1

Medication Reconciliation and Assessment

• Create an accurate medication list including all prescriptions, over-the-counter medications, supplements, and herbal remedies to identify discontinued, missing, or incorrectly taken medications, according to the Mayo Clinic Proceedings 2, 1
• Document all known diagnoses, conditions, existing laboratory results, and medication-related problems in the electronic medical record, as suggested by the Journal of Internal Medicine 3, 4

Interaction Assessment

• Evaluate potential drug-drug interactions using interaction databases, paying particular attention to QT prolongation risks, anticoagulant interactions, and serotonin syndrome potential, as recommended by the Mayo Clinic Proceedings 2, 1
• Identify medications that may worsen existing conditions (drug-disease interactions), such as NSAIDs in heart failure, chronic kidney disease, or hypertension, according to the Journal of Internal Medicine 2, 5

High-Risk Medication Identification

• Use validated tools like Beers Criteria or STOPP/START to identify potentially inappropriate medications in older adults, as suggested by the Mayo Clinic Proceedings 2, 1
• Pay special attention to high-risk drug classes including sedatives/hypnotics, opioids, anticholinergics, benzodiazepines, anxiolytics, and hypoglycemics, according to the Journal of Internal Medicine 2, 5

Patient Preferences and Goal Setting

• Discuss with the patient the purpose of medication optimization to improve quality of life and function, as recommended by the Journal of Internal Medicine 6
• Encourage patients to express their personal values, aims, and priorities regarding treatment, according to the Journal of Internal Medicine 3, 6

Deprescribing When Appropriate

• Target medications from which patients no longer derive reasonable benefit, as suggested by the Mayo Clinic Proceedings 2
• Consider deprescribing when potential harm outweighs benefit, including education about risks for patients and families, according to Praxis Medical Insights 1

Monitoring and Follow-Up

• Schedule regular follow-up appointments to assess medication effectiveness and adverse effects, as recommended by the Journal of Internal Medicine 3, 6
• Increase monitoring frequency during care transitions (hospital admission, transfers between wards, discharge), according to the Journal of Internal Medicine 3, 6

Special Considerations for NCD Management

• Assess the management of chronic pain, depression, anxiety, and other common comorbidities, as suggested by the Journal of Internal Medicine 3, 6
• Evaluate physiological and functional status, nutritional and hydration requirements, according to the Journal of Internal Medicine 3, 6
• Consider using a multidisciplinary team approach, especially involving clinical pharmacists when available, as recommended by Praxis Medical Insights 1