Polypharmacy and MS

Polypharmacy: What You Need to Know

Living with MS often means managing a wide range of symptoms with many medications. But when the number of medications becomes too high, or when some are no longer needed, problems can occur. This is called polypharmacy. 

What Is Polypharmacy?

Polypharmacy usually means taking five or more medications regularly, but problems can happen with fewer. Each medication may help on its own, but taking several drugs together raises the risk of side effects or interactions.   

“Central nervous system-active polypharmacy” refers to the use of multiple medications that affect the brain and nervous system at the same time—such as antidepressants, anti-anxiety drugs, sleep aids, or pain medications. These medications are often riskier than other medications because they may affect your mood, alertness, coordination, memory, and decision-making. 

What are the risks of taking many medications?

• Drug interactions: The more medicines a person takes, the higher the chance that the drugs could interact with each other in harmful ways. This can make some medicines less effective or cause unexpected side effects. 

• Side effects: Each medicine can have its own side effects. When several are taken together, these side effects can add up, making a person feel worse instead of better. 

• Cognitive problems and fatigue: Studies show that people with MS who take many medications are more likely to feel tired and have trouble with memory or thinking. 

• Depression and anxiety: There is a link between taking many medications and having more symptoms of depression in people with MS. 

• Quality of life: Polypharmacy is linked to a lower quality of life, more hospital visits, and a higher risk of falls. 

Why Polypharmacy Happens in MS

You may be at higher risk of polypharmacy for several reasons: 

• MS often requires multiple medications for different symptoms. 

• You may have several doctors who all prescribe different drugs. 

• Hospital stays or relapses can lead to temporary or permanent medication changes. 

• As you get older, or develop other health problems, your medication needs might change. 

When Are You at Risk for Unnecessary Medications?

Even though each medication may have been started for a good reason, some may no longer be necessary or safe over time. Your risk of being on unnecessary medications may increase in the following situations.  

1. After Hospitalization or a Relapse
   New medications are sometimes added during hospital visits by doctors you may not see again. Some of these drugs are only meant for short-term use. After you go home, review your medication list with your regular neurologist or primary care doctor. 
2. When Seeing Multiple Providers
   If your doctors don’t know your most up-to-date medications and doses, you might end up taking too much of a medication or have harmful drug interactions. Keep a list of all your medications and don’t assume your records are automatically updated. 
3. If You’re Experiencing New Side Effects
   Sometimes, what seems like a new MS symptom might be a side effect of a medication. Contact your doctor if you develop a new symptom and ask if it may be from a medication or a combination of medications. 

How to Manage Medications

Keep a Complete Medication List 

Include prescriptions, over-the-counter medications, supplements, and vitamins. Make sure to list the dose you are using and how often you take each medication. Share it at every appointment. If keeping a list does not work for you, bring your pill bottles or take a photo of them. 

Ask your doctor or pharmacist to review your medications at least once a year. You may be taking a medication they do not know about. 

Ask These Questions: 

• Why am I taking this? 

• Is this still necessary? 

• Is this dose too high? 

• What are the side effects? 

• Could any of my medications interact with others? 

Watch for Red Flags 

Signs of overmedication may include dizziness, confusion, drowsiness, or frequent falls. Don’t ignore these. 

Specific Drug Combinations to Avoid 

Some drugs taken together have a significant risk of complications. For example, opioids taken with Benzodiazepines (such as Ativan, Xanax, or Klonopin) can affect breathing or cause significant confusion. 

What About Over-the-Counter Medications and Supplements? 

Over-the-counter drugs and supplements may seem harmless, but some may have real risks. They also can interact with prescription medications. Common concerns include: 

• Antihistamines (like Benadryl) can cause drowsiness or worsen bladder symptoms. 

• St. John’s Wort can interfere with antidepressants or MS medications. 

Always check with your doctor or pharmacist when taking any new over-the-counter products. 

Final Thoughts

Managing MS is hard enough without the extra problem of taking medications that may be causing you harm. By staying informed, asking questions, and working with your care team, you can make sure your treatment is safe and right for you. 

Want to Learn More? 

• Health in Aging Foundation: https://www.healthinaging.org/medications-older-adults/medications-older-adults-should-avoid