Polypharmacy: Strategies for rationalization

Abstract

Introduction: The polypharmacotherapy is a recently used term to define the simultaneous use of some drugs. Until now, the mostly used term has been polypharmacy, which has a negative connotation. The negative sense is related with inappropriate drug uses, iatrogenic risk and health costs.The appropriate polypharmacotherapy is a patient-centered approach challenge, and the family doctor should be able to apply individually the best available evidence. Therapeutic reasoning process: The prescription decision is a complex procedure.The main determinants of drug prescription are: the basic pharmacologic education of the doctor, the pharmaceutical marketing and the guidelines (synthesizing the best evidence). To acquire a correct therapeutic reasoning it is useful to apply some tools such as: P-drugs identification, Beers list (elderly), automated supports to prescription and acronyms (AVOID Mistake, NO TEARS, among others). Polypharmacotherapy reasoning strategies:The approach of polypharmacotherapy is a quaternary prevention measure which recommends a reflexive medicine with patient participation. Some logic sequence of steps are listed, such as: exhaustive drug listing (including herbals, dietetic, alternatives), pharmacologic knownledge about prescribed drugs, simple regime and explicit therapeutic aims.