Polypharmacy and Medication Review: Asking for a Safer Pill List

Polypharmacy and Medication Review: A Calm Guide for Families

When to call 911 or Poison Help

• Call 911 if someone who takes several medicines is hard to wake, has trouble breathing, has a seizure, or has collapsed.
• For a suspected overdose, call Poison Help: 1-800-222-1222 (same line used on our medication-safety page).

For day-to-day safety habits (pill boxes, acetaminophen limits, grapefruit), see Medication safety for seniors—this page focuses on too many medicines and how to ask for a review.

Key takeaways

• As people age, they often take more prescription and OTC medicines; FDA notes that raises the chance of side effects and interactions, and that the body may handle drugs differently.[1]
• The 2023 AGS Beers Criteria® lists medicines that are typically best avoided by adults 65+ in most circumstances or in specific situations—as a tool for shared decisions, not a rule to stop every listed drug on your own.[2]
• Risk of harm can be higher with advanced age, cognitive or physical impairment, many chronic conditions, frailty, kidney impairment, and a high degree of polypharmacy.[2]
• Never stop or change a prescription without talking with your clinician or pharmacist first.[1]
• Keep one list on

and bring it to every visit.

What “polypharmacy” means here

In everyday clinic language, polypharmacy means using multiple medicines (including OTC drugs, vitamins, and supplements) for health conditions. FDA explains that older adults are more likely to use more medicines, and that liver and kidney changes can alter how drugs break down and leave the body.[1]

This page does not invent a “safe number of pills.” What matters is whether each medicine still has a clear purpose, whether side effects add up, and whether a clinician has reviewed the whole list together.

What the 2023 Beers Criteria is—and isn’t

The American Geriatrics Society’s 2023 update is an explicit list of potentially inappropriate medications (PIMs) for older adults. An expert panel reviewed evidence since the 2019 update.[2]

Important limits from the paper itself:[2]

• Intended for adults 65 and older in ambulatory, acute, and institutional settings—except hospice and end-of-life care settings
• Designed for use in the United States
• Should support, not replace, shared clinical decision-making
• Should not be oversimplified as “avoid in everyone over age 65”—many criteria have exceptions
• Some criteria distinguish starting a drug versus continuing one already in long use (including considering deprescribing for current users)

We do not reprint drug-class tables here. Those lists are for clinicians and can be misread without your full history. Ask your doctor or pharmacist to apply the criteria to your chart.

Why a periodic review helps (without scare tactics)

Medicines that worked for years may need adjusting later in life.[1] A review is a chance to:

• Confirm each medicine still matches a current goal
• Spot duplicates (two products with the same ingredient)
• Reduce dizziness, sleepiness, or confusion that can raise fall risk (see also What to do after a fall and Fall risk assessment)
• Plan deprescribing—the medically supervised process of lowering or stopping medicines that are no longer needed or may be causing harm

FDA’s older-adult tips also stress: take medicines as prescribed; don’t share prescriptions; don’t skip or stop without advice; store properly; watch food/alcohol interactions; and keep a current list for every provider.[1]

How to ask for a medication review (script)

Bring one list that includes prescriptions, OTC drugs, vitamins, supplements, eye drops, and as-needed pills.[1]

Try these questions:

1. “Can we do a full medication review—including OTC and supplements?”
2. “For each one: what is it for, and do I still need it?”
3. “Could any combination be making me dizzy, sleepy, foggy, or unsteady?”
4. “Are any of these on the Beers Criteria for my age, and if so, what are safer options for me?”
5. “If we stop or lower something, how do we taper, and what withdrawal symptoms should I watch for?”
6. “Can we use one pharmacy so interactions are checked in one place?”

Ask for a follow-up visit after any change. Put allergies, medicines, and emergency contacts on

.

Who to involve

Drug-cost questions: Medicare Part D.

FAQ

Should I stop a medicine because it’s on the Beers list?
No. The 2023 criteria are meant for thoughtful shared decisions, not self-discontinuation.[2]

Is there a maximum number of pills?
No single number is stated on the FDA consumer page we opened. Focus on indication, side effects, and a clinician-led review.[1]

Does the Wellness visit include a medicine review?
Medicare’s yearly Wellness visit includes a review of current prescriptions. See Medicare Annual Wellness Visit.

• Related: Medication safety for seniors
• Related: What to do after a fall
• Related: Medicare Annual Wellness Visit
• Related: Stroke symptoms

Sources

1. U.S. Food and Drug Administration. 5 Medication Safety Tips for Older Adults. FDA Consumer Update. Content current as of February 15, 2024. https://www.fda.gov/consumers/consumer-updates/5-medication-safety-tips-older-adults. Accessed October 30, 2026. (Full page opened.)
2. 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. PMID: 37139824. PMC: PMC12478568. https://pmc.ncbi.nlm.nih.gov/articles/PMC12478568/. Accessed October 30, 2026. (Full article opened.)

Disclaimer

This article is for general education only and is not medical, legal, or financial advice. Do not start, stop, or change any medicine based only on this page. Talk to your doctor or pharmacist about your situation. In an emergency, call 911.

Attribution

Portions of this page are adapted from "HowToLiveBetter" (高性价比人生指南) by eternity4719, https://github.com/eternity4719/HowToLiveBetter, licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Changes: topic idea adapted from Chapter 34 themes; rewritten for the U.S. context from FDA consumer guidance and the 2023 AGS Beers Criteria paper (not a direct translation).