The multipill challenge.

As you age you may find yourself taking more medications. In fact, the elderly are prescribed twice as many medications and purchase seven times as many nonprescription drugs as younger patients. But as sixteenth-century physician Paracelsus summed it up "All substances are poisons; there is none which is not a poison. The right dose differentiates a poison from a remedy." In today's terms it means the greater the number of drugs you take (prescribed and over-the-counter), the greater the risk of drug-related problems. It's called polypharmacy, and the elderly (age 65 and older) are particularly vulnerable.

In general, older persons become sick more often, take longer to recover from an illness or hospitalization, take more medications, have more side effects, and may react to drugs differently than anticipated because of changes in their body organs.

And that's just part of the issue. It's estimated that 75 percent of physician visits end with a written prescription. This practice comes in part from patient expectations. It's often easier for a busy practitioner to prescribe a medication rather than counsel, educate, or reassure an anxious patient.

Pharmaceutical marketing to physicians and patients exerts additional prescribing pressure. Also, physician specialization contributes to instances of multiple prescribers (e.g., cardiologist, gastroenterologist, rheumatologist, etc.). An individual provider may be unaware of all the prescribed medications a person is taking. And if you visit multiple pharmacies, you lose a potentially valuable check in the system to monitor drug usage.

Other potential problems stem from hoarding old drugs, self-treatment with over-the-counter drugs, or taking prescription medications borrowed from friends.

Make sure you understand new medication instructions and changes in drug regimens.

Terminology may be confusing. For example, the inadvertent use of both a generic and brand-name drug, such as verapamil and Calan, could result in twice the recommended dosage.

Here are some ways you can prevent polypharmacy.

1. Bring all drugs, prescribed and over-the-counter, to each physician office visit and keep a current medication list with you at all times.

2. If your medications require three or four daily doses, ask your doctor or pharmacist if the schedule can be simplified or reduced. Consider cost differences as well.

3. Learn to recognize and report potential side effects.

4. Ask your doctor (or doctors) to review your treatment plan at least every three or four months. Drugs that are no longer needed should be discontinued.

5. Use only one pharmacy for all your prescription and nonprescription medications, and ask your pharmacist to review your medications with you.

6. Request verbal and written information from your doctor or pharmacist regarding any medication you are taking. Make sure you know at least the following for each medication: name and strength, reason for use, when, how much and for how long to take, expected effects, side effects, and major drug or food interactions.

7. Talk with your doctor and pharmacist if you have any questions or problems with your medications. Communicate your concerns and follow the counsel you receive.