How many medications are too many?

Katkreek asked...

My mom just got a new prescription for high blood pressure medication, and her doctor wants her to take a vitamin D supplement, too. Because she also has a heart condition, arthritis, and diabetes, this will bring the grand total to ten different pills she has to take. Too many? Should I ask about cutting back?

Expert Answer

Dr. Leslie Kernisan is the author of a popular blog and podcast at She is also a clinical instructor in the University of California, San Francisco, Division of Geriatrics.

It's impossible to say whether ten pills daily is too many, just right, or even too few, without knowing all the specifics relating to your mother's health. But you're right to be concerned about it, since -- given the reality of today's overloaded practice environments -- it's easy for prescriptions to add up without close scrutiny.

Your best bet is to schedule a dedicated visit to her primary care provider to address this issue. You should bring all medications in a bag, including over-the-counter medicines, herbals, supplements, and the medications prescribed by all of her other providers.

During the visit, specifically let your mother's doctor know that she'd like to be on fewer medications, if possible. Ask her doctor to explain the purpose for each medication; this helps ensure that all the drugs are for active problems requiring medication. Also ask about the pros and cons of each prescription, and whether he or she thinks each is absolutely necessary. Her doctor may discover that:

  • Some medicines are "left over" from an earlier situation (such as a hospitalization).
  • She's taking two redundant medications for the same condition, unnecessarily. (It's common to take several medications for a single condition, but they're usually from distinct drug classes; still, I often see patients who are needlessly on, say, both atenolol and metoprolol, which both belong to the beta-blocker group of blood pressure medicines.)
  • A medicine was started for, say, arthritis pain or depression, but the dose was not adjusted (ramped up or tapered down) when it should have been.

It can be very helpful to ask a doctor to explain the possible consequences of stopping a given medication. Sometimes a trial of stopping something can help both the doctor and patient figure out if a medication is really needed; just be sure to schedule appropriate follow-up care before you leave the office.

Also worth asking about: combination medicines. These deliver two drugs in one pill (such as two types of blood pressure medicine). Patients like the convenience, but it can be a bit trickier for providers to monitor and adjust the dosages of such medicines.

Respectfully requesting a medication review can help you ensure that your mother is getting the right care -- and could even help minimize side effects and prevent dangerous drug interactions. Though you didn't mention your mom's age, if she has lots of medical problems or is quite frail, it might be worthwhile to have her medications reviewed by someone with particular experience in caring for the elderly. This is because some medications that are tolerated well by younger people can cause falls, confusion, or other side effects in a vulnerable elder.