Blog

 

One in four Canadian seniors was prescribed ten or more classes of drugs in 2021. That count comes from the Canadian Institute for Health Information, which tracks public drug program claims. If your own list has crept up that way, it probably happened one sensible decision at a time. 

 

The blood pressure pill came from your family doctor years ago. A cardiologist added two more after the stress test, and a walk-in clinic prescribed something for your stomach last winter. Nobody, on any of those days, laid all of them out on one table. 

 

If you take multiple prescriptions, a medication review is the appointment where that happens. A pharmacist goes through everything you take, prescribed or not, and checks how the whole list works together. 

 

Most people assume somebody is already doing this, and in a narrow sense, several people are. 

 

Every Prescription Made Sense on Its Own 

A prescriber checks a new drug against the medications recorded in their own chart. The cardiologist in Kitchener knows what the cardiologist prescribed, and usually what your referral letter listed. Whether it also shows the walk-in visit in Guelph, or the magnesium from the health food store, depends on what you mentioned. 

 

The pharmacy's software screens each new prescription against your profile, which catches a lot, but it only sees what that pharmacy dispensed. Samples from a specialist's office, a prescription filled while travelling, and anything bought off a shelf never enter the record. 

 

Clinicians have a word for a long medication list: polypharmacy. It describes a situation, not a mistake, and many people on ten medications need all ten. 

 

When a Side Effect Gets Its Own Prescription 

Amlodipine (Norvasc) is a widely used blood pressure medication, and ankle swelling is a known side effect. The swelling looks like fluid retention, so it sometimes gets treated as a new problem with a water pill.  

 

Researchers have measured how often. A 2020 study in JAMA Internal Medicine followed Ontario adults 66 and older who had just started a calcium channel blocker, amlodipine's drug class. All had high blood pressure. Over the next year, they were about twice as likely to end up on a loop diuretic as patients given other blood pressure drugs.  

 

The swelling from this drug class comes from fluid shifting within the body, rather than from too much fluid in total. A strong water pill then removes fluid the person needs. In older adults, the study's authors warned, that raises the risk of falls and kidney injury. 

 

Pharmacists call this a prescribing cascade. A drug causes a symptom, the symptom is read as a new condition, and a second drug arrives to treat it.

 

Nobody in that chain was careless. Each prescriber answers for the prescription they wrote, and nobody is automatically assigned the whole list. 

 

When a cascade is found, the fix belongs to the prescriber. A lower dose or a different blood pressure drug may clear the swelling and take the water pill with it. Sometimes the second drug is needed for another reason and stays. 

 

The Same Drug Under Two Names 

Duplication is the plainer problem, and it hides well, with acetaminophen (Tylenol) as the usual example. It sits in cold and flu products and in some prescription pain medications, alongside the plain tablets in the cupboard. 

 

Health Canada puts the adult maximum at 4,000 mg a day, the same as eight extra-strength tablets. It also warns against taking more than one acetaminophen product at a time, since too much can cause severe liver damage. 

 

Somebody who takes it daily for arthritis and adds a cold remedy for a week can pass that limit. They may have followed the directions on every box. 

Prescriptions can duplicate too, as when somebody goes home from the hospital with a new blood pressure medication and keeps taking the old one.

 

What a Medication Review Looks At 

The pharmacist sits down with you for about half an hour, away from the counter. Everything gets lined up together: prescriptions, non-prescription products, vitamins, herbal remedies, eye drops, inhalers and creams. 

 

Each item gets the same treatment, starting with what it's for and whether that reason still applies. The dose gets checked against your age and kidney function as they are now, not as they were when the prescription started. 

 

Then the pharmacist reviews the full list, which is the part no single prescription check can do. Two items may be doing the same job, or one may be treating a side effect of another. This is also where drug interactions between prescriptions from different offices get caught, along with supplements that block a prescription from being absorbed. 

 

Timing comes up as well, since somebody taking nine medications at four different times of day will miss some. Say so if that's happening, since what to do after a missed dose differs from one drug to the next. Where the schedule itself is the obstacle, blister packs separate each day's medication into labelled compartments. 

 

You leave with a written record of everything you take, signed and dated by you and the pharmacist. Ontario's own instruction is to bring it to every doctor's appointment and hospital visit. 

 

 

Who Qualifies for a MedsCheck in Ontario 

Ontario funds this appointment through a program called MedsCheck, and you qualify if you take three or more prescription medications for a chronic condition. With a valid health card, the appointment costs you nothing.

 

Anyone diagnosed with Type 1 or Type 2 diabetes also qualifies, medicated or not, and the program covers one review a year. 

 

Ontario also funds a home version, MedsCheck at Home, for people on three or more chronic medications who can't get to a pharmacy. That visit can include clearing unused or expired medication out of the cabinet. Ask your pharmacy whether it can arrange one for a housebound relative. 

 

For someone with diabetes or heart disease, the review is one piece of how a pharmacist helps manage a chronic condition between doctor's visits. An earlier article covers what else a pharmacist does beyond filling prescriptions, including renewals and minor ailment prescribing. 

 

Bring the Bottles 

A medication review can only cover what lands on the table. Bring the actual containers where you can, since a label shows the strength and directions that memory rounds off. 

 

The forgotten items tend to be the occasional ones. Think of the sleep aid, the antacid, the inhaler from two winters ago, or anything borrowed from a spouse's supply. Vitamins and herbal remedies count, and Ontario's instructions for the appointment name them specifically. 

 

Mention what you've stopped as well, whatever the reason was. A prescription you quit taking after it upset your stomach may still be listed as active on your file. The pharmacist can only correct the record once somebody says so. 

 

If you fill prescriptions at more than one pharmacy, bring those bottles too. Each pharmacy's record shows only what it dispensed, so the review may be the first time the two lists meet. 

 

Write your questions down before you come, since half an hour goes quickly. Ontario's description of the appointment includes how to use inhalers and needles, so bring those along if the technique has never felt right. 

 

A Review Doesn't Always Mean Fewer Pills 

Some people put off a review because they expect to lose a medication they rely on. The change that comes out of one is often small: a pill moved to bedtime, a duplicate dropped, a question sent to the doctor. 

 

A proposed change to a prescription goes back to the prescriber with the pharmacist's reasoning attached. Don't stop anything on your own in the meantime, even a drug you now suspect. Some medications cause problems of their own when they're stopped abruptly. 

 

When a drug does come off the list, prescribers call it deprescribing. It gets planned like any other treatment change, sometimes with a gradual step-down and a follow-up to see how you're doing afterward. 

 

A long list isn't automatically a bad one, and somebody with heart failure, diabetes and arthritis may need every item on it. Whether ten medications is too many has no general answer; it depends on which ten. 

 

Book Sooner After a Hospital Stay 

The yearly schedule suits a list that isn't changing, and a hospital stay changes it. Doses get adjusted on the ward, new drugs get started, and the discharge papers don't always match the bottles waiting at home. 

 

For this reason, Ontario allows a follow-up outside the annual review, so you don't need to wait for the year to run out. The province lists three triggers: going into or coming out of hospital, a major change in your medications, or a referral from your doctor. 

 

The same goes for the weeks after a new specialist joins your care. A new prescriber means a new chart, and that chart starts with only what you told them. 

 

Book a medication review at any Cook's Pharmacy location across Waterloo Region and Guelph. Bring every bottle, box and supplement you take, including the ones you've stopped.