If you have MS, it’s quite likely that you are taking several medicines each day. Taking multiple medicines is called polypharmacy. It may be necessary to take several medicines to help manage MS symptoms. But over time, the number of medicines you take can increase. The more medicines you take, the greater the risk of side effects and drug interactions. Some medicines can contribute to MS symptoms such as fatigue, falls or thinking and memory problems. It also becomes harder to keep track of the dose and timing of each medicine.
In this study, the researchers wanted to understand how common polypharmacy is in a large group of people with MS, who is most likely to be taking multiple drugs, which drug classes and which combinations are most often prescribed.
The researchers analysed pharmacy data for prescription medicines dispensed during 2017 in British Columbia, Canada. Data was analysed for more than 14,000 people with MS. Polypharmacy was defined as taking 5 or more medicines for at least 30 consecutive days.
The results showed that more than 1 in 4 people (28%) routinely taking 5 or more medicines.
Polypharmacy was more likely for women, people who were 50 years or older, those with other medical conditions, and those living in more deprived neighbourhoods.
The most frequently prescribed classes of medications were anti-depressants, followed by anti-epileptics, medicines for stomach ulcers and acid reflux, cholesterol-lowering medicines, and muscle relaxants such as baclofen. People often experience several MS symptoms such as nerve pain, spasticity and depression so taking multiple medicines may be appropriate. The study was not able to assess the reasons for prescribing the medicines or their effectiveness.
The researchers concluded that polypharmacy is common in MS and recommend further research to look at potential consequences of inappropriate polypharmacy. An accompanying editorial suggests steps that could be taken by people with MS and health professionals to manage the number of medicines they are taking.
Background
If you have MS, it’s quite likely that you are taking several medicines each day. Taking multiple medicines is often essential to help you manage MS and cope with the variety of symptoms you may experience. You may also need medicines for other health conditions and you may need to take one medicine to counter the side effects of another. Taking multiple medicines is called polypharmacy.
It may be entirely appropriate to take multiple medicines, but experience from other health conditions suggests that once started, medicines can be difficult to discontinue. Over time, the number of medicines you take can increase even though they are no longer needed or the original reason for taking them has been forgotten. This can potentially lead to health risks.
A small number of studies have looked at polypharmacy in MS but have focussed on small groups attending a single MS clinic. In this study, the researchers wanted to understand how common polypharmacy is in a large population-based group of people with MS, who is most likely to be taking multiple drugs, which drug classes and which combinations are most often prescribed.
How this study was carried out
The researchers examined pharmacy data collected over a 12-month period (January to December 2017) in British Columbia, Canada. The data recorded prescription drugs only and did not cover use of over-the-counter medications or products such as supplements or vitamins. Data was analysed for more than 14,000 people with MS. Polypharmacy was defined as taking 5 or more medicines for at least 30 consecutive days.
What was found?
The results showed that more than 1 in 4 people (28%) were routinely taking 5 or more medicines. 1 in 20 people (5%) were taking 10 or more medicines.
Polypharmacy was more likely for women, people who were 50 years or older, those with other medical conditions, and those living in more economically deprived neighbourhoods.
The most commonly prescribed classes of medications were anti-depressants, followed by anti-epileptics, medicines for stomach ulcers and acid reflux, cholesterol-lowering medicines, and centrally-acting muscle relaxants such as baclofen. Almost half (43%) had also filled at least one prescription for an opioid. Opioids are powerful pain killers but, when taken routinely, can lead to addiction and other problems.
Anti-depressants were most frequently co-prescribed with anti-epileptics and stomach ulcer drugs.
The risk of being admitted to hospital was almost double for people with MS exposed to polypharmacy compared to those who were not, even after allowing for other contributory factors.
What does it mean?
The researchers concluded that polypharmacy is common in people with MS, with more than 1 in 4 people routinely taking 5 or more medicines. Women, older persons, those with other medical conditions and those from more deprived areas were most likely to be affected. They recommend further research to look at potential consequences of inappropriate polypharmacy.
Taking multiple medicines may be appropriate. The study was not able to assess the reasons for prescribing the medicines or their effectiveness. The classes of medicines most contributing to polypharmacy in this study are routinely prescribed for MS symptoms or for other common medical conditions:
- Anti-depressants – used in MS for depression or for nerve pain, for example amitriptyline
- Anti-epileptics – used in MS for nerve pain and for spasticity, for example gabapentin
- Medications for stomach ulcer and acid reflux – may be prescribed to reduce stomach discomfort, for example omeprazole
- Cholesterol-lowering medicines – reduces risk of heart problems or a stroke, for example simvastatin
- Centrally-acting muscle relaxants – used in MS for spasticity, for example baclofen
To some extent, the level of polypharmacy found in this study reflects the fact that people often experience several MS symptoms such as nerve pain, spasticity and depression. But, the more medicines you take, the greater the risk of side effects, drug interactions and harmful combinations. Some medicines can cause or worsen MS symptoms such as fatigue, falls or thinking and memory problems. It also becomes harder to keep track of the dose and timing of each of the medicines, which ones need to be taken with food and so on.
An accompanying editorial considers polypharmacy is an under-recognised problem which needs to be further investigated. The editorial suggests some steps that could be taken by people with MS and health professionals to manage the number of medicines they are taking, including:
- Regularly review the effectiveness of medicines for symptoms
- When possible, avoid using two or more medicines to manage a symptom
- Use caution prescribing gabapentin and pregabalin to treat pain
- Try non-drug-based approaches to manage symptoms, for example exercise for fatigue or stretching to help with spasticity
Chertcoff A, et al.
Polypharmacy and multiple sclerosis: A population-based study.
Multiple Sclerosis Journal 2023; 29: 107-118.
Summary
Full article
Bourdette D, et al.
Polypharmacy in multiple sclerosis: More is not necessarily better.
Multiple Sclerosis Journal 2023; 29: 3-5.
Full article
Managing MS involves two different approaches:
Learning to manage your symptoms takes time and you may need to try several options to find out what works best for you. Reading up about the different options can be helpful, so you can talk them through with your GP or MS team.
You can find out more about symptoms and treatments on the MS Trust website
It’s important that you take medicines as advised by your doctor. Don’t stop any treatments without first discussing this with a health professional.
If you are concerned about any of the medicines you are taking, talk to your neurologist, GP, MS nurse or a pharmacist. You can ask for a structured medication review. If you are taking several medicines your GP or pharmacist can help by synchronizing repeat prescriptions and using an electronic prescription service. Some pharmacies will deliver prescription medicines to your home. A pill organizer (sometimes called a dosette box) can help you take the correct medicines at the correct time.
In England, people with MS have to pay prescription charges for symptomatic treatments, unless you qualify for free prescriptions for another reason. Prepayment certificates are available which can save you money if you require several medications regularly.
There are no prescription charges in Scotland, Wales and Northern Ireland.
