Polytherapy and Potential Drug–Drug Interactions in Geriatric Patients of a Tertiary-care Hospital

Introduction: Polytherapy, the concomitant use of five or more drugs, is a prevalent public health problem, especially in the elderly. The elderly are susceptible to multiple chronic illnesses, which makes the use of polytherapy inevitable; however, it increases the risk of potential drug–drug interactions (PDDIs). Moreover, the use of multiple medications not only increases the risk of PDDIs but also the use of potentially inappropriate medication (PIM), medication non-adherence leading to skipped doses/overdoses. The aim of this study was to investigate the polytherapy prevalence and its implications, such as PDDIs, prevalence of PIM using the Beers Criteria-2023, and analyse the fixed-dose combinations (FDC) prescribed to the elderly. Methods: A retrospective cross-sectional study was conducted on 100 patients visiting the geriatric OPD in a tertiary-care hospital in Gujarat, India. Prescription data were analysed for PDDIs using Medscape.com. PIM analysis was done using the AGS-Beers Criteria-2023. Lastly, all FDCs prescribed to patients were checked for their inclusion in the WHO Essential Medicines List-2025/National List of Essential Medicines-2022. Results: It was found that 80% (95% CI: 72%–88%) of the patients were on polytherapy. Drugs affecting the cardiovascular system were the most prescribed. A total of 537 PDDIs were flagged, with 99.07% of those flagged in patients with polytherapy. It was also found that 78.38% (95% CI: 69.0%–87.8%) of the patients aged 65+ were on at least one PIM, with the most common PIM being proton-pump inhibitors and benzodiazepines/z-drugs. Additionally, only 23.29% of the different FDCs prescribed to patients were included in either the WHO EML-2025 or NLEM-2022. Conclusion: This research underscores high polytherapy prevalence, calling for vigilant policies on rational prescribing, practice of evidence-based medicine, medication reviews, and strict policies on FDC formulation.