Are You Taking Too Many Medications?

The biggest risks may not be the number of pills you take—but which drugs you’re taking, and whether anyone is reviewing the whole list.

As we get older, it’s common for the medication list to grow. One prescription becomes three, three become six, and before long, keeping track of everything can feel like a part-time job.

But the number of medications alone doesn’t tell you whether your treatment is appropriate. Some people need several medications to manage serious conditions. Others may be taking drugs that are no longer necessary, duplicate another treatment, interact with something else they take, or create risks that outweigh their benefits.

There is another side to this problem, too: some people aren’t receiving medications that could help them.

The real question isn’t simply, How many pills am I taking? It’s this: Does every medication on my list still have a good reason to be there—and is anyone reviewing the whole picture?

What the research tells us

A national study published in JAMA in 2021 examined medication-related emergency department visits during 2017–2019. Among adults aged 65 and older, anticoagulants—commonly called blood thinners—were associated with an estimated 4.5 emergency department visits per 1,000 people annually, while diabetes medications were associated with 1.8 visits per 1,000 people annually.

These figures describe emergency visits attributed to medication harms during therapeutic use. They do not mean that these medications are generally unsafe or that the prescriptions were unnecessary. Blood thinners and diabetes medications can prevent serious complications, but they require appropriate prescribing, monitoring, and follow-up.

An earlier national study using 2013–2014 data found that medications classified as “always avoid” for older adults under the American Geriatrics Society Beers Criteria were implicated in fewer than 2 in every 100 emergency department visits for adverse drug events among adults aged 65 and older.

That finding is worth understanding in context. It is an older estimate, and it does not measure today’s medication risks. It also shows why the discussion must be more precise than simply blaming the number of prescriptions: certain medications deserve particular scrutiny, while many others are essential.

Five Things Worth Reviewing

1. Blood thinners: essential for many, but not risk-free

Anticoagulants such as warfarin, apixaban (Eliquis), and rivaroxaban (Xarelto) can prevent strokes and other dangerous blood clots. For people who need them, stopping treatment without medical guidance can be dangerous.

But the treatment needs to be reviewed regularly.

Warfarin requires INR blood testing to assess how effectively blood clotting is being controlled. People taking direct oral anticoagulants such as apixaban or rivaroxaban generally do not need routine INR monitoring, but they still need appropriate follow-up, including assessment of kidney function, possible drug interactions, bleeding risk, and whether the dose remains suitable.

Questions worth asking include:

• Is this medication still necessary, and is the dose appropriate for me?
• If I take warfarin, are my INR results staying in the intended range?
• If I take a direct oral anticoagulant, is my kidney function being checked when appropriate?
• Could another medication or supplement increase my bleeding risk?
• What signs of bleeding should prompt me to seek urgent care?

Never stop or change a blood thinner on your own. The objective is safer treatment, not abandoning protection against a stroke or blood clot.

2. Diabetes medications: tighter control isn’t always better

Diabetes treatment can become too intensive, particularly for older adults who have multiple health conditions, frailty, limited life expectancy, or a high risk of low blood sugar.

Insulin and certain medications, including sulfonylureas, can cause hypoglycemia. Severe episodes may lead to confusion, falls, loss of consciousness, or other serious consequences.

The American Diabetes Association’s 2026 Standards of Care recommend individualized treatment goals for older adults. They also recommend avoiding overtreatment and considering medication deintensification or simplification when appropriate.

That doesn’t mean everyone with diabetes should take less medication. It means treatment should match the person’s overall health, daily functioning, risks, and preferences—not simply pursue the lowest possible blood glucose number.

Ask your clinician:

• What blood glucose or A1C target is appropriate for me?
• Have I had low blood sugar that might indicate my treatment is too intensive?
• Is my insulin regimen more complicated than it needs to be?
• Could a lower-risk treatment achieve an appropriate level of control?
• What should I do if my appetite, kidney function, or general health changes?

Do not reduce insulin or other diabetes medication without a safe, individualized plan.

3. Sleep aids and antihistamines: familiar doesn’t mean harmless

Some medications used for sleep, allergies, or anxiety deserve particular attention in older adults.

Diphenhydramine, found in products such as Benadryl and some nighttime sleep aids, has anticholinergic effects. These can contribute to confusion, constipation, urinary problems, and other adverse effects. Regular use can be particularly concerning when combined with other medications that have similar effects.

Benzodiazepines, such as lorazepam and diazepam, and certain prescription sleeping pills, such as zolpidem, can increase the risk of sedation, impaired coordination, falls, and other problems.

The risks vary by medication, dose, duration, and individual circumstances. A drug that was appropriate for a short-term problem may deserve another look if it has become a nightly habit.

Ask whether a safer alternative is available and whether the medication is still helping enough to justify its risks. Some medicines, especially benzodiazepines, should be tapered under medical supervision rather than stopped abruptly.

4. Anti-inflammatory painkillers and long-term acid suppressants

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help with pain and inflammation. However, they can also increase the risk of gastrointestinal bleeding, kidney problems, fluid retention, and cardiovascular complications. These risks can be especially important for older adults and people taking blood thinners or certain blood-pressure medications.

Proton pump inhibitors (PPIs), such as omeprazole, reduce stomach acid and are valuable treatments for several conditions. Some people need them long term, including those at substantial risk of gastrointestinal bleeding. But continued use should have a clear reason, and the need for treatment should be reviewed periodically.

Don’t assume that a medication is unnecessary simply because you’ve taken it for years. Instead, ask:

• What condition is this treating?
• Is it still necessary at this dose?
• Are there safer alternatives for my circumstances?
• If it is no longer needed, how should it be stopped?

In some cases, stopping a PPI can cause temporary rebound acid symptoms. A plan may be preferable to abruptly discontinuing it.

5. Combinations, duplicates, and prescriptions that outlive their purpose

Sometimes the greatest risk comes not from a single medication but from the combination.

A prescription may be added to treat a side effect of another drug. Two products may contain the same active ingredient. A medication prescribed after surgery or an acute illness may remain on the list long after the original reason has disappeared.

Over-the-counter medicines, vitamins, herbal products, and supplements also count. They can interact with prescription drugs or duplicate their effects.

A medication review should look at the complete list, including:

• Prescription medicines from every clinician.
• Over-the-counter painkillers, allergy medicines, and sleep aids.
• Vitamins, minerals, herbal products, and supplements.
• Medicines taken only occasionally.
• Drugs that were prescribed for a temporary problem.

The question isn’t whether each drug can cause side effects in isolation. It’s whether the entire combination makes sense for you today.

The medication nobody reviews may be the one that matters

Nobody is in charge of keeping your list short.

Your primary-care clinician may not know every medication prescribed by your specialists. Your pharmacist may see some prescriptions but not have your complete medical history. A specialist may focus on the condition they treat rather than the combined effects of all your medications.

There are exceptions. Some healthcare teams coordinate medication reviews, and Medicare offers a Medication Therapy Management (MTM) benefit to eligible people with Medicare Part D drug coverage. But you shouldn’t assume that someone is automatically reviewing every medication, supplement, interaction, and changing health concern.

You may have to start the conversation yourself.

Ask for a brown-bag medication review

A simple way to begin is to gather every medication and supplement you use and bring them to a clinician or pharmacist. This is often called a “brown-bag review.”

Bring the actual containers when possible—not just a list from memory. Include prescriptions, over-the-counter products, vitamins, herbal supplements, and medicines you take only occasionally.

Ask the reviewer to look for:

• Medications that may no longer be necessary.
• Duplicate treatments or overlapping ingredients.
• Drug interactions and combinations that increase falls, bleeding, confusion, or other risks.
• Doses that may need adjusting because of kidney function, changing health, or other factors.
• Conditions for which you may be undertreated.
• Appropriate monitoring, including blood tests where needed.
• A safe plan for any medication that should be reduced or discontinued.

Ask for an updated medication list afterward. Keep a copy and bring it to appointments, particularly when seeing a new clinician or visiting an emergency department.

What about Medicare’s medication review benefit?

Medicare Part D plans must have medication therapy management programs for eligible members who meet program criteria. These services are intended to help people use medications safely and effectively, often through a review with a pharmacist or other qualified professional.

Eligibility rules and how the service is delivered can vary by plan. Contact your Part D plan and ask whether you qualify for medication therapy management and how to arrange a comprehensive medication review.

Don’t assume you qualify automatically, and don’t assume that a review has already happened just because you have prescription coverage.

Can reducing medication actually be safe?

Sometimes, yes—but it depends on the medication, the person, and the condition being treated.

A randomized clinical trial known as OPTIMISE studied selected adults aged 80 and older whose systolic blood pressure was below 150 mm Hg and who were taking at least two blood-pressure medications. Their doctors considered them suitable for a supervised medication reduction.

At 12 weeks, 86.4% of participants assigned to medication reduction and 87.7% receiving usual care still had systolic blood pressure below 150 mm Hg.

That provides evidence that a carefully selected, supervised reduction in blood-pressure medication can be feasible in some older adults over the short term. It does not establish that deprescribing reduces falls or hospitalizations, nor does it prove that long-term stroke or cardiovascular risks are unchanged.

This distinction matters. Deprescribing is not a competition to see who can take the fewest pills. It is a clinical process of weighing expected benefits against potential harms, then monitoring the result.

For some people, the best decision is to discontinue a drug. For others, it is to continue it, adjust the dose, substitute a safer option, or simplify the schedule. Some people also need treatment that they are not currently receiving.

Never stop a prescribed medication abruptly or change the dose on your own. Certain medicines require gradual tapering, and stopping others can quickly increase the risk of serious illness.

The bottom line

Medication safety isn’t just about avoiding unnecessary prescriptions. It’s about making sure the medicines you take are appropriate for your health today, that risky combinations are recognized, that monitoring is happening, and that important conditions aren’t being left untreated.

Your health changes. Your kidney function may change. Your risk of falls or bleeding may change. A medication that made sense five years ago may deserve another look today.

You don’t need to distrust every prescription. You do need to feel comfortable asking why you’re taking it, what benefit it provides, what risks it carries, and whether it still belongs on your list.