How pharmacists review interactions when you take many medicines

Each added medicine brings the possibility of an interaction, a side effect or a missed dose. The NHS England guidance describes problematic polypharmacy as multiple medicines whose potential harm exceeds benefits, which includes situations where the person lacks understanding of the regimen or finds it too difficult to follow. Our polypharmacy and anticholinergic burden guides discuss the older-adult picture.

Many medicines are appropriate, so the goal is not simply fewer tablets. It is the right medicines, at the right doses, for what matters to the person.

A structured review is a comprehensive look at all medicines, including those bought over the counter, herbal products and items prescribed by hospital specialists. The pharmacist checks the original reason for each medicine, whether it is still working, whether side effects have appeared and whether any combination carries a known interaction.

NHS England describes the review as taking into account all aspects of health and includes safety assessments and effectiveness evaluations, with personalised approaches. A review may lead to stopping, reducing, switching or continuing medicines, with a plan agreed with you.

• The reason each medicine was started.

• Whether it is still needed and working.

• Side effects and how you take it in practice.

• Interactions between prescribed, over-the-counter and herbal products.

• Monitoring tests that are due.

NHS England lists people who may benefit, including those living in care homes, those taking 10 or more medicines with complex polypharmacy, people on medicines associated with medication errors, those with severe frailty, isolation or recent hospital admissions or falls, and people using potentially addictive pain medicines.

Primary care networks identify eligible patients, but anyone worried about their medicines can ask their GP surgery whether a review is suitable.

Pharmacists use clinical knowledge and reference sources to check pairs and groups of medicines, then consider the person: kidney and liver function, age, other conditions and test results. The interaction lists on NHS medicine pages are a helpful public example. The anticoagulant page says to speak to your GP, anticoagulant clinic or pharmacist before taking any other medicines, including over-the-counter ones.

A common pattern is that the problem is not a single dramatic pair but several smaller effects adding up, such as multiple sedating, blood-pressure-lowering or kidney-affecting medicines. Our guides on triple whammy kidney risk and sedative combinations give examples.

Bring all your medicines in their boxes, including creams, inhalers, patches, supplements and herbal products. Note when you take each one and any you skip. Write down side effects, falls, dizziness, confusion or sleep problems. Bring questions: what is this for, can it be stopped, is there a simpler schedule?

If you have difficulty with swallowing, opening packs or remembering doses, say so, because options such as different formulations or reminder aids may exist.

Expect a clear plan: what is changing, what is staying the same and when to follow up. Do not stop a medicine by yourself because you read an interaction online; agree changes first, and check that your repeat prescription list reflects them.

Tell a pharmacist whenever something is added, such as a hospital discharge medicine or a short course from another clinician, because the review is only as accurate as the list it is based on. For urgent concerns about a medicine, NHS 111 is available.