At a glance
A polypharmacy review is a structured consultation in which a doctor or clinical pharmacist goes through every medication a patient is taking and decides which ones are still needed, which can be stopped, and whether any are causing harm.
When a person takes five or more medications at the same time, the risk that those drugs will interact with each other, or cause side effects on their own, rises sharply. The review examines each drug against the patient's current conditions, kidney and liver function, and any new symptoms. The goal is to arrive at a shorter, safer medication list that still controls all the conditions that need treatment.
Medical Condition
Polypharmacy review is most often requested for older adults whose medication lists have grown over many years of managing multiple chronic illnesses, but it can benefit any patient whose drug regimen has become complex.
- Older adults (usually 65 or over) taking five or more medications daily
- Patients experiencing new symptoms that may be side effects of a current drug, such as dizziness, confusion, or falls
- Anyone recently discharged from hospital whose medication list changed during the stay
- Patients with declining kidney or liver function, where drug clearance slows and doses may need adjusting
- People diagnosed with a new condition whose treatment might conflict with existing medications
- Patients who see multiple specialists and whose prescriptions have accumulated without a single doctor overseeing the whole list
- Residents of care homes or aged-care facilities as part of regular safety monitoring
A polypharmacy review is not suitable in every situation. It is generally deferred if the patient is acutely unwell and needs urgent treatment first, or if stopping any drug at that moment would pose an immediate medical risk. Your doctor will assess the right timing.
Risks & Complications
A polypharmacy review is a consultation, not an invasive procedure, so it carries no physical risks of its own. The recognised concerns relate to changes that may follow the review rather than to the review itself.
- Withdrawal effects when a medication that the body has adapted to is reduced or stopped, such as temporary rebound symptoms
- Worsening of a condition if a drug is deprescribed (gradually stopped) too quickly or without adequate monitoring
- The possibility that a symptom wrongly attributed to a drug turns out to have another cause, delaying investigation
- Patient anxiety about stopping medications that have been taken for a long time and feel reassuring
- Need for closer follow-up after changes, which requires the patient to attend additional appointments
Preparation & Procedure
No fasting or physical preparation is required before a polypharmacy review because nothing is injected or cut. The preparation is mostly about gathering information so the consultation uses its time well.
Before the appointment, patients are usually asked to collect everything they take, including prescription drugs, over-the-counter medicines, vitamins, herbal supplements, and traditional remedies. Bringing the original packaging, or a complete written list with the name, dose, and how often each is taken, gives the reviewing doctor the clearest possible picture.
Some clinics ask for recent blood test results covering kidney function (creatinine), liver function, and electrolytes (minerals such as sodium and potassium that affect how drugs work). If those results are not already available, the clinic may arrange them in advance.
The review itself typically follows these steps.
- The doctor or pharmacist interviews the patient (and a carer or family member if present) about current symptoms, daily routine, and any difficulties with the current medications
- Each medication is checked against the patient's active diagnoses to confirm it still has a clear reason to be prescribed
- Drugs are assessed for interactions with each other and for appropriateness given the patient's age and organ function
- Any medication that is no longer needed, duplicated, or causing more harm than benefit is identified for stopping or reducing
- A plan is made for how any changes will be introduced, usually gradually, and what symptoms to watch for
- The revised medication list and the reasoning behind each change is explained to the patient in plain language
Aftercare
After the review, the focus shifts to watching how the body responds to any medication changes, because even planned reductions can occasionally produce unexpected effects.
- A follow-up appointment is usually scheduled within a few weeks to check whether deprescribed medications were stopped smoothly and whether any symptoms emerged
- Patients are advised to note any new or returning symptoms after a drug is reduced and to report them before the next scheduled visit if they feel concerning
- Blood tests may be repeated after certain drugs are stopped, particularly those that affect kidney function, fluid balance, or blood chemistry
- If multiple medications were changed at once, changes are usually staggered so that the cause of any new problem is easier to identify
- The updated medication list should be shared with all other doctors and specialists the patient sees, so no one inadvertently re-prescribes something that was intentionally stopped
- Lifestyle adjustments, such as diet, fluid intake, or physical activity, may be recommended as part of managing conditions with fewer drugs
- An annual review is reasonable for older patients on complex regimens, since conditions and organ function continue to change over time
Cost & What Determines It
The cost of a polypharmacy review varies considerably depending on who conducts it, where, and how complex the patient's medication list is. A brief primary-care review is priced very differently from a detailed geriatric specialist consultation that includes laboratory work and pharmacist input.
- Complexity of the medication list: more drugs and more conditions mean a longer, more demanding review
- Clinician type: a review by a specialist geriatrician or a dedicated clinical pharmacist typically costs more than one conducted by a general practitioner
- Hospital or clinic class: private specialist hospitals charge more than community clinics or outpatient pharmacist services
- Country and city where the review takes place, as labour costs and facility fees differ widely across healthcare systems
- Whether blood tests or other investigations are needed before or after the review
- Number of follow-up consultations required to complete the deprescribing process safely
- Involvement of a multidisciplinary team (for example, a geriatrician, pharmacist, and nurse working together)
When a hospital or clinic offers a package, it usually covers the initial consultation and a standard set of blood tests. Items such as additional specialist opinions, extra follow-up visits, or new medications introduced during the process are commonly billed separately.
BPJS Kesehatan and most Indonesian private health insurance policies do not cover medical treatment received abroad. Patients who travel overseas for this kind of consultation typically pay from personal savings or through an international private health insurance plan that explicitly covers outpatient specialist consultations. Requesting a written cost estimate from the clinic before travelling is the most reliable way to avoid unexpected charges.
Frequently Asked Questions
How many sessions does a polypharmacy review take?
Most people complete a polypharmacy review in one or two appointments, though some cases need a follow-up visit to check how medication changes are settling. The number of sessions depends on how many medicines you are taking and how complex your health conditions are. Your doctor will let you know after the first assessment whether further meetings are needed.
What happens during a polypharmacy review, and does it feel uncomfortable?
A polypharmacy review is a conversation, not a procedure, so there is nothing physically uncomfortable about it. Your doctor or clinical pharmacist will go through every medicine you take, ask about side effects you have noticed, and look for combinations that may be causing problems. You may be asked to bring all your pill bottles or a written list of everything you take, including vitamins and herbal supplements.
How soon will I notice a difference after my medications are adjusted?
Some people feel better within days of stopping a medicine that was causing side effects, while for others the benefit builds gradually over several weeks. The timeline depends on which medicines are changed and how your body responds. Your doctor will usually arrange a check-in, either in person or by phone, to see how you are getting on after any adjustment.
How much does a polypharmacy review cost?
The cost varies depending on the hospital or clinic's fee structure, the seniority of the specialist conducting the review, and whether follow-up sessions or additional tests are needed. A review involving many complex conditions and multiple follow-up appointments will generally cost more than a single straightforward session. Requesting a written estimate from the hospital before you book is the most reliable way to understand what you will pay.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
