A 63 year old female presents with complaints of taking too many medications and that her “my medications are making me sick”.  In addition, she reports that she feels nauseated every morning after breakfast and associates it with her morning pills.  She has no idea which medication is doing it, but has been tempted to just stop taking them all.  Her current morning medications are:

1. Calcium 600 mg
2. Propranolol 20 mg
3. Lisinopril 10 mg
4. Magnesium 800 mg
5. Sucralfate 1 gram
6. Omeprazole 20 mg
7. Niacin 500 mg
8. Rosuvastatin 20 mg
9. Meloxicam 15 mg
10. Aspirin 81 mg

My first thought here would be to look at what medications does she actually still need.  Assessing pain would be important to see how much help the meloxicam has provided the patient.  Magnesium and niacin are a couple of supplements and I would be sure to look at why these are being used.  Checking a magnesium level may be helpful or at least assessing if the patient has been low in the past.  Obviously stopping any medications that were not necessary would be a good first step.

If all the medications were deemed appropriate and necessary, my next step would be to likely change the timing of some of them.  I think moving a couple of these medications to noon or mid-afternoon would be a thought.

Another consideration would be a dose reduction of some of these medications or possibly splitting up the dose to twice per day.  Be aware that this does not help the patient take less pills however and actually adds more pills to the daily routine.

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