Swallowing a handful of pills is a daily routine for many, from young adults managing anxiety to older individuals handling chronic conditions. In the U.S., 13% of people take five or more prescription medications, and for those aged 65 and older, this number rises to 42%.

Managing multiple medications can lead to potential issues. One pill’s side effect might lead to another prescription, creating what experts call a “prescribing cascade.” Long-term drug use can cause harm, interactions with new medications, or side effects that worsen over time, potentially leading to cognitive decline and fall-related injuries.

“Our metabolism changes as we age,” says Dr. Elizabeth Bayliss, who studies deprescribing at Kaiser Permanente’s Institute for Health Research in Aurora, Colorado. “Our ability to metabolize long-term medications may shift over time.”

The Lown Institute labels this phenomenon as medication overload, which is expected to result in 4.6 million hospital visits this decade.

If your pill regimen is becoming overwhelming, consider requesting a medication review. Here’s how to approach the process of “deprescribing.”

Request a Prescription Review

Start by consulting a trusted professional, such as your doctor or pharmacist, advises Lisa McCarthy, a pharmacist and deprescribing expert at the University of Toronto.

If discussing with your doctor, schedule a dedicated appointment rather than waiting until the end of a brief visit. Make it clear when booking that you want to review your medications.

Since your doctor may not have a complete overview of all your prescriptions if multiple prescribers are involved, a pharmacist can be invaluable. They can review all your medications and provide suggestions for you to share with your doctors, says pharmacist Bradley Phillips of the University of Florida College of Pharmacy.

“We’re considered the medication experts,” Phillips notes.

Assess Potential Medication Issues

Common medication side effects—such as swelling, incontinence, restlessness, or insomnia—are sometimes treated with additional drugs. McCarthy encourages asking your doctor if a symptom might be related to one of your medications.

She also suggests following up with: “Do I still need this medication?”

Pharmacist Barbara Farrell reports that many individuals experience dramatic improvements when their medications are adjusted. For instance, a 77-year-old woman reduced her daily pills from 32 to 17 and was able to walk with a cane and return to knitting after initially being sedated and unable to communicate.

Gradual Medication Reduction

While some medications can be stopped abruptly, others require a gradual taper to avoid withdrawal symptoms or severe side effects. This is especially crucial for drugs used for depression, insomnia, and anxiety.

Therapist Molly Bernardi, who had been on various medications for two decades, began tapering down her doses after suspecting they were causing worsening issues with digestion, balance, memory, and vision. She gradually reduced each of her four medications, finding the process particularly challenging, especially with benzodiazepines.

She used support groups, breathwork, and prayer to manage withdrawal symptoms and found that experiencing even small moments of well-being made the effort worthwhile.

Stay Informed About Your Medications

Even in well-connected health care systems, information about prescriptions isn’t always shared among doctors, and they may not be aware of your over-the-counter drugs, vitamins, or supplements.

McCarthy emphasizes that you are the only person who knows everything you are taking. Keep an up-to-date list of all your medications, including reasons for each prescription and when you started taking them.