More than 1 in 5 Americans ages 62 to 85 take medication combinations that carry a risk of a potentially major drug interaction, according to recent research published in JAMA. The same study found that the share of older adults taking five or more prescription drugs climbed from 31% in 2015 to 2016 to 35.7% in 2021 to 2023.
The interaction risk eased slightly over that stretch, falling from 25.7% to 22.3%. Supplement use moved the other way. The share of older adults taking five or more dietary supplements rose from 12.6% to 16.7%.
Researchers from the University of Southern California, Johns Hopkins and NORC at the University of Chicago drew on a nationally representative survey of about 5,000 older adults living in the community rather than in nursing facilities.
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Antidepressants top the list
Antidepressants were the drug class most often involved, showing up in potentially major interactions for 7.2% of older adults. Statins followed at 5.2% and antiplatelet drugs such as aspirin at 4.5%, according to a summary of the findings.
Some combinations became less common. Opioids in risky combinations fell from 5.6% to 4%, and benzodiazepines, the class that includes Xanax and Valium, from 2.1% to 0.9%. Muscle relaxants went the other direction, rising from 1.4% to 2.5%.
“Efforts to reduce polypharmacy and harmful drug interactions should focus on commonly used interacting regimens, particularly those involving antidepressants,” lead researcher Dima Mazen Qato of the USC Mann School of Pharmacy and Pharmaceutical Sciences said in a news release.
A flagged combination is not automatically a mistake. Doctors sometimes prescribe interacting drugs together on purpose and watch for trouble. The danger grows when nobody has the full list, which becomes more likely as the number of prescribers, pharmacies and supplement bottles rises.
Supplements count. The National Institutes of Health’s Office of Dietary Supplements warns that vitamin K can weaken the effect of the blood thinner warfarin, and that St. John’s wort can speed the breakdown of many medicines and make them less effective, including some antidepressants and heart medications. Several popular supplements are also under scrutiny for reasons unrelated to interactions.
A bad reaction can get expensive
Adverse drug events send more than 1.5 million people to U.S. emergency departments each year, and almost 500,000 of them need hospitalization, according to the Centers for Disease Control and Prevention. Adults 65 and older make more than 600,000 of those visits annually, more than twice as often as younger people.
Interactions are only one cause of adverse drug events, but each trip to the hospital can bring copays, coinsurance and, for an admission, the Medicare Part A deductible. A drug you no longer need also costs money every month you keep refilling it, and a supplement costs money whether or not it does anything.
Your drug plan may already offer a free review
Every Medicare drug plan, whether a stand-alone Part D plan or a Medicare Advantage plan with drug coverage, must run a medication therapy management program. If you qualify, the services cost you nothing.
Plans set their own eligibility rules within federal limits. A plan cannot require more than three chronic conditions from a list that includes diabetes, high blood pressure, high cholesterol, heart failure, arthritis and bone disease, respiratory disease and mental health conditions. Nor can it require more than eight Part D drugs.
Members must also be likely to exceed a yearly drug-cost threshold, which the Centers for Medicare & Medicaid Services set at $1,276 for 2026.
Enrollment is automatic for people who meet the criteria, though you can opt out. The centerpiece is a comprehensive medication review, a one-on-one conversation with a pharmacist or other qualified provider, in person or through a live telehealth session. Afterward, you get a written summary, an up-to-date medication list and a recommended to-do list you can take to your doctor.
Plans also review eligible members’ medications at least quarterly.
To find out where you stand, call the member services number on your plan card and ask whether you are enrolled in the plan’s medication therapy management program. If a pharmacist calls claiming to be from your plan, hang up and dial that number yourself before sharing any personal information.
No program? Use your wellness visit
If you do not meet your plan’s criteria, the Medicare yearly wellness visit includes a review of your current prescriptions. You pay nothing for the visit if your provider accepts assignment, although you may owe for extra tests or services added during the same appointment.
Bring everything to that appointment, not just a list: prescription bottles, over-the-counter pain relievers and sleep aids, vitamins and herbal products. A pharmacist can also check for interactions, which is easier when you fill all your prescriptions at one pharmacy.
Do not stop or cut back on a prescription on your own. Some medicines, including certain antidepressants, can cause problems when stopped suddenly, so any change should come from the prescriber.
Then match your plan to your new list
Medicare open enrollment runs Oct. 15 to Dec. 7, and any plan change you make takes effect Jan. 1, according to Medicare.gov. Timing a medication review before or early in that window lets you shop with an accurate list. Dropping one expensive drug, or switching to a generic, could change which plan costs you least.
That matters more in 2027, when the standard Part D deductible rises to $700. Enter every drug and dose into Medicare’s plan comparison tool rather than assuming this year’s plan still fits, and use these open enrollment tips to check networks and pharmacies too.
For drugs you end up paying for outside your plan, you can compare pharmacy prices before your next refill, since the same medication can cost very different amounts from one store to the next.
AARP membership includes savings on prescriptions and eyeglasses, along with discounts on everyday purchases such as rental cars and hotels. As low as $15 for your first year with auto-renewal. One use of a travel or dining benefit can cover the cost.
The study measured potential risk, not actual harm. A review can tell you whether your own list belongs in that 22.3%, and it may cost you nothing more than a phone call to your plan.
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