Medication review (polypharmacy) (Structured medication review)
A careful, shared review of all an older person's medicines together, to keep the ones that help, safely reduce any that no longer do, and make taking them simpler and safer.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It reviews all your medicines together — prescribed, over-the-counter and supplements — not one at a time, which matters most when you take several.
- It checks each medicine still helps and is safe for you now, and considers safely reducing any that no longer do (deprescribing) — never stopping medicines without advice.
- The aim is fewer side effects, a simpler routine and safer medicines, built around what matters to you.
- It is a shared decision and a plan; the benefit comes from acting on it safely, with clear monitoring and follow-up.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Checks every medicine still has a purpose and still helps you
An urgent medicine problem — such as a suspected serious side effect or reaction — which needs same-day clinical help, not a routine review.
You go through every medicine with the clinician, discuss side effects and concerns, and agree what to continue, change or safely reduce.
A clear written plan, with changes explained and shared with your GP and pharmacy.
You go through every medicine with the clinician, discuss side effects and concerns, and agree what to continue...
Blood tests may be checked or arranged — for example kidney function — to make changes safely and confirm doses...
Agreed changes are made, with reductions usually phased in gradually rather than all at once, and clear advice on...
You and your clinician keep an eye on how you feel and how your conditions respond, adjusting the plan if a change...
What is a medication review for polypharmacy?
A medication review is a thorough, shared conversation about all the medicines a person takes — prescribed, bought over the counter, and supplements — looking at them together rather than one at a time. It is especially important for older people taking several medicines (sometimes called polypharmacy), because as the list grows, so does the chance of side effects, interactions, and medicines that no longer suit you.
The review checks that each medicine still has a clear purpose and is still helping, that the benefits outweigh the risks for you now, that doses suit your kidneys, liver and frailty, and that the regimen is manageable. Where a medicine is no longer needed or may be doing more harm than good, the review considers stopping or reducing it — this is called deprescribing, and it is always done carefully, gradually where needed, and with monitoring. It is never a reason to stop medicines on your own.
A medication review is a consultation and a plan; the benefit comes from the shared decisions and from acting on them safely. Done well, it can reduce side effects, simplify your routine and make your medicines safer — but it depends on honest discussion of what matters to you and clear follow-up. You should be fully involved, because the goal is medicines that work for your life and your priorities.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
A structured medication review compared with a repeat prescription
| Feature | Structured medication review | Repeat prescription |
|---|---|---|
| What it does | Reviews all medicines together | Reissues existing medicines |
| Looks for harm | Yes — side effects, interactions | Not usually |
| Your priorities | Central to decisions | Often not discussed |
| Can reduce medicines | Yes, safely | Rarely the focus |
| Time | A longer appointment | Often automatic |
Repeat prescribing keeps medicines going; a structured review steps back to ask whether each one is still right for you, together with all the others.
Preparing for your appointment
- Bring all your medicines in their boxes, or an up-to-date list, including patches, inhalers, creams, eye drops, painkillers, and anything bought without a prescription or as a supplement.
- Note any side effects or symptoms you wonder might be from your medicines — for example dizziness, drowsiness, falls, confusion, stomach upset or tiredness.
- Think about which medicines you find hard to take, easy to forget, or are not sure why you take.
- Write down what matters most to you — for example fewer tablets, fewer side effects, or staying independent — so the plan reflects your goals.
- Bring details of any allergies or past bad reactions to medicines.
- Bring recent test results or letters if you have them, and your GP and pharmacy details.
- If someone helps you with your medicines, it can help to bring them along.
What happens
A medication review is usually a longer appointment — in person, by phone or video, or at home — with a GP, a pharmacist, or a specialist. It starts with going through every medicine you take, including over-the-counter remedies and supplements, and what each is for. You will be asked how you take them, whether you ever miss doses, and whether you have any side effects or concerns.
The clinician weighs up, with you, whether each medicine is still doing more good than harm given your health, kidney and liver function, frailty and goals. They look for interactions, duplication, medicines that increase falls risk, and anything that could be simplified. Sometimes blood tests are checked or arranged to guide decisions.
Together you agree a plan. This may mean continuing medicines as they are, changing doses, switching medicines, or safely stopping or reducing some — with any reductions usually made gradually and with monitoring, and clear advice on what to watch for. The plan is shared with your GP and pharmacy. A good review is a genuine two-way conversation that respects your wishes, explains the reasons clearly, and never pressures you to stop something you rely on.
Is this appointment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- An urgent medicine problem — such as a suspected serious side effect or reaction — which needs same-day clinical help, not a routine review.
- A request simply to stop medicines quickly without proper assessment or monitoring.
- As a substitute for managing an acute illness that is driving symptoms.
- Where essential information — the full medicines list, recent results, or the reasons medicines were started — is missing and cannot be obtained.
Delay or rearrange if…
- The person is acutely unwell, when the medicines picture is changing and a later review is more meaningful.
- A recent hospital stay means changes are still settling and need to be confirmed first.
- Key information — a complete medicines list, recent blood tests, or specialist input — is missing.
- The person is too unwell or overwhelmed on the day to take part in shared decisions.
Alternatives to discuss
- Continuing current medicines with routine GP and pharmacy oversight if they are working well.
- A targeted review of one problem area (such as sedatives or falls-risk medicines) rather than a full review.
- Specialist condition review where one disease dominates the medicines.
- Support with taking medicines — such as a dosette box or reminders — if the issue is practical rather than the medicines themselves.
- Watchful monitoring with a planned future review.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Checks every medicine still has a purpose and still helps you
- Can reduce side effects, interactions and the burden of taking many medicines
- Can safely cut out medicines that are no longer needed or may be doing harm
- Can simplify your routine, making medicines easier and safer to take
- Can lower risks such as falls, drowsiness or confusion linked to certain medicines
- Puts your own goals and preferences at the centre of decisions about your medicines
Risks & complications
- Talking through every medicine takes time and can feel like a lot to take in
- Uncertainty or worry about changing medicines you have taken for a long time
- Needing blood tests or follow-up to make changes safely
- Temporary symptoms when a medicine is reduced or stopped, which is why it is done gradually and monitored
- A condition becoming less well controlled if a medicine is reduced, needing the dose to be put back or adjusted
- Withdrawal effects if a medicine such as a sedative is reduced too quickly (avoided by tapering slowly)
- Confusion if changes are not clearly explained or the new plan is not shared with everyone involved
- Harm from a medicine being stopped abruptly rather than reduced safely — which is why you should never stop medicines on your own
The review itself is just a conversation, so the risks come from the medicine changes it leads to. Reducing or stopping a medicine can occasionally let a condition flare or cause withdrawal effects, which is exactly why deprescribing is done gradually, with monitoring and clear safety advice. The single most important rule is never to stop or change medicines on your own — agree changes with your clinician and follow the plan. Ask what to watch for and what to do if you feel worse.
Published figures to discuss
A medication review is a consultation, so it has no physical complication rate of its own. The risks and benefits lie in the changes it leads to. Taking many medicines is, on average, linked to more side effects, interactions and harm, and safe deprescribing can reduce these — but how much any individual gains, and the chance that a reduced medicine needs restarting, depends entirely on which medicines, which conditions, and the person's goals. Because of this, no fixed percentages are given; the key safeguards are gradual change and monitoring.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Adverse drug events in older adults | Common and increase with polypharmacy, frailty and kidney impairment | Falls, confusion, constipation, bleeding, low blood pressure and low sodium are common medicine-related presentations. | NHS Specialist Pharmacy Service — Person-centred approach to polypharmacy and medication reviewsps.nhs.ukSource-linked context |
| Ten or more regular medicines | High-risk polypharmacy marker | The number is not the whole story, but it should prompt structured review of benefit, harm and patient priorities. | NHS Specialist Pharmacy Service — Person-centred approach to polypharmacy and medication reviewsps.nhs.ukSource-linked context |
| Anticholinergic medicines worsening cognition, constipation, urinary retention or falls | Clinically important and often overlooked | Bladder tablets, sedating antihistamines, some antidepressants and antipsychotics are common contributors. | Guide sourcesClinical context |
| Withdrawal or rebound after stopping medicines abruptly | Uncommon but important for steroids, beta-blockers, benzodiazepines, opioids and some antidepressants | Deprescribing should usually be planned and monitored, not done as a sudden tidy-up. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from a medication review. What matters afterwards is that any agreed changes are made safely — usually gradually and with monitoring — that you understand the new plan, and that your GP and pharmacy have it. You should never stop or change medicines on your own.
- Having a lot to take in after going through every medicine
- Making changes gradually rather than all at once
- Needing blood tests or a follow-up to make changes safely
- Mild, temporary symptoms when a medicine is reduced, which settle
- Being reviewed again as your health or circumstances change
Aftercare
- Follow the agreed plan exactly, and never stop or change a medicine on your own — speak to your clinician first.
- Make sure you understand which medicines have changed, how, and why, and have it in writing.
- Update your medicines list and make sure your GP, pharmacy and anyone who helps you all have the new plan.
- Watch for the symptoms you were told about when a medicine is reduced, and report them rather than stopping the plan yourself.
- Keep any blood tests or follow-up appointments needed to make changes safely.
- Use one pharmacy where you can, and ask about aids such as a dosette box if remembering medicines is hard.
- Seek urgent help for signs of a serious reaction, a sudden flare of a condition, or any symptom you were told to treat as urgent.
- All your medicines in their boxes, or an up-to-date list
- Over-the-counter remedies and supplements included
- A note of side effects or symptoms you wonder about
- A note of allergies or past bad reactions
- Your own goals — for example fewer tablets or side effects
- Recent test results or letters if you have them
- Knowing who to contact if a change does not suit you
⚠ Get urgent help if…
- Signs of a serious allergic reaction to a medicine — facial or throat swelling, difficulty breathing, widespread rash — call 999
- A sudden, severe flare of a condition after a medicine change (for example chest pain, severe breathlessness, or a much higher or lower blood sugar)
- Severe dizziness, fainting or a fall after a change
- Marked drowsiness, confusion or unsteadiness, especially after starting or changing a sedative or painkiller
- Black or bloody stools, vomiting blood, or unusual bruising or bleeding
- Symptoms of stopping a medicine too quickly that you were warned about
- Any symptom your clinician told you to treat as urgent
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good medication review leaves you with a medicines list where each item has a clear purpose, the benefits outweigh the risks for you, and the routine is as simple and safe as possible. For some people this means fewer medicines and fewer side effects; for others it means confirming that the current medicines are right and well understood.
The review cannot promise that reducing medicines will always be possible or that you will feel different straight away, and some medicines remain essential lifelong. The aim is safer, better-matched medicines, decided with you. Your clinician should explain the reasons for any change, what to expect, and what to do if a change does not suit you.
The right set of medicines changes over time — with new conditions, changes in kidney or liver function, increasing frailty, or shifting goals. So a medication review is not a one-off; medicines should be reviewed periodically and after any major change in health or a hospital stay. A plan that suits you now may need revisiting later.
Related tests, treatments or support
A medication review is often part of a comprehensive geriatric assessment and overlaps closely with falls and frailty assessments, since many medicines affect balance and reserve. It works best alongside your GP and pharmacy, and may prompt blood tests or referral for a specific condition. Your clinician will explain how it fits with the rest of your care.
Follow-up & long-term care
After the review you should have a clear, written plan, with any changes shared with your GP and pharmacy, and know how and when changes will be made and monitored. You should be told what to watch for, who to contact if a change does not suit you, and when your medicines will next be reviewed. Reductions are usually phased and checked rather than made all at once.
- Keep an up-to-date medicines list and bring it to every appointment
- Use one pharmacy where possible, and consider a dosette box if remembering is hard
- Never stop or change medicines on your own — agree changes first
- Keep any blood tests or monitoring needed for your medicines
- Ask for a review after any new diagnosis, hospital stay or change in health
Repeat, follow-on and what comes next
- The right medicines change over time, so reviews should be repeated as health and circumstances change.
- A medicine that is reduced may sometimes need to be restarted or its dose adjusted if a condition flares.
- Changes are often phased in gradually and monitored rather than made all at once.
- Hospital stays frequently change medicines, prompting a fresh review afterwards.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear written plan, with changes explained and shared with your GP and pharmacy.
- Reductions made gradually where needed, with monitoring and clear safety advice.
- A named contact for if a change does not suit you, and advice on what to watch for.
- Blood tests or monitoring arranged where changes require them.
- A planned future review, recognising the right medicines change over time.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The length of the appointment and whether more than one is needed
- Whether it is done by a GP, a pharmacist or a specialist such as a geriatrician
- Whether it includes coordinating across several conditions and specialists
- Any blood tests arranged to make changes safely, charged separately
- Follow-up reviews and monitoring as changes are made
- Letters to your GP and pharmacy and any onward referral
- Who carries out the review and how long it lasts
- Whether a written plan and letters to your GP and pharmacy are included
- Whether blood tests or monitoring are included or charged separately
- How follow-up to make and check changes is arranged and charged
- What happens if a change does not suit you and needs adjusting
- The cancellation policy
On the NHS? Medication reviews are available on the NHS through GP practices and pharmacists; private reviews may be used for a longer appointment, speed or a second opinion.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Stopping medicines abruptly rather than reducing them safely with monitoring.
- Making changes without clearly explaining the reasons, benefits and what to watch for.
- Not involving the person's priorities, or pressuring them to stop something they rely on.
- Not sharing the new plan with the GP, pharmacy and anyone who helps with medicines.
- In private care, not being clear which tests and follow-ups are extra.
Marketing red flags
- Promising to 'get you off all your tablets' as a selling point.
- Rapid medicine-stopping without assessment, monitoring or GP involvement.
- Selling supplements or products alongside, or in place of, prescribed medicines.
- Treating fewer medicines as automatically better, regardless of your conditions.
- No plan for monitoring, follow-up or communicating changes to your usual team.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Does each of my medicines still have a clear purpose and still help me?
- Are any of my medicines likely to be causing my symptoms or side effects?
- Can any be safely reduced or stopped, and how would that be done and monitored?
- Which medicines are essential to continue, and why?
- What should I watch for after a change, and what do I do if I feel worse?
- When will my medicines next be reviewed, and who do I contact in the meantime?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my appointment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this appointment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is a medication review available on the NHS?
Does this mean my medicines will be taken away?
Is it safe to stop a medicine I've taken for years?
What is deprescribing?
Why does taking several medicines matter?
Should I bring my supplements and over-the-counter remedies?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE NG5 — Medicines optimisation NHS Specialist Pharmacy Service — Person-centred approach to polypharmacy and medication review British Geriatrics Society — Older adult pharmacy resources Department of Health and Social Care — National overprescribing review report NHS — Medicines A to Z
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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