Pill Burden

People tend to have more illnesses as they age. As a result, many older adults with HIV take many pills for other conditions. Often, all the meds you take are needed. But there are many situations when there may be too many pills being taken.


Some people don’t take the right medicine for their problem. For example, some people use cold medicine to help them sleep, even if they don’t have a cold. This is wrong. You should use sleep aids, not cold medicines, if you have problems sleeping.


Not every illness needs to be treated with meds. For example, back pain may get better with massages or a heating pad instead of drugs. Also, meds should only be taken for the length of time prescribed by your health care provider.


One drug can affect another drug you’re taking, causing a drug interaction. Sometimes, one medicine can make another less active or make another drug too strong, causing unwanted side effects.


Many meds have side effects that can lower your quality of life. If any of your meds are causing unpleasant side effects, ask your doctor what can be done. If you’re taking a large quantity of medicines, you might have difficult managing them all. Also, side effects or drug interactions are more likely with the more pills you take.


You should periodically bring all your medicines with you to your new appointment with your doctors. You should bring everything that goes into your mouth (prescription meds, over-the-counter meds like Tylenol or Nyquil, vitamins, herbs, even things like Rolaids) and put them all in a bag. You should ask your doctor if any pill should be stopped or changed. Your pharmacist is also a good person to help you address any issues with pill burden.


You should tell your doctor if you stop taking one med or start another. This includes over-the counter meds, vitamins and herbs, supplements, etc. Your doctor can check for any drug interactions before you start a new medicine. You should
never stop your HIV meds without talking with your doctor first!

If you get sick after starting a new med, you should ask your healthcare provider if you might be experiencing a side effect. If a drug is making you sick, ask if you can switch to a different one.

What you can do yourself


You should find the best way to take the right number of pills at the right time as prescribed. For many, an “organizer pillbox” is the best way to know if you have taken a dose or not. The most helpful pillboxes have compartments for each day of the week and for different times of each day. Some of them are sophisticated, with timers and alarms and automatic dispensers to help you organize your dosages. Your phone can also be used to set alarm to remind you when to take your pills. You might also take your dose along at the same time every day when you do another activity such as brushing your teeth.

If you need more support, ask your doctor to refer you to an adherence counselor who can help you create the system that is best for you.

You should avoid missing doses of your HIV meds. Missing more than two or three doses a month can lead to drug resistance. Once you develop resistance to an HIV drug, the drug will never work for you again.


Pharmacists are a great resource for people who are taking multiple meds and can answer many questions. You should introduce yourself to a pharmacist and build a relationship so that she or he becomes familiar with your situation. Some pharmacies will sort your meds into plastic packages, called blister packs. All you have to do is open the packs and take the pills inside. You do not have to sort anything yourself. If you can, find a pharmacy that has worked with people with HIV. They may have more experience with HIV drug interactions and with helping people take their HIV meds correctly


Older adults with HIV must face the reality of having to take a number of medications every day. They include the all-important antiretroviral therapy (ART). They may also have to take medications for other diseases associated with aging such as heart disease, kidney disease and lung disease. In addition, they may have intermittent conditions, such as allergies or pain, that require over-the-counter pills. The combination of all these issues may result in the need to take a large number of pills daily. The technical name of this is “polypharmacy.” There are various definitions of what is too many pills, but polypharmacy is generally considered 5 or more pills each day. Fortunately, HIV treatment has improved over the last decade with the introduction of more single-dose regimens and a reduction in the average daily number of pills. Estimates from various studies of older adults with HIV suggest they take on average of 3 to 7 pills per day.


Polypharmacy in older adults with HIV can result in unwanted consequences. A person may become confused about the number and type of medications that they are taking. As a result, they may take too few or too many pills. Also, the burden of taking multiple pills daily may cause “burnout,” resulting in pills being missed and poor adherence. This can lead to poor HIV viral suppression and a drop in CD4 levels.

A major risk of taking a number of drugs are interactions that can affect potency. This is especially important with HIV meds that can interact with other drugs causing either too much or too little of the HIV meds being available in the body. This situation can occur when more than one physician is prescribing medications and there is not coordination between providers. For example, interaction between medicines can lower blood pressure that result in a fall and a fracture.

Drug-drug interactions can also occur with supplements that can cause increases or decreases in the effectiveness of medications. For example, St. John’s Wort for self-treatment of depression can decrease the effect of certain HIV meds.


In dealing with polypharmacy, you must have an open discussion with your healthcare team about your medications and pill regimen. Your providers need to know about all your prescriptions including over-the-counter medications you are taking. This information needs to be carefully updated at each visit.

Periodically, your healthcare team should review medications that are absolutely necessary and those might be discontinued. In some cases, you might want to have a partner, relative, or friend (caregiver) participate in this discussion since it is easy to forget issues you want to raise. You might discuss the pluses and minuses of changing to a single pill per day ART medication. Also, your healthcare provider might need to coordinate with other specialists who are managing other diseases and conditions about reducing your medicines.

You have responsibility to keep track of your medications, including refilling prescriptions and using pill boxes to help you manage your regimens. You might also benefit from regular discussions with a pharmacist familiar with HIV medications and your situation. In addition, you will benefit from maintaining a healthy lifestyle, including diet, physical activity, and social interaction.


Older adults with HIV are benefitting from the availability of medicines that improve health and extend life span. However, polypharmacy can affect quality of life. You should work toward finding the right balance in the number of daily medications that support your health and well-being.