4. Effectiveness - Are therapeutic objectives being achieved?

Polypharmacy guidance: Appropriate prescribing making medicines safe, effective and sustainable 2026-2029
National

Process

Identify the need for adding/intensifying drug therapy to achieve therapeutic objectives

  • to achieve symptom control
  • to achieve biochemical/clinical targets
  • to prevent disease progression/exacerbation
  • is there a more appropriate medication to achieve goals?

 

Medicines to review

The table below brings together some common areas where prescribers may be able to take action. This list is not exhaustive and does not replace individual clinical judgement. For more detail see Detail by therapeutic area based on amalgamated medication assessment tool.

 

If therapeutic objectives are not achieved:

Consider intensifying existing drug therapy

For patients with the following indications

Consider if patient would benefit from specified drug therapy

Laxative - Constipation

Warfarin - INR control

Rate limiting drugs - heart rate

Antihypertensives - BP control

Respiratory drugs – Symptoms

Pain control

Antidiabetics - HbA1c control

see Drug efficacy & applicability (NNT) table

Post MI - antiplatelet, statin, ACEI/ARB, beta blocker

Stroke/TIA – antithrombotic/antiplatelet, statin, ACEI/ARB

LVSD – diuretic, ACEI/ARB, beta-blocker

AF – anticoagulant, rate control

T2DM – metformin

High fracture risk – bone protection

Clozapine therapy – laxative (see MHRA warning 2017)

T2DM & ASCVD/cHF/CKD – SGLT-2i/GLP-1RA