or different prescribers with the potential for serious or troublesome side effects due to interactions of these medications with each other.  That definition can now be extended to supplements, that have not been tested as to interactions in the vast majority of products. Not infrequently the elderly will be prescribed 10-20 different medications a day, often by a combination of their primary care physician (PCP) and specialists.  The PCP, for medical-legal purposes, will rarely remove medications started by a specialist, even if there are potential drug interactions since he would be subject to medical malpractice suits if anything happened to the patient from such removal of a drug.  Patients taking supplements may be unaware that many supplements are mislabelled, have unlabeled components, or illegally contain prescription drugs.  Homeopathic drugs may contain active ingredients in high concentrations that are labeled as inactive or may actually contain prescription drugs.  Naturopathic doctors add their own concoctions that may have interactions with prescription drugs.  This all leads to a drug soup, that may be deadly.  Algos attempts to reduce the number of prescription drugs through serially withdrawing non-critical drugs then re-introducing them to detect side effects and clinical effects.  No one needs to be taking 25 drugs plus 10 supplements a day.  

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POTENTIAL INTERACTION IMPACT

If a patient is taking two drugs that have the potential for sedation, then there is a possible amplification of effect that can prove dangerous.  For instance, benzodiazepines (e.g. Xanax, Klonopin, etc) and opioids can have such a profound interaction that the hyper-sedation may lead to death.  Frequently doctors do not appreciate the potential severity of these interactions, and will prescribe this combination liberally to their patients.  Of those dying of opioid overdose, 25% have also benzodiazepines as a contributing factor.  Now consider there may be more than one interaction between two drugs.  For instance in addition to sedation, there is also confusion, and respiratory depression.  Therefore serious side effects between an opioid and benzodiazepines are at least 3 interactions.  

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For patients taking three drugs that have a single drug-drug interaction, the number of interactions is 3 but there are 7 different possible interactions between all three drugs. For 4 drugs, the number of single drug interactions is 6 but given multiple drug combination interactions occurring at the same time, the number is over 30.  For 6 drugs the number of potential interactions is several hundred.  For 10 drugs it will be in the tens of thousands.  In cases where there are two interactions between drugs (e.g sedation and respiratory depression) the numbers are much higher.  Easily for a person taking 7 drugs the overall number of potential interactions are in the millions.  This is far too high for any pharmacy or doctor to warn patients about, therefore those engaging in polypharmacy (the rule rather than the exception in the elderly population) are very highly likely experiencing significant side effects due to drug interactions and may not be aware of these.  Frequently doctors cannot figure out complex drug-drug or drug-supplement interactions, resulting in long term health problems that may be misdiagnosed, or even worse, treated with yet another pill.