Polypharmacy and Deprescribing in Internal Medicine: Strategies to Reduce Adverse Events in Patients with Multimorbidity

Abstract

Introduction: Polypharmacy is one of the major challenges in contemporary Internal Medicine, particularly among patients with multimorbidity, and is associated with an increased risk of adverse drug reactions, drug interactions, hospitalizations, and impaired quality of life. In this context, deprescribing has emerged as an effective strategy to optimize pharmacotherapy and improve patient safety. Objective: To analyze the scientific evidence regarding polypharmacy and deprescribing in Internal Medicine, highlighting strategies to reduce adverse events in patients with multimorbidity. Methods: This narrative literature review was conducted through searches in the PubMed/MEDLINE, Scopus, Web of Science, Virtual Health Library, SciELO, and Cochrane Library databases. Original articles, systematic reviews, meta-analyses, clinical trials, guidelines, and institutional documents published between 2015 and 2026 addressing polypharmacy, deprescribing, multimorbidity, and patient safety were included. Results: The evidence indicates that polypharmacy is directly associated with an increased incidence of adverse drug reactions, drug interactions, hospitalizations, and mortality, particularly among older adults and patients with multiple chronic conditions. Deprescribing strategies, combined with systematic medication review and the use of tools such as the Beers Criteria and the STOPP/START criteria, have proven effective in reducing potentially inappropriate prescriptions, optimizing treatment, and improving patient safety. Conclusion: Deprescribing is an essential strategy in Internal Medicine, contributing to the rational use of medications, reduction of adverse events, and promotion of safer, individualized, and evidence-based healthcare.