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

Written by Scottish Government, experts from NHS Scotland and experts by experience and in collaboration with SIGN, the guidance updates the previous 2018 edition to ensure appropriate prescribing of medicines to optimise treatment outcomes and achieve the best care.  

The guidance is endorsed by the Royal Pharmaceutical Society, the Royal College of General Practitioners, the Royal College of Physicians of Edinburgh and the National Centre for Sustainable Delivery.

Polypharmacy represents a growing global challenge due to aging populations with increasing prevalence of multimorbidity. Care of adults with multiple medical conditions is often overly complex and rarely person-centred. This leads to poor health outcomes, unsustainable levels of expenditure and avoidable environmental damage, all of which disproportionately affects the most vulnerable in society. The updated polypharmacy guidance continues to place the individual at the centre and places greater emphasis on shared decision-making to actively engage them in safe and effective care using the 7-Steps model for medicines reviews.  

The revised guidance has been expanded to provide additional practical support to multidisciplinary teams (MDT) implementing the 7-Steps medication review and includes: 

1. Updated Cumulative Toxicity table and anticholinergic burden guidance to help target harm reduction 
2. Updated Drug Efficacy (Numbers Needed to Treat) tables to help discussion with the individual regarding the relative potential benefits of a range of common therapeutic interventions 
3. Enhanced clinical hot topics considering specific patient groups such as those with mental health conditions, frailty and comorbidities (often more prevalent in deprived areas) 
4. Additional case studies to support learning for use by the MDT across different settings, e.g. GP practice, secondary care clinics and palliative care 
5. Updated  National Polypharmacy Indicators further developed and prioritised to support national progress, understand prevalence and monitor clinical outcomes including a suite for care homes 
6. Revised case finding indicators to support identification of individuals (including those at risk of medicine related harm) for review in practice 
7. Revised Medication Sick Day Guidance including new medicines, such as those used in the management of diabetes that can cause harm  

To assist implementation of polypharmacy reviews, we have developed an implementation toolkit allowing clinicians to select the step(s) to implementation most useful to themselves, their practice and their boards. A free, accredited training package on undertaking comprehensive 7-Steps polypharmacy reviews for multidisciplinary professionals is also available on Turas