Support Yellow Card: report suspected reactions in patients taking multiple medicines

Be especially alert for adverse drug reactions (ADRs) in patients taking more than one medicine and report any suspected ADRs to the Yellow Card Scheme. Show your support for the MHRA’s ADR awareness week campaign on 17–23 February 2020 by sharing material on social media and discussing with colleagues and patients the importance of reporting suspected side effects.

What can you do to improve the safe use of medicines?

  • don’t delay in reporting suspected adverse drug reactions (ADRs) to the Yellow Card Scheme online or via the Yellow Card app (download from the Apple App Store or Google Play Store)
  • when prescribing or reviewing medicines for people with complex or multiple conditions, consider if medicines use is optimised and there is good justification for use of those medicines at the same time
  • use the product information for medicines to identify interactions, relevant precautions, and safety monitoring advice
  • talk to your colleagues about the importance of monitoring and regularly reviewing people who are taking multiple medicines and discuss with them how reporting suspected ADRs to the Yellow Card Scheme improves the safe use of medicines
  • follow us on our social media channels and show your support for the importance of reporting suspected ADRs by retweeting, commenting, liking, and sharing material with your social media contacts using #PatientSafety, #polypharmacy, #yellowcard

Advice you can give to patients, families, and caregivers about medicines safety

  • following the instructions in the leaflet that comes with your medicines lowers the risk of some side effects – this includes taking the right dose at the right times and whether to take it with or without food or drinks
  • report suspected side effects to the Yellow Card Scheme; even if you have recently stopped a medicine due to a suspected side effect or interaction with other medicines, foods, or herbal products
  • if you or a member of your family are using multiple medicines, you can talk to your doctor, nurse, or pharmacist about a medicines review

Patient on multiple medicines? Watch out for interactions and side effects

The MHRA’s adverse drug reaction (ADR) awareness week campaign will be taking place on 17–23 February 2020. This year’s theme is the importance of reporting side effects during polypharmacy.

Polypharmacy is the routine use of 4 or more prescription, over-the-counter, or traditional medicines at the same time by a patient. Some polypharmacy, such as in secondary prevention of cardiovascular events, can reduce the risk of future morbidity and mortality in patients. However, polypharmacy can also increase the likelihood of a patient having side effects, as well as increase the risk of interactions between medicines and with foods or herbal products.

Polypharmacy in older people

Polypharmacy is very common, especially in older individuals who are likely to be taking medicines for chronic long-term conditions.1 In 2017, a study into medication use in older people (65 years and older) in England showed a 4-fold increase in the number of people taking 5 or more medicines (from 12% to 49%).2 A third of people older than 75 years in England now take at least 6 medicines, and over 1 million people take 8 or more medicines a day.3

In addition to older people being more likely to be on multiple medicines, they may also be more susceptible to developing adverse reactions since they may metabolise or excrete medicines less effectively and be more sensitive to their effects. Therefore, it is particularly important to regularly review the need for medicines being taken by older people and to be vigilant for interactions and suspected adverse drug reactions.

Information and resources about polypharmacy

Polypharmacy is one of WHO’s 3 Global Patient Safety Challenges, which aim to shine a light on particular patient safety issues that pose a significant risk to health.

NICE’s Key Therapeutic Topic on Multimorbidity and polypharmacy provides advice on problematic polypharmacy and on optimising a person’s medicines to support the management of long-term health conditions.

Other important resources are:

If deprescribing is considered, available resources should be used, including advice in the Summary of Product Characteristics, to ensure safe and effective withdrawal of medicines. This is particularly important for some medicines such as opioids, antidepressant medicines, and corticosteroids, where abrupt discontinuation should be avoided.

How does reporting improve medicines safety?

The MHRA continually reviews the safety of all medicines. Some adverse drug reactions can only be identified when medicines are used for a long time in a wide range of different people, so it is very important that suspected adverse drug reactions are reported to the Yellow Card Scheme.

Every report made by a healthcare professional or a patient or caregiver plays a critical role in understanding the benefits and risks of medicines in clinical use, allowing action to be taken to minimise risks. Reporting helps to improve the safe use of medicines for all patients and, in some cases, can result in better tailored prescribing advice, which can help improve adherence to treatment.

About the Yellow Card Scheme

All healthcare professionals, parents, and caregivers can report any suspected adverse reactions to the Yellow Card Scheme, including to:

  • medicines

  • vaccines

  • blood factors and immunoglobulins

  • herbal medicines

  • homeopathic remedies

It is easy to report on the Yellow Card website or via the Yellow Card app. Download the app via iTunes Yellow Card for iOS devices or via PlayStore Yellow Card for Android devices.

You can also use the app to access the latest safety information from the MHRA about medicines and medical devices on the Newsfeed. Search for medicines to see details of Yellow Card reports others have made. Medicines of interest can also be added to a Watch List to receive news and alerts about new side effects and safety advice as it emerges.

We also have dedicated guidance on the Yellow Card Scheme for healthcare professionals including accredited CPD e-learning modules.

The Yellow Card Scheme can also be used to report suspected concerns about medicinal devices, defective medicines, and side effects or safety concerns about e-cigarettes or refill liquids.

Local networks and resources

Healthcare professionals in all settings throughout the UK can contribute to improved medicines safety and awareness reporting of suspected adverse drug reactions. One way to support the safety culture for your organisation is to engage with key networks and resources available locally.

The UK’s 5 regional Yellow Card Centres work with healthcare professionals, patients and organisations to promote the Yellow Card Scheme and the importance of reporting reactions. Your local Yellow Card Centre can help you or your organisation to raise awareness of the Yellow Card Scheme.

In England, you can also engage with your local Medication Safety Officer (MSO). The MSO of your NHS trust, CCG, or community pharmacy helps to support healthcare professionals in reporting suspected adverse drug reactions to the Yellow Card Scheme and medication errors via local reporting mechanisms. MSOs also work as a group to identify local and national trends in safety reporting, share best practice for new medicines risk advice, and support other medication safety champions in local committees, networks, and groups.

About the campaign

The reporting of suspected adverse drug reactions is key to patient safety. This campaign builds on the past award-winning campaigns to help encourage greater local and national awareness about the importance of reporting to support the earlier detection of safety issues.

Campaign material freely available for reuse includes a general animation about reporting and infographics. Material is also available on the Yellow Card website.

The MHRA’s ADR campaign follows on from international MedSafetyWeek in November 2019, which the MHRA and Uppsala Monitoring Centre coordinate.

Article citation: Drug Safety Update volume 13, issue 7: February 2019: 5.

  1. Cantlay A, et al. Polypharmacy in the elderly. InnovAiT 2016; 9: 69–77. 

  2. Gao L, et al. Medication usage change in older people (65+) in England over 20 years: Findings from CFAS I and CFAS I. Age and Ageing 2018; 47: 1–6. 

  3. Health and Social Care Information Centre. Prescriptions dispensed in the community, statistics for England, 2004–2014. Published July 2015. Accessed October 2019. 

Published 12 February 2020