Medicines can prevent strokes, control blood pressure, relieve pain, treat infection, stabilise mental illness and reduce disease complications. They can also cause side effects, interact with other medicines and require monitoring. A Physiology First approach should therefore never be anti-medication. It should be pro-understanding, pro-monitoring and pro-review.
Primary Australian health context: AIHW Australia's health 2026, supplemented by Healthdirect and Australian Government pharmacy-care guidance.
The Australian picture
Australia's Health 2026 shows how central medicines are to chronic-disease management. In 2024-25, almost 113 million cardiovascular medicine prescriptions were dispensed through the Pharmaceutical Benefits Scheme, representing 34% of all PBS prescriptions.[1]
The report also shows increasing dispensing of mental-health medicines over the past decade, and rapid growth in the use of GLP-1 medicines for weight management, while noting uncertainty about long-term outcomes and access barriers for some newer treatments.[1]
This reinforces an important point: medicines are a major part of modern health care, and monitoring their benefits and harms is part of good care.
Every medicine should have a reason
For each medicine, a person should ideally know the indication - the condition or risk it is intended to treat - and what outcome would show that it is helping.
Sometimes the outcome is a symptom, such as pain. Sometimes it is a measurement, such as blood pressure, LDL cholesterol, HbA1c or heart rate. Sometimes it is prevention of a future event, which makes ongoing risk assessment and adherence especially important.
A medicine can be appropriate even when the person feels no immediate difference.
| Question | Why it matters | Examples of monitoring |
|---|---|---|
| What is it treating? | Without a clear indication, it is difficult to judge whether ongoing treatment still makes sense. | Diagnosis, risk factor or symptom the medicine targets. |
| Is it working? | Some effects are felt; others require measurement or long-term risk reduction. | BP, HbA1c, lipids, symptom scores, event prevention, functional improvement. |
| What are the known harms? | Side effects can be mistaken for new disease or lead to additional medicines. | Dizziness, swelling, sedation, gastrointestinal symptoms, bleeding, falls or laboratory abnormalities. |
| What needs laboratory monitoring? | Some medicines affect kidney function, liver function, electrolytes, blood counts or drug levels. | Creatinine/eGFR, potassium, sodium, liver tests, blood counts or other medicine-specific tests. |
| Does it interact? | Prescription medicines, over-the-counter products, supplements and alcohol can interact. | Full medicine and supplement list reviewed by a pharmacist or doctor. |
| Does the dose still fit? | Ageing, weight change, kidney/liver function and new illness can alter how medicines are handled. | Clinical review after health changes, hospitalisation or new symptoms. |
| Is the person actually taking it? | Complex schedules, cost, swallowing difficulty, memory and side effects can reduce adherence. | Medication list, dose administration aid, pharmacy history and practical barriers. |
Polypharmacy deserves review, not panic
Healthdirect defines polypharmacy as taking five or more medicines. This can be entirely appropriate when a person has several chronic conditions, but it increases the possibility of interactions, duplicated effects, side effects and medication errors.[2]
Older adults can be particularly vulnerable because ageing changes body composition and the way medicines are processed and eliminated. Healthdirect recommends keeping an up-to-date medicine list and asking for regular medicine reviews; it notes that medicines may ideally be checked every 6 to 12 months, or sooner when treatment changes.[2]
The goal of review is not automatically to reduce the number of medicines. It is to make sure each medicine still has a role, the dose is appropriate and the combination remains safe.
Home Medicines Reviews are an underused tool
Australian Government pharmacy-care guidance notes that pharmacists can conduct Home Medicines Reviews, where medicines are reviewed in the person's home to improve understanding and minimise harm. Residential Medication Management Reviews are also available in eligible residential aged-care settings.[3]
These reviews can be especially useful when someone takes multiple medicines, has recently been in hospital, is experiencing possible side effects, has difficulty managing the regimen or sees multiple prescribers.
What is worth recording?
A useful medication record is more than a list of brand names. It can include:
- Medicine name and active ingredient.
- Dose, timing and how it is actually being taken.
- The reason it was started and who prescribed it.
- The measurable target or expected benefit.
- Known side effects or new symptoms since it was started or changed.
- Required blood tests or clinical monitoring and when they were last done.
- Over-the-counter medicines, vitamins, herbal products and supplements.
- Recent changes after hospital admissions, specialist appointments or pharmacy substitutions.
Medicines can change nutritional and physiological context
Some medicines alter appetite, body weight, bowel function, fluid balance, blood pressure, electrolytes or glucose. Others can interact with foods, alcohol or supplements.
That does not mean every symptom or nutrient level is caused by medication. It means that when physiology changes after a treatment change, the medicine list should be part of the investigation.
Questions worth asking
A practical medication review can begin with:
- Why am I taking each medicine?
- What result tells us it is working?
- What side effects should I watch for?
- Do I need blood tests, blood-pressure checks or other monitoring?
- Could this medicine interact with my other prescriptions, supplements or alcohol?
- Has my kidney function, weight, age or health status changed enough to affect the dose?
- Would a pharmacist-led Home Medicines Review be useful?
- Is there any medicine I am taking that no longer has a clear indication?
Do we know what every medicine is doing, what benefit we expect, what harm we are watching for and when we will review it?
Do not stop medicines abruptly on your own
Some medicines can cause rebound symptoms, withdrawal effects or serious risk if stopped suddenly. Treatment changes should be made with the prescriber or another clinician who understands the person's conditions and medication history.
The Physiology First role is to encourage understanding and appropriate monitoring - not to replace prescribing decisions.
The Physiology First takeaway
Medicines are part of physiology because they deliberately change physiology. That is their purpose. Good medication care therefore includes knowing the target, monitoring the response, watching for side effects and revisiting the plan as the person changes.
The goal is not fewer medicines at any cost. The goal is the right medicines, for clear reasons, at appropriate doses, with the right monitoring.
KNOW MEASURE UNDERSTAND CONNECT QUESTION OPTIMISE RE-MEASURE
[1] Australian Institute of Health and Welfare (2026). Australia's health 2026. Australian Government. https://www.aihw.gov.au/reports/australias-health/australias-health-2026
[2] Healthdirect Australia. Medicines safety for older people. https://www.healthdirect.gov.au/medicines-safety-for-older-people
[3] Australian Government Department of Health, Disability and Ageing. Pharmacy care. https://www.health.gov.au/topics/primary-care/what-we-do/pharmacy-care
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