OBJECTIVES: Metabolic syndrome is a cluster of several common metabolic disturbances, including inter alia hypertension, hyperglycaemia and dyslipidaemia. Each of these risk factors requires multiple agents to reach desired therapeutic goals. The aim was to determine the average pill burden level in patients treated concurrently with antidiabetic-, antihypertensive- and lipid-lowering agents. METHODS: A retrospective, quantitative drug utilization review was conducted utilizing national medicine claims data obtained from a South African Pharmaceutical Benefit Management company for the period of January 1, 2008 to December 31, 2008. Average pill burden (AvPB) was calculated as the average number of tablets received per prescription over the study period divided by the number of days medication was supplied for. Combination products were counted once. As-needed-medication and other chronic medication were excluded from the analysis. Data for 17 866 patients were analysed using the SAS for Windows 9.1® programme. RESULTS: Patients had an overall AvPB of 2.7±1.20 per prescription, with a rate of 2.8±1.21 among males (n = 9 632) vs. 2.6±1.18 for females (n = 8 234). Patients aged 0-15 years (n = 2) had an AvPB of 1.2±0.30 per prescription, vs. 2.3±1.49 for those aged 16-30 years (n = 53), 2.6±1.11 for those 31-45 years (n = 992), 2.8±1.18 for those 46-60 years (n = 5 768), 2.8±1.23 for those 61-75 years (n = 7 641) and 2.5±1.17 for those older than 75 years (n = 3 410). CONCLUSIONS: Metabolic syndrome patients are prescribed multiple drug therapies. Our results show that the average pill burden among private health care South African patients receiving antidiabetic-, antihypertensive- and lipid-lowering agents concurrently were the highest among men, and increased progressively with age to peak in those aged 61-75 years. Further studies are necessary to determine the influence of pill burden on adherence, drug interactions and treatment cost.