OBJECTIVES: To estimate the incidence of polypharmacy and its strength of association with respect to medication regimen among patients (pediatric and adults) visiting ED of a tertiary care hospital in Karachi Pakistan. METHODS: Retrospective data was collected of all patients, who visited the Emergency Department (ED) of Aga Khan University Hospital, Karachi (AKUH) during January, 2012 to December, 2012. The detailed clinical records on medication prescribing from admission through discharge of all patients was reviewed. RESULTS: Total 51,000 patients visited ED during January 2012 till December 2012, out of those polypharmacy was common in 40% of patients. Male were 56.6%(9,837) while  43.4% (7,553) were females. Peadiatric patients were 17.9% (3,145) while 79% (14,279) were adults. The most common triage category for patients was P3 with 37.2% (6,483). Most of these patients were those who were recommended admission in other wards 59.6% (10,146), 26.5% (4,514) discharged patients and 9% (1,536) leave against medical advice (LAMA)  patients. CONCLUSIONS: The perils and problems associated with Poly pharmacy are a subject of interest as polypharmacy was significant finding among all ED patients. The results from this study  serves as a baseline to identifying the drug- related problems among EP and could helpful for pharmacists and physicians  to develop and implement strategy for risk management in tertiary care hospital. Keywords: Polypharmacy, Emergency Department, Emergency patients