OBJECTIVES: To evaluate the drug utilization pattern among the elderly hospitalized patients who were heavy drug users. METHODS: A descriptive, cross-sectional study was carried out from December 2015 to March 2016 in six tertiary-care hospitals of the Punjab province of Pakistan. The study population was patients aged ≥60 years, taking ≥5 medicines/day and being hospitalized in the hospitals. Data was collected from 600 hospitalized elderly patients (100 patients per hospital). All medicines prescribed in each in-patient chart were noted on a pre-designed pro-forma and were classified under ATCl classification system. Multiple linear regression analysis was used to find the independent factors associated with heavy drug use. A P-value of < .05 was considered statistically significant. RESULTS: In 600 hospitalized in-patient (male 52.7% and female 47.3%) charts, 3,179 medicines were prescribed. The most commonly prescribed drug classes were: A: alimentary tract and metabolism 80% (A02: drugs for acid related disorders 64.5%, A03: drugs for functional gastrointestinal disorders 21.5%, etc.), N: nervous system 66.3% (N02: analgesics 67.2%, N03: antiepileptic’s 11.2%, etc.), J: anti-infectives for systemic use 62.2% (J01: antibacterial for systemic use 82.5%, J04: antimycobacterials 15.3%, etc.) and C: cardiovascular system 48.3% (C07: beta blocking agents 19.8%, C10: lipid modifying agents 16.5%, etc.), respectively. The most commonly prescribed active substances were: A02BC01 (omeprazole 51.3%), N02BE01 (paracetamol 50.8%) and J01DD04 (ceftriaxone 40.2%), respectively. In multiple linear regression analysis, male gender (95% CI -.205, -.006, p = .039), being divorced (95% CI -.604, -.136, p = .002) and presence of comorbidity (95% CI .068, .267, p = .001) were the independent predictors of heavy drug use. CONCLUSIONS: The rational use of medicines is of utmost importance, most particularly in the elderly population. It is highly recommended that more consideration should be given to the elderly hospitalized patients who are heavy drug users.