OBJECTIVES: To estimate the incidence of polypharmacy and its association with respect to medication regimen, patient safety and health hazards among patients 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 and receive five or more medicines either during ED stay or at discharge. The detailed clinical records of these patients were reviewed includes their demography, diagnosis, presenting complaints, number and category of medicines etc.

RESULTS: Total 51,000 patients visited ED during January 2012 till December 2012; out of those 40% of patients have Polypharmacy. Male were 56.6 % (9,837), 79% (14,279) were adults from which 31% (115) were > 60 years of age. Patients with GI symptoms were 2% (105).The most common triage category for patients were P3 (means patients’ needs investigation and management in ED but was not critical or life threatening) with 37.2% (6,483). Most of these patients 59.6% (10,146) were advised admission to the hospital while 26.5% (4,514) patients were discharged and 9% (1,536) patients were Leave against Medical Advice. The most frequent prescribed medicines were antibiotics 91.6%, proton pump inhibitors 31.5%, electrolytes 29% followed by maintenance fluids 22.3% etc

CONCLUSIONS: Polypharmacy is significant finding among all ED patients especially elderly. Polypharmacy can have significant effects on patient quality of care as well as communication gap between patient and pharmacist can lead to adverse outcome .The results from this study can serves as a baseline to develop guidelines to deal with Polypharmacy in ED of Low middle income country (LMIC).

KEY WORDS: Emergency Department (ED), Low middle income country (LMIC), Pakistan, Polypharmacy