The term polypharmacy refers to patient use of five or more medications.  The World Health Organization recognizes that the definition is numerical, but recommends treatment decision be made utilizing evidence-based medicine in an effort to prevent polypharmacy.  The concept of rational polypharmacy in pain management is based upon combining agents with synergistic activity in an effort to control pain while minimizing adverse effects.  Polypharmacy does increase the risk of prescribing cascades by adding additional medications to manage the adverse effects of other medications.  Preventing polypharmacy can be managed by ensuring patients have a complete list of all medications with directions. This program will review definitions of polypharmacy and recognizing when prescribing cascades are present.  Additionally, pharmacologic and clinical interventions will be discussed for managing polypharmacy utilizing patient cases.