A medication review is a planned conversation with a pharmacist, GP or nurse to check that each medicine you take is still right for you. In England, GP practices offer Structured Medication Reviews, usually with a clinical pharmacist, and prioritise people who take many medicines, are severely frail or housebound, or have recently had falls or a hospital stay. Community pharmacies also run the free New Medicine Service for some newly prescribed medicines, including for gout and osteoporosis. Bring every medicine you use, including creams, injections, supplements and shop-bought painkillers. Never stop or change a prescribed medicine yourself — ask first.
This guide is for one job: getting a useful review of your medicines and knowing what to ask. If you are about to start a new arthritis medicine, also use our 10 questions for a new medicine. For food, alcohol and supplement clashes, see food, drink and arthritis medicines. If tablets leave you drowsy at night, see sleeping tablets and night falls.
Which kind of review do you need?
Structured Medication Review (GP practice, England)
NHS England describes a Structured Medication Review as a full review of all your medicines that takes your whole health into account, where you and the clinician work as equal partners to weigh up benefits, risks and alternatives. Clinical pharmacists working in GP practices are expected to lead them. Practices are asked to identify people who would benefit most, including people:
- living in care homes
- taking 10 or more medicines
- taking medicines commonly linked to medication errors
- who are severely frail, isolated or housebound, or have had recent hospital admissions or falls
- taking potentially addictive pain medicines
How many reviews a practice can offer depends on its pharmacist capacity, so it is worth asking even if you have not been invited.
New Medicine Service (community pharmacy, England)
The NHS New Medicine Service is free if you live in England and have been prescribed a new medicine for certain conditions. The list includes gout, osteoporosis, high blood pressure, type 2 diabetes, depression and several heart and lung conditions. Rheumatoid arthritis and osteoarthritis are not currently on the list. When you collect the new prescription, ask the pharmacist if you can take part. You will have 3 appointments over several weeks, by phone or in a private consultation room, and the pharmacist can refer you back to your GP surgery if needed.
Everyday pharmacist advice and your specialist team
You can ask a community pharmacist about side effects, shop-bought medicines or how to take a medicine at any time. Questions about DMARDs, biologics or blood monitoring usually go to your rheumatology team or specialist nurse advice line. Wales, Scotland and Northern Ireland run their own pharmacy and GP services, so ask your local pharmacy or GP practice which reviews they offer.
How to ask for a review
- Ask GP reception: "Could I have a structured medication review with the practice pharmacist?" Say why — for example, many medicines, dizziness, a recent fall or a recent hospital stay
- After a hospital stay, ask your GP practice or pharmacy to check that your list matches the discharge letter
- When you collect a new prescription for an eligible condition, ask about the New Medicine Service
- A carer or relative can come with you, or join a phone appointment, if you would like them to
What to bring
- All your medicines in their boxes, or a full up-to-date list: tablets, liquids, patches, inhalers, eye drops, creams and gels
- Injections such as methotrexate or biologics, even if a homecare company delivers them
- Shop-bought painkillers, cold and flu remedies, vitamins, supplements and herbal remedies
- Your repeat prescription slip, any blood-monitoring results or booklet, and any steroid card
- Allergies and side effects you have had in the past
- An honest note of how you actually take them — including doses you skip and why — and how much alcohol you drink
Questions to ask
- What is each medicine for, and do I still need it?
- Could any of these make me dizzy, drowsy or unsteady, or raise my risk of falls?
- Do any of them clash with each other, or with shop-bought painkillers or supplements?
- Am I doubling up on an ingredient? For example, the NHS warns against taking paracetamol at the same time as other medicines containing paracetamol, such as cold and flu remedies
- Which blood tests or checks do I need, and how often?
- What should I do with my medicines if I am ill, being sick or not eating and drinking? Do any have sick day rules?
- If I take steroids, do I need bone protection or a steroid emergency card?
- My hands are stiff — could easy-open lids, larger labels or different packaging help? See our dosette box and blister pack guide
- What should I do if I miss a dose?
Never stop or change medicines yourself
A review is a shared decision, not a cut-the-list exercise. Some medicines are dangerous to stop suddenly — steroids are the best-known example — and others, such as some sleeping tablets, strong painkillers and antidepressants, may need a planned reduction. Changes to arthritis medicines such as DMARDs or biologics are usually agreed with your rheumatology team. Our stopping arthritis medication safely guide explains why.
If you think a medicine is causing a side effect, speak to your pharmacist or GP. You can also report suspected side effects to the MHRA Yellow Card scheme.
Medicines and falls
The NHS lists side effects of some medicines among the causes of falls, and advises speaking to a GP or pharmacist if you think your medicines could be affecting your balance. NICE falls guidance recommends considering a structured medication review for people who need a full falls assessment, to find medicines that may raise falls risk. It notes that psychotropic medicines — which include some medicines for sleep, anxiety, depression and epilepsy — are linked to a higher risk of falls. If you have had a fall, also read our confidence after a fall guide.
After the review
- Ask for your updated medicines list in writing, and keep a copy with your flare action plan
- Check any new instructions with the pharmacist when you next collect your prescription
- Book a follow-up if a change was made, and note how you feel over the next few weeks
If you care for someone with lots of medicines
- With their agreement, help them gather every medicine before the review — including the ones in handbags, bedside drawers and the fridge
- Mention new confusion, sleepiness, falls or changes in eating, as these can be linked to medicines
- Ask the pharmacist whether a different pack or reminder system would make things safer
When to get urgent help
- Call 999 for swelling of the lips, mouth, throat or tongue, difficulty breathing, chest pain, collapse or sudden confusion
- Contact NHS 111 if you think you have taken too much of a medicine, or a new side effect worries you and your GP surgery or pharmacy is closed
- Same-day GP, pharmacist or rheumatology advice line for signs of infection while on immune-suppressing arthritis medicines — see our infection watch guide
- Speak to your GP or pharmacist soon about new dizziness, drowsiness or falls since a medicine was started or changed
Frequently asked questions
Is a medication review the same as my annual review?
Not always. Some annual reviews focus on one condition. Ask whether yours will look at every medicine you take, including ones from the hospital and the pharmacy shelf.
Will the pharmacist take me off my arthritis medicines?
No change should be made without talking it through with you. The point is to make sure each medicine is still helping more than it harms. Arthritis-specific medicines are usually changed only with your rheumatology team involved.
Can I get the New Medicine Service for methotrexate?
The New Medicine Service covers specific conditions, and rheumatoid arthritis is not currently one of them. You can still ask your pharmacist questions at any time, and your rheumatology team or advice line remains the main contact for methotrexate.
Sources and further reading
- NHS England: Structured medication reviews and medicines optimisation
- NHS: Get help with newly prescribed medicines (New Medicine Service)
- NICE NG5: Medicines optimisation
- NICE NG249: Falls — assessment and prevention in older people
- NHS: Falls
- NHS: Taking paracetamol with other medicines
- MHRA: Yellow Card scheme (report side effects)
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist, physiotherapist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Starting a new arthritis medicine — 10 questions
- Food, drink and arthritis medicines — interactions
- Stopping medication safely — why you should ask first
- Sleeping tablets and night falls — drowsy medicines
- Steroid emergency cards — red and blue cards
- Bone protection on steroids — DEXA and vitamin D
- Confidence after a fall — falls services
- Dosette boxes and blister packs — when hands are stiff
- Painkillers and NSAIDs — safety basics
- Flare action plan — keep your list with it