Pharmacovigilance of cardiovascular drugs polypharmacy in the geriatric population in India.

Cardiovascular diseases (CVDs) constitute the leading cause of morbidity and mortality in India and represent a growing public health concern among the geriatric population. India is undergoing a rapid demographic transition, with a steadily increasing proportion of individuals aged 60 years and above. This ageing population is characterized by a high prevalence of multiple chronic conditions, including hypertension, diabetes mellitus, dyslipidaemia, coronary artery disease, heart failure, and arrhythmias. The coexistence of these conditions necessitates long-term pharmacotherapy with multiple medications, resulting in widespread polypharmacy. While polypharmacy is often clinically justified in cardiovascular care, it significantly increases the risk of adverse drug reactions (ADRs), drug–drug interactions (DDIs), medication non-adherence, functional decline, hospitalizations, and mortality in older adults. Cardiovascular drugs are among the most frequently implicated agents in serious and preventable ADRs due to their narrow therapeutic indices, complex pharmacokinetics, and altered pharmacodynamics in the elderly. Pharmacovigilance plays a critical role in identifying, assessing, understanding, and preventing medication-related harm, particularly in vulnerable geriatric populations. In India, the Pharmacovigilance Programme of India (PvPI) has strengthened national drug safety surveillance; however, under-reporting of ADRs, limited geriatric-specific data, lack of interdisciplinary collaboration, and fragmented healthcare delivery remain major challenges. This review comprehensively examines the burden of cardiovascular diseases and polypharmacy among geriatric patients in India, explores the mechanisms underlying increased ADR risk, highlights commonly implicated cardiovascular drug classes and interactions, and discusses clinical, organizational, and digital strategies—including artificial intelligence—to strengthen pharmacovigilance and improve drug safety outcomes