Polypharmacy has now increasingly come into focus as the recipient of healthcare in old age worldwide. In elderly it is associated with frequent adverse drug reactions (ADRs) and drug-drug interactions resulting in significant morbidity. Geriatrics is still an emerging specialty in South Asia, especially in Pakistan, where multiple reasons for polypharmacy exist. An extensive literature review of articles using key words like 'polypharmacy,' 'elderly' was conducted. The recently updated Beers Criteria of classification of inappropriate drugs in the elderly was reviewed in detail. Articles of relevance to polypharmacy and evaluation of guidelines for appropriate interventions to minimise inappropriate drug prescribing were also reviewed. Commonly prescribed drugs like psychotropic, cardiovascular, nonsteroidal anti-inflamanatory drugs (NSAIDs) and oral hypoglycaemics can cause significant adverse events when prescribed to the elderly. Primary care physicians may use evidence based non-pharmacological interventions which may be appropriate to use in selected cases. Drugs can affect quality of life and morbidity in the elderly. A basic understanding of ageing physiology and pharmacology along with a step-wise approach to prescribing in the elderly maybe helpful in minimising iatrogenic complications of commonly used drugs in this age group.