Polypharmacy is increasingly recognized as a growing challenge in Tanzania’s evolving landscape of chronic disease management. Traditionally defined by the number of medications a patient uses, polypharmacy has often been approached as a simple numerical phenomenon [1]. However, this perspective underestimates the complex and often hidden risks associated with inappropriate drug combinations, self-medication, and fragmented care. In daily practice, primary care clinicians frequently encounter patients presenting with nonspecific symptoms such as dizziness, fatigue, palpitations, edema, or poor glycemic control symptoms that may be mistakenly attributed to disease progression rather than early manifestations of drug‑related harm. This opinion article argues that polypharmacy should be reframed not as a matter of “how many drugs,” but as a dynamic, risk‑laden process shaped by uncoordinated prescribing, widespread over‑the‑counter medication use, and limited pharmacovigilance.