What are the advantages of combination drugs?

What are combination drugs?

It is the pharmaceutical formula that includes two or more active ingredients in a single administration, be it a tablet, vial, lozenge, etc. Its use has been widely discussed in recent years, more for academic than practical reasons. The scientific basis has its raison d'être is pharmacological synergy, that is, the quantitative increase in the pharmacological action of a drug when administered together with another. The joint action of the different active principles is greater than that of each of them separatelyor.

Types of combination drugs

Basically, there are two types of "synergy" between active ingredients:

• Additive synergy: if the effect of drugs A and B together is EQUAL to the effects of A and B administered separately. These types of synergies are of little use because the same effect can be achieved by increasing the dose of one of them. On the other hand, many additive combinations have a higher risk of side effects.
• Empowerment Synergy: if the effect of drugs A and B together is HIGHER than the effects of A and B administered separately. The association of paracetamol and Codeine can also be considered a "potentiation synergy" because the effect of both drugs administered at fixed doses is greater than that obtainable from one of the two by increasing their individual doses.

1. antibiotics

The use of 2 or more antibiotics will be indicated in the following cases:

• "Mixed infections" in which a single antibiotic "does not reach" the different types of pathogens.
• Initial practical treatment ("Empirical", that is, "practical") of serious infections of unknown cause until the results of the study are available.
• Infections due to multidrug-resistant organisms or that form resistant strains during the course of treatment (eg, Koch's Bacillus).
• Difficult-to-eradicate infections (for example, infections in bone prostheses, infections of the inner walls of the heart (Endocarditis)

For the association of two or more antibiotics, the following must be taken into account:

• That the mechanism of action of both antibiotics is different, that is, that they act on different cellular structures of the same developing germ.
• That they do not have the same type of toxicity, so as not to enhance a specific adverse effect.
• That they are synergistic to increase the bactericidal power and not antagonistic.

Examples:

• amoxicillin / Clavulanic Acid as a broad spectrum antibiotic used in countless infections (respiratory, skin, etc.)
• Isoniazid / Rifampicin in long-term therapies
• trimethoprim / Sulfamethoxazole continues to play a role in some common infections

2. pain relievers

Used in combination most frequently in the "chronic pain" (although also in acute pain pictures):

The association of a habitual antipyroid / analgesic () with a weak opioid (Codeine) is ideal. This combination is widely accepted by the O.M.S. On the other hand, the association of two antipyretics with Codeine does not provide better clinical results.

3. Antihypertensives

It is the best example illustrates the suitability of fixed drug combinations in Primary Care. Current presentations easily meet the needs of our hypertensive patients.

Antihypertensive ADFs have 2 interesting features:

• The two substances present empowerment synergy, the sum of their effects being greater than that of the drugs separately
• One of the drugs reduces the likelihood and intensity of side effects of the other active principle. For example, the association of the diuretic spironolactone (does not cause potassium loss) and Altiazide (favors urinary potassium excretion)
• The association of 20 mg of lisinopril with 12.5 mg of hydrochlorothiazide it has been shown as effective as 40 mg of lisinopril.

4. Bronchodilators

They are another great example of the usefulness of ADFs:

• Fenoterol / Ipratropium Bromide: it is useful for acute and chronic respiratory infections to associate a bronchodilator with an active principle that reduces bronchial secretions (Ipratropium).

• By drugs in combination at fixed doses we understand the pharmaceutical or "galenic" formula that includes two or more active ingredients in a single administration, be it a tablet, vial, dragee, etc.
• The pharmacological association at fixed doses (ADF) is based on the fact that the joint action of the different active principles is greater than that of each one of them separately.
• antibiotics, analgesics, antihypertensives, and bronchodilators are great examples of the usefulness of ADFs.
• Always consult a specialist before taking any medication. They have a 24-hour Medical Guidance service, so that you can consult any questions you may have regarding taking medications.

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