In a CMAJ news article,1 Roger Collier discussed the benefit of fixed-dose combination drugs. This innovation promotes adherence and is a promising locus for pharmaceutical development, but such pills offer only a partial solution to the challenges associated with multiple-medication treatment regimens.
A 2008 review suggests that high dosing frequency of medications may have the most consistent negative effect on adherence.2 In addition to reducing the pill burden, fixed-dose combination drugs may improve adherence through reducing both the frequency of taking medications and the challenges in interpreting how medications are to be taken. These outcomes can also be accomplished when health professionals consolidate instructions on how to take medications into a list that groups medications that can be taken together. Unfortunately, few older patients, who struggle with the most complex medication regimens, will adequately consolidate instructions on their own.3
Medication regimen complexity can be evaluated only after consideration is given to how the instructions for taking individual medications fit together when seen as part of a unified script. The CMAJ news article1 cited justified concern over the lack of customization offered by combination pill approaches. A truly person-centred approach to simplifying medication regimens requires an assessment of regimen complexity in each unique case, including ways to reduce the number of doses and medications.4 The individual benefits of therapeutics must be weighed against the costs of multiple-medication regimens when drugs are prescribed concurrently. There are important implications for adherence, patient safety and quality of life.
The simplest medication regimen that meets the mutual and explicitly defined goals of patient and physician is surely the best one. Simplification must go beyond reducing the pill burden through combination pills.
References
- 1.Collier R. Reducing the “pill burden.” CMAJ 2012; 184:E117–8 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ingersoll KS, Cohen J. The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med 2008;31:213–24 [DOI] [PMC free article] [PubMed] [Google Scholar]
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