Friday, May 23, 2008


The World Congress of Cardiology has just ended in Buenos Aires, Argentina. Amonst the many things discuss was a paper promoting a 3 in 1 combo pill to be taken as a prevention pill for heart disease. This pill is being manufactured by a Spanish company ( so Spain is good for other things besides bull fights and football). Dr V Fuster, presented a paper testing the new combo pill which contains a bit of aspirin, a bit of statins and a bit of ACE-I. Obviously the theoretical basis for this combo pill is strong. All the three drugs, individually, has been shown to reduce the incidence of cardiac events. At the right dose, statins has also been shown to regress atherosclerotic plaques. What will happen when all three drugs are combined together has to be closely studied. Will it be a straightforward combination of all the good effects of all three drugs or will it not be. I have been using a 2 in 1 combo pills like caduet ( Norvasc + lipitor ) by Pfizer and Exforge ( valsartan and norvasc ) by Novartis, and so far, they have been working well. I have seen good BP control and lipid level controls with no increase in side-effects. It is only important to note that I do not start them off with combo pills. I have them stable on the two pills individually and then make an offer to the patients to switch them to the comb pill. It is important to know that we need combo pills because of our strategy to prevent heart diseases and also in our endeavor to better manage coronary artery disease. I often see patients who suffer from heart disease, who also has a bit of hypertension, diabetes and obesity. These patients often end up taking 7-8 medications ( pills ). It is my standard joke with them that their morning pill- taking is almost like a breakfast with "smarties ". Therefore combo pills do have a role, as it is cost saving and also enhances compliance. Senior citizens are less likely to forgot pills if they are only taking 2-3 pills. What I am very concerned about combo pills is that you are unable to individualise pill dosages when they are combined. Not everyone can tolerate, or need - Norvasc 5 mg combined with lipitor 10mg ( as in Caduet ). Some patients need lipitor 10mg, but norvasc 10 mg. It that case, you may have to revert to individual drugs again. I am sure that seeing the need, the pharmas will bring out a wider range of combo pills with many more dosage combinations. I am also quite keen to know which pharma is making this new 3 in 1 combo pill and what will it be called? Spanish name does intrigue me.

1 comment:

Lily said...
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