A single pill to treat multiple ailments

You may have heard of the medical term ‘pill burden’. This refers to the realization that many people with chronic illnesses tend to take too many meds in any given day, sometimes for a lifetime. It’s no wonder then that some pills will be forgotten and missed out, interfering with optimal disease control. But what if all those different meds were combined into a single pill?

The combination of several types of meds aimed at simultaneously treating related diseases is already in existence. Such combinations are referred to as ‘polypills’ or ‘combopills’. Essentially, a number of drugs that treat different, and usually related conditions, are compounded into a single pill. The doses are worked out to be either curative of the specific conditions, or just preventive. Thus you end up swallowing only a single pill to treat a multiplicity of ailments.

The initial interest and application of polypills was in cardiovascular diseases. Those with heart disease can end up taking lots of medications to control hypertension, reduce cholesterol levels, and limit the risks of blood clots. A polypill combining all such medications makes sense, optimally improving compliance and limiting progression to heart attacks and strokes. There are other applications of polypills in infectious diseases like TB and HIV, where multiple intake of different kinds of pills is the norm.

The use of polypills in disease prevention programs, on a wider population basis, has even been suggested. Non-communicable diseases, especially cardiovascular and metabolic diseases, are on the spotlight. There appears to be a likelihood of reducing heart attacks and strokes if whole populations are given a fixed-dose polypill that lowers blood pressure and cholesterol, and reduces the risk of blood clots. Other polypills may reduce the rates of diabetes and some types of cancers.

The benefits of polypills are obvious. Pill burden immediately becomes a thing of the past, compliance with medications is improved, resulting to near optimal disease control. The overall cost of medications may be lower, improving access to needy populations in low income countries. If the envisaged disease prevention with polypills bears fruit, this would have a positive effect on economics.

But there are some concerns with polypills as well. Some combinations may provoke unintended and harmful side effects in the long ran. Fixed doses, especially for preventive applications, may not suit everyone. This however could be addressed by individualized compounding of polypills in specialized chemists, or hospital pharmacies. And drug manufacturers may not be too interested in merging their products into polypills. This will inadvertently eat into their bottom lines.

Either way, polypills are already in the market. If you already swallow a handful of pills a day, for whatever reason, it helps to check with your doctor if a polypill is available to ease your burden.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. amurage@mygyno.co.ke