Doctor reveals hidden risks of popular combination drugs: Know why the govt banned them

What is a combination drug?

When two or more drugs are combined in a fixed ratio into a single dosage form, it is termed as fixed dose combination (FDC). They are not only intended for fever and cold but also as anti-hypertensives, where the combination drug addresses both blood pressure and cholesterol. There are combination antibiotics too.

Why have they gained popularity?

Combination drugs were largely approved to provide symptomatic relief. For example, you could have a combination of two painkillers for dulling an intense jab of pain or an antacid with an anti-nausea drug to make you feel better momentarily. FDCs are seen as a handy tool to lower the pill burden of older patients who suffer from chronic illnesses and find it difficult to track their dosage at different times of the day. For instance, if a patient has to take three different medications for a particular treatment, they may forget to take one, especially if they have to be taken at different times. But if all three medications are combined into one tablet or one syrup, the chance of them missing their dosage is remote. Some people get confused by the separate instructions. So they are seen as a good way to ensure compliance and discipline.

Why could they pose a problem?

Since such drugs have many disparate components punched together, we do not know whether they would be compatible with each other. They may be metabolised or broken down in the body differently when taken individually and when they are in combination. Each component may have a different activity time, that is the time when each peaks and degenerates in the body. Their performance graphs may not be the same. They may not be symbiotic with each other and as they move through the body, the body itself may respond differently to them. Since there are varied components, there is no guarantee that after they are broken down, their particle size and crystal size will be the same. These inconsistencies could affect their absorption in the body, they could work at cross purposes and end up eroding the efficacy they were intended for.

Besides, we don’t know how each of these combination drugs may affect each individual’s body, particularly when they are already taking other medication or have differing conditions or complexities. There could be long-term side effects that we may not be aware of.

Should there be an adverse reaction in the body, it may be difficult to identify the active ingredient responsible for causing the reaction in a combination drug.

But the biggest dangers could come from antibiotic combinations as they might lead to antimicrobial resistance when microbes beat the drugs because of their overuse. In fact, studies of several antibiotic combinations have reported no additional advantage over their individual dosage. So stick to conventional advisories by doctors.