In November 2015, the FDA approved the HIV-1 medication Genvoya, a once-daily pill containing fixed doses of the HIV drugs elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide.
This is the latest once-daily medication to be produced to treat HIV, a disease that used to be managed primarily with many different pills taken multiple times a day. Polypharmacy regimens are not only inconvenient; the complexity of balancing medication schedules and refills can lead to risks in patient adherence and overall safety.
During my surgery rotation in my third year, I developed a nasty case of strep throat and was prescribed Augmentin, a combination drug that needs to be taken twice a day. Just one pill two times a day. I am embarrassed to say that more than once, I forgot to take my second dose. Meanwhile, the patients I was seeing were being asked to take more daily medications than I could count. If I was struggling to remember to take two pills a day, what were my patients experiencing?
The risks that come when patients are taking so many medications go beyond simply missing the appropriate dosage. Both the financial and time burdens of refilling so many medications frequently lead patients to discontinue some regimens altogether. This event can become even further complicated if these patients then come to the hospital and receive treatment as if they were still adhering to their medication regimen, a situation that has the potential for morbid consequences, if not fatal ones.
That being said, combined polypharmacy is not without risk. Most prominent in my mind is the challenge of drugs like Percocet, which combines oxycodone and acetaminophen; the former is an opioid, and the latter is a pain reliever. While the two drugs are an effective treatment for severe pain, in the setting of addiction, patients’ efforts to consume more of the opioid can result in fatal overdoses because of serious liver damage from the acetaminophen.
Thus, the principle of combination medication must be taken with a grain of salt, and the risks of using addictive medications certainly must be weighed. In the case of HIV medications, however, there is promise of incredible improvement in patients’ lives and overall health care.
Over the years, I look forward to seeing this principle expand into a broader range of diseases requiring multiple medications, such as hypertension. This is not simply a matter of convenience; simplifying medications may improve, and even save, lives.