The polypill could make your medicines much easier to take.
The older we get, the more likely we are to develop heart disease, diabetes, arthritis, and other chronic health problems. Treating these diseases can require a cocktail of medications, which is why nearly half of older adults take five or more pills a day. Keeping track of all these drugs is a feat of memory and organization.
What if you could reap the benefits of several drugs—in a single pill? The combination "polypill" is an idea that's been in development for several years, and it could be available to you in the not-too-distant future.
Problem with too many drugs
The more medicines you take each day, the greater your odds of forgetting to take them. Compliance in older adults is "unbelievably bad," says Dr. Christopher Cannon, professor of medicine at Harvard Medical School and a cardiologist at Brigham and Women's Hospital.
Dr. Cannon sees patients with stents who fail to take the aspirin they need to prevent a heart attack or stroke. He also has patients who aren't properly controlling their high LDL cholesterol with statin drugs.
Combining three, four, or five pills into one could help solve these kinds of compliance problems. "The concept is that simplicity will make it easier to take the medicines," Dr. Cannon says.
One polypill combines three blood pressure medicines (ramipril, thiazide, and atenolol) with a statin (simvastatin) and aspirin.
Does the polypill work?
Studies conducted so far on the pill have been very promising. The Indian Polycap Study (TIPS) found that combining five drugs—three blood pressure medicines, a statin, and an aspirin—in one pill significantly reduced blood pressure and LDL cholesterol. Another study earlier this year found similar reductions with a pill combining four drugs (three blood pressure medications and a statin).
Yet a few questions still need to be answered before the polypill can be ready for general use:
Will the blood pressure and cholesterol reductions seen in studies translate into a lowered risk for heart disease? That remains to be seen.
Do these drugs work as well together as they do individually? In studies, each component of the polypill seemed to be doing its job. The statin drug lowered cholesterol, and the blood pressure medicine lowered blood pressure. However, in one study, the statin lowered cholesterol slightly less in the polypill than when it was taken alone, suggesting that certain drugs may lose some of their potency when combined.
Will combining drugs increase side effects? So far, studies on the polypill have not shown any increased side effect risk, but this remains a real concern, because it would be very difficult to isolate which drug is causing the problem. "If you develop a side effect from one of the five medications, the only thing you can do is stop all five at once," Dr. Cannon says. "So if you developed muscle aches from the statin, then you'd have to stop the blood pressure drug and the aspirin, along with the statin, to stop that side effect."
The polypill's most obvious application is in third-world countries, where it's currently being tested. A single-dose pill could be lifesaving for people who are able to see a doctor only once a year and who can't manage several drugs on their own.
In the United States, the most likely use for the polypill will be to improve compliance—ensuring more people take their medicine and get the intended results. Experts are also hopeful that polypills will save money. Dr. Cannon says the price of these pills still hasn't been established, but if they can reduce heart attacks and strokes, they could have a big impact on health care costs.
When might you expect to get a polypill prescription from your doctor? Possibly as early as a year or two from now, once researchers determine the correct doses, Dr. Cannon says.
Even if the polypill becomes available soon, you should still find ways to manage multiple medications. Ask your doctor if you can simplify your drug regimen by using longer-acting versions of your medications or changing the dose. Use a pillbox that you prefill every week, so you take the correct pills at the right time.
Doctors are cautious about prescribing combination pills, because it is difficult to sort out the individual benefits or side effects of each drug. Dr. Celeste Robb-Nicholson, Harvard Women's Health Watch editor in chief, explains how doctors typically prescribe existing combination pills: "The best way to use them is to first start a patient on the individual pills, to see how well they work and make sure there are no adverse effects. Then, if the person does well on these pills over a few months to a year, prescribing a polypill that combines the individual medications might make sense."