Polypill

Last night I attended the launch of a poly-pill for the treatment of cardiovascular diseases. The talk was organized by Cadilla Pharmaceuticals at Satkar residency and the speaker was the eminent cardiologist Dr. Dayanand Kumbla.

Most of the patients require multi drug therapy for the control of various problems and they get fed up of popping in many pills in a day. The concept of a poly-pill is to put together many drugs in a single pill for convenience. That is an advantage but I personally have reservations. It is fine for a patient taking these drugs in that particular doses in a fixed combination, but may be incorrect for a generalized thoughtless prescription. It may put an additional burden on a physician to think correctly at the very short time available of writing down a prescription in a busy schedule.

This pill known as Polycap contains Symvastatin 20mg, Ramipril 5mg, Atenolol 50mg, HCTZ 12.5mg, Aspirin 100mg.

Here comes the problem for me and may be for a few fellow practitioners.

Though many studies have been published on symvastatin, it is atorvastatin that has mostly been in use over the past few years. Now rosuvastatin is gaining popularity and will be the future popular statin.

Ramipril is mostly used post episode, more for secondary prevention than for a primary prevention. Ramipril with HCTZ will be beneficial for hypertension control in this polypill.

Atenolol has had its good time and is on retirement. Other beta blockers are more favoured in practice. Due to the side effects of impotency and adverse lipids highlighted during the promotion of Atenolol as a first line treatment for young hypertensives, I never used it for HT control in young people and preferred the other molecules instead. Role of B-blockers post episode is non debatable. Hence use will be mostly for secondary prevention

Aspirin 100mg is fine, but should be used with close monitoring.

All the molecules being in a fixed dose, there is no scope for titration. In a busy schedule, a larger than required dose may go to some patients. When each drug is written separately, we can give a thought to each doses. Secondly, if many companies come out with this concept, there should be a standard drug list in each polypill, or else there will be a great strain on a prescribing physician to remember what drug and in what doses the various pills contain and probability of error increases.

The only positive thing is a convenience for the patient, but a great responsibility on the doctor, hence the use will be very restricted.

Well, only time will tell about the success of a Polypill.