What do a Swiss Army knife, Pantene Pro-V Full & Thick 2-in-1 Shampoo+Conditioner, and Glucovance have in common?
They're all combination products, designed to save you time, money, or both. Drug companies are introducing more combo medications -- two drugs in one pill -- to take advantage of patent expirations and competition from generics. Glucovance is a combination of glyburide and metformin, two medications that help people with type 2 control blood glucose.
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Most combination pills deliver just two different types of medicine. Usually the two meds work together to treat one disease in different ways. Some pills contain two drugs to treat conditions that commonly occur together, such as high blood pressure and high cholesterol.
Actoplus Met: Combines Actos and metformin
Avandamet: Combines Avandia and metformin
Avandaryl: Combines Avandia and glimepiride
Duetact: Combines Actos and glimepiride
Glucovance: Combines glyburide and metformin
Janumet: Combines Januvia and metformin
Metaglip: Combines glipizide and metformin
PrandiMet: Combines Prandin and metformin
Combination diabetes drugs can encourage people to take medications as prescribed -- and can save them money, says Shannon Miller, a professor of pharmacy practice at Albany College of Pharmacy in New York. Typically, insurance companies charge a copay for each prescription received. Combination pills require just one copay, even though you're getting two medications, she says.
For Jack (last name withheld to protect privacy), who has type 2 diabetes, switching to combination drugs to control blood glucose, high blood pressure, and high cholesterol cut his number of daily pills from 11 to seven. He saves $40 a month on copays, for an annual savings of $480.
Although costs vary based on specific medications and health-plan coverage, the savings can be significant. A 2003 article in the journal Clinical Diabetes compared costs for 30 doses of five combination diabetes medications at four pharmacies in Columbus, Georgia, and two online pharmacies. Most combinations cost the same or less than the retail price of the drugs when sold individually (brand name or generic), the report says.
"The use of the two combination pills metformin/glyburide and metformin/rosiglitazone would save more than $50 per month compared with taking the same doses of medications purchased individually," the article says. Some diabetes combination medications are available in generic forms, but there is little cost difference between the combination generics and the two medications as individual generics.
Convenience and cost are great reasons to switch to a combination pill, but there may be some drawbacks. Most combination pills have only a few options for doses, which can make it difficult for your physician to adjust your doses.
Robert Busch, M.D., an endocrinologist in Albany, New York, says most combination drugs are OK, but he seldom prescribes the ones that include sulfonylureas. "You can't taper one [medication] without the other," he says. If your doctor changes the dose of one of the drugs, you may have to switch back to two pills if the new dose combination is not available as a single pill.
Only you and your doctor can decide if a combination pill is right for you. First ask your pharmacist if there is a pill that combines your current drugs and doses and to see if it's on your insurance formulary. If one is available, ask your doctor about it. To switch to a combo pill, you will need a new prescription. Combination pills are not for everyone. But if they're an option for you, it can mean easier prescription management.
Marty Irons, a member of Diabetic Living's editorial advisory board, practices pharmacy in Vermont.
Alexis King is a clinical pharmacist with the University of Virginia Health System.