Drug–drug combinations revisited

The use of fixed-dose combinations (FDCs) in the daily practice of pharmacotherapy is increasing after years in the shadows. The main reasons for this renewed popularity are the increasing number of drugs prescribed per patient and the complexity of current pharmacotherapy. A lack of efficacy of current monotherapies in many diseases together with advances in knowledge on pathophysiological disease mechanisms have also created a push towards development of new FDCs. For the regulatory authorities in Europe, however, it is unclear whether FDCs in general have a positive benefit–risk balance. Hence, more research is needed to show that use of FDCs improves treatment effectiveness through better compliance, adherence and quality of life for patients, which may lead to a positive pharmacoeconomical benefit for society. Evidence-based data are thus needed, especially for those patient groups requiring multiple drugs—for example, the elderly. In this context, hospital practice regarding FDCs is crucial, as the recommended pharmacotherapy at discharge of the patient serves as a role model for outpatient care, and therefore needs greater recognition. The benefit–risk balance and pharmacoeconomical consequences of FDCs should also be a subject for attention in the hospital pharmacy setting.