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Irrational fixed-dose drug combinations: a sordid story of profits before patients

Chander Mohan Gulhati


Anyone with even an elementary knowledge of medicine knows that, ideally, drugs should be administered as single molecules based on the specific requirement of each patient. This enables the prescriber to select specific drugs in specific doses for specific durations. Only under exceptional circumstances are fixed dose combinations (FDCs) allowed. These are when (a) two or more drugs have a synergistic action, i.e. the combination acts to achieve a better therapeutic response than the individual drugs alone; (b) there is corrective action, and one drug acts to reduce the incidence and/or severity of adverse effects caused by the other; (c) two or more molecules are normally needed and taken by the patient concurrently – provided the dosage of each drug does not need to be individualised, or (d) prescribing two or more drugs separately could result in one of them not being ingested, and this would adversely affect the patient’s health.

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