A polypill or single pill combination (SPC) is a type of drug combination consisting of a single drug product in pill form (i.e., tablet or capsule) that combines multiple active pharmaceutical ingredients. The prefix "poly" means "multiple", referring to the multiplicity of distinct drugs in a given "pill". Precisely, a polypill contains at least 4 ingredients (fixed-dose combinations of 2 or 3 drugs are not polypills). A synonym is combopill. Polypills commonly target treatment or prevention of chronic conditions. Polypills may be consumed by healthy people as a preventive medicine, and/or treating actual pathophysiological condition(s), the former typically involving lower dosages than the latter. Polypills reduce the number of tablets or capsules (generally orally administered), which in turn facilitates handling and administration of pharmaceuticals as well as easing the burden of managing multiple pills. The drugs in a given polypill are typically aimed at a single underlying condition (or group of related conditions). The term polypill was coined in the context of cardiovascular disease prevention, but gained broader acceptance, including for combinatorial drug products that predated the term. Polypills can be custom-made for specific patients by a compounding pharmacy. Physicians in most jurisdictions have wide discretion to prescribe customized products containing unique drug-dosage combinations (and/or formulations thereof) specifically for individual patients.
For treatment or management of disease Polypills are a useful therapeutic tool for those afflicted with various diseases/conditions, by consolidating multiple medications into a single product and thereby simplifying medication administration for healthcare personnel as well as alleviating pill-burden for patients. HIV, mental-health, transplant, and certain other patient groups are known for especially high pill-burdens (whether temporary or indefinite). Also, elderly patients in particular are likely to require several medications on a daily basis for managing multiple conditions, and they are also particularly susceptible to difficulties remembering or keeping track of their regimen.
Origin of multi-drug pill usage Combinatorial drug products were proposed for treating diagnosed conditions long before they were proposed for preventive medicine, including "aspolol" (a combination of aspirin and atenolol) for those diagnosed with cardiovascular disease. Fixed-dose combination (FDC) products today are also common for treating other diseases, such as tuberculosis and HIV/AIDS.
Developments in polypill usage for disease therapy
Treating cardiovascular disease One of the first recommended roles of a polypill was as a means of providing recommended medications to people with heart disease, stroke and other forms of cardiovascular disease. Most cardiovascular disease patients do not receive recommended medications long-term: the proportion of cardiovascular disease patients not receiving a statin, aspirin and blood pressure lowering medication long-term ranges from about 50% in high income countries to over 90% in low income countries. In 2001, a World Health Organization and The Wellcome Trust meeting of experts to discuss interventions for non-communicable diseases noted “the use of a single pill could well encourage patients to adhere to treatment as well as seriously reduce the cost of the drugs” A programme of research was outlined, including stability and bio-availability testing followed by assessment of short-term effects on blood pressure, cholesterol, platelet aggregation, safety and side effects. In 2002, the World Health Organization Annual Report outlined the substantial potential public health impact and cost-effectiveness of scaling up access to combination cardiovascular treatment and an editorial in The Lancet noted that a four component combination pill would reduce cardiovascular risk by about 75% among people with vascular disease.
Treating diabetes and metabolic syndrome Polypills have been proposed for managing diabetes (and potentially for pre-diabetes). Diabetes - particularly Type II diabetes - is a major cause of morbidity and mortality. Diabetes also contributes substantially to cardiovascular risk, yet some ingredients appropriate for a cardiovascular polypill may not be advisable for patients with diabetes (such as beta-blockers and thiazide diuretics). A polypill for diabetes could include a statin (to reduce LDL cholesterol and for their anti-inflammatory properties), an ACE inhibitor (for blood pressure control and to protect the kidneys), aspirin (for antiplatelet and anti-inflammatory properties), and metformin (a medication for diabetes that is also associated with weight loss).
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