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Heartbeat: Fixed dose combination drugs for hypertension
  1. Antonio Luiz Ribeiro1,
  2. Catherine M Otto2
  1. 1 Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  2. 2 Division of Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto{at}

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Fixed dose combination (FDC) drugs are standard practice in the treatment of infectious diseases, but their role in chronic non-communicable diseases is unclear. FDC anti-hypertensive drugs are an attractive option to improve compliance by reducing the number of pills taken daily, particularly in elderly patients who generally require more than one drug to control blood pressure and often are on multiple other medications. However, there are concerns that FDC antihypertensives might increase the risk of medication errors, specifically therapeutic duplications resulting in potentially serious drug-drug interactions, compared with prescribing each component of the FDC separately.

In order to answer this question, Moriarty and colleagues1 retrospectively evaluated all primary healthcare prescriptions in Ireland for the 2015 year, using the Primary Care Reimbursement Services administrative pharmacy claims database. The primary outcome was therapeutic duplication, defined as the use of an anti-hypertensive drug of the same class in an FDC preparation and as a separate drug, prescribed at the same time. The secondary outcome was the presence of a potentially serious drug-drug interaction involving a component of an included antihypertensive FDC and another co-prescribed medication. From 307,833 FDC prescriptions and 1 51 632 separate component prescriptions for anti-hypertensive agents, therapeutic duplication was twice as likely with a FDC but still occurred in only 0.8% of patients, most often involving calcium channel blockers. The risk of a drug-drug interaction between medications prescribed a the same time (most …

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