What is Combination Therapy?

Combination therapy is a common practice in many medical disciplines. It is generally defined as the use of more than one drug agent to treat the same disease. Sometimes the term is also used to describe combining several therapies, particular cancer therapies like surgery and chemotherapy, to most effectively combat cancer.

Most medical practitioners feel that the least amount of medication should be used, and except for a few aggressive diseases like HIV, doctors may favor starting patients on one medication. However, even when dosing is adjusted, a single medication may not always achieve the desired results, and many drugs have maximum doses, which may be reached without creating the effects necessary.

The confusing thing is that a single medication can be partially effective, so it’s not necessarily a good idea to remove that medication and try something else. Instead, to get a more effective treatment, doctors add a medication to address the symptoms of disease that are not yet being controlled.

There are many common examples of when combination therapy is employed. A person with bipolar disorder for instance, may seldom achieve total management on a single medication. Doctors frequently combine mood stabilizers (lithium, carbamazepine, divalproex sodium, and lamotrigine) with an atypical antipsychotic medication such as Geodon®, Seroquel®, or Abilify®. Occasionally patients need two mood stabilizers in the first class in order to adequately manage mood swings, or they could have trouble sleeping or unresolved anxiety that is addressed by using a benzodiazepine. It’s often quite possible for those with this condition to take three or more medications.

Another example of combination therapy can be found in the treatment of asthma. Some people use a steroid based inhaler, but also retain their albuterol or short acting inhaler for asthma attacks. Additionally a patient could be prescribed allergy medicines or be put on an oral steroid to help reduce inflammation that may provoke the disease.

There are certain drawbacks to using combination therapy. Some medications used in combination create greater risk for side effects than they do separately. Medications like lithium used with carbamazepine increase risks for contracting Stevens-Johnson syndrome, a very serious skin disease. Though the condition may improve for those on combination therapy, excessive side effects from several drugs can make some people feel lousy.

With certain conditions there really is not choice but to combine therapies because a single drug is not effective enough. While this may improve health, some people will deal with double the side effects. On the other hand, improved health can also translate to feeling better and a number of people tolerate taking several medications without significantly increased side effects.

Certainly combination therapy runs the risk of potentially dangerous drug interactions. This is why doctors should always ask what patients are taking, including any over the counter drugs or herbal preparations. When a patient can’t or doesn’t volunteer this information, a doctor may unknowingly prescribe something that shouldn’t be taken in combination with current medicines. Doctors have to know what they do when they start combining meds, and significant attention must be paid to the issue of combining newer medications which may have unknown interactions with those presently taken. It’s therefore a very nuanced therapy in many of its applications, particularly as more medications are combined together.