Ask The Expert
Medications

First of all, let me explain these pills:

• Avandamet is a combination of Avandia® (a thiazolidinedione) and Metformin.
• Avandaryl™ is a combination of Avandia® plus Amaryl® (a sulfonylurea)
• Actoplus met™ is a combination of Actos® plus Metformin.
• Duetact™ is a combination of Actos® plus Amaryl®.
• Glucovance® is a combination of Glucophage® and Glyburide® (a sulfonylurea).
• Metaglip™ is a combination of Metformin and Glipizide® (a sulfonylurea).

Why combination pills?

As stated in Clinical Diabetes, volume 21, #4, 2003, a primary motive for developing combination pills was economic-it enabled the manufacturer to extend the patent life and profitability of the oral agent because the patent protection was due to expire, and it created a new market for a combination agent that would be more effective than any single type of oral agent.

As explained in other answers, because type 2 diabetes is a progressive disease with multiple defects, it is common that most people may eventually require more than one category of diabetes medication. Studies show that when needed, combining 2 or more diabetes pills with different mechanisms of action can be very effective due to the complementary and additive effect of these combinations.

Misconceptions

While it is common to require 2 or more types of oral agents, this is not always the case.

• Best choice? Some physicians were under the misimpression that these combinations were "better" or the "best choice" for type 2 diabetes. While this may apply in some cases, it is not always true.
  • For example, some people have experienced unnecessary hypoglycemia due to the sulfonylurea component in the combination pill, when perhaps they only needed the Metformin component. So in this situation, the combination pill was certainly "stronger but not necessarily the best choice for that person.
• More expensive? Because these combination drugs were newer and were not available in generic form, they were perceived as being more expensive than if each drug were given separately. But actually, this is not always the case as you will read below.

Benefits

Simplifies your regimen: In general, surveys reveal that as people are required to take more medication, their adherence rate deteriorates - i.e. they forget to take all their pills and/or take them at the wrong time. Since many people also take medication for high blood pressure and lipids, the rationale is that reducing the number of pills you take might make you more likely to comply with your prescribed regimen.

Reduces your costs if using copayments: In some cases, you might have a separate co-pay for each individual drug, while you would have only one co-pay with a combination drug. In other cases, your co-pay might be higher for the combination drug but generally, according to the Clinical Diabetes article, it would not be more than the combined co-pays of each individual drug.

So while combination pills might be right for you, always be sure to discuss all your medications, side effects, safety precautions, and possible interactions with your physician.