Key points on fixed-dose combination medicines

Prescribers are increasingly faced with a range of fixed-dose combination medicines (FDCs) as an option in place of individual components prescribed separately. Switching patients from individual medicines to fixed-dose combination medicines must be done judiciously taking the following into consideration:

Assess patient’s need

  • Evidence for improved adherence with combination medicines is strongest when the reduction in pill burden is greatest1,2
    Assess the level of complexity involved in a patient's medicine regimen before choosing fixed-dose combination therapy.
  • A large number of factors contribute to non-adherence3
    Do not choose fixed-dose combination therapy solely on the possibility of improved adherence, convenience or cost advantages of the preparation.
  • Will the benefits outweigh the risks?

Table 1. Benefits and risks of fixed-dose combination medicines



Decreased pill burden

Reduced cost

Being unable to adjust the doses of individual components in specific patients7,8

Misidentifying the causative medicine when the patient experiences side effects

Over- or under-dosing

Individualise therapy

  • It is best to start and stabilise patients on the individual components before starting the corresponding fixed-dose combination medicine9
    This facilitates adjustment of dose based on response and monitoring of adverse effects.
  • Be alert to unintended double- or under-dosing at the time of switching and discuss this with the patient
    show patients which medicines are being replaced by the combination medicine. Encourage them to use and maintain a Medicines List to keep track of the active ingredients as well as the brand names of their medicines.

Monitor response

  • Identify which component(s) in a fixed-dose combination are responsible for adverse effects if they occur
    Watch for signs and symptoms specific to individual components.
  • Patients taking fixed-dose combination medicines may be eligible for a Home Medicines Review
    Patients at risk of medicines-related problems are:
    • those taking five or more regular medicines
    • those taking more than 12 doses of medicine a day
    • those who have had a significant change to their medicine regimen in the past 3 months or who have symptoms of an adverse drug reaction.10

For more information

  1. Moulds RFW. Combination products – love them or loathe them? Aust Prescr 2001;24:127–9. [Full text]
  2. Llibre JM, Arribas JR, Domingo P, et al. Clinical implications of fixed-dose coformulations of antiretrovirals on the outcome of HIV-1 therapy. AIDS 2011;25:1683–90. [PubMed]
  3. Australian Government Department of Health and Ageing. Compliance Medicines Working Group Report to Pharmaceutical Benefits Advisory Committee. April 2010. [Online]  (accessed 11 December 2012).
  4. Simons LA, Ortiz M, Calcino G. Persistence with a single pill versus two pills of amlodipine and atorvastatin: the Australian experience, 2006–2010. Med J Aust 2011;195:134–7. [PubMed]
  5. Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension 2010;55:399–407. [PubMed]
  6. Bangalore S, Kamalakkannan G, Parkar S, et al. Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med 2007;120:713–9. [PubMed]
  7. Alphapharm Pty Limited. Glucovance. 2010. [Online] (accessed 9 October 2013).
  8. Merck Sharp & Dohme (Australia) Pty Limited. Juvicor Product Information. 2012. [Online] (accessed 28 February 2013).
  9. Gadzhanova S, Gillies M, Roughead E, et al. Fixed dose combination diabetes medicines - usage in the Australian veteran population. Aust Fam Physician 2011;40:811–5. [PubMed]
  10. Australian Government Department of Health and Ageing. Home Medicines Review (HMR). 20 August 2013. [Online] (accessed 9 October 2013).