The combined effect of drugs

Currently, Despite the considerable progress of Pharmacology and Clinical Pharmacology, especially, and the emergence of a new discipline - clinical pharmacy, there is still no single explanation widely used in medical practice, the concepts of "combination drug" and "the combined effect of drugs".

The term "combination drug" comes from the Latin combinatio, that is - a combination of, compound in a specific order.

In the pharmaceutical technology to combine drugs usually carry complex compositions, submitted by drug agents and auxiliaries with different physico-chemical properties, able to form various disperse systems. The main purpose of such combinations is to get a more stable dosage system with satisfactory technological, biological and consumer characteristics. This is achieved by increasing the solubility or miscibility of ingredients, viscosity changes of the system, selection of optimum composition of excipients or type of dosage form, improve the taste or smell of medicine, address its irritant action on fabric or discomfort (pain) when used, increase duration etc. d.

In medical practice to combined medicines include formulations, which includes medicinal substances, for the most part with different mechanism of influence on some etiological factors of disease, the main links of pathogenesis, one of the symptoms of the disease or the various clinical manifestations.

Have a right to exist both in the approach to the definition of "combined medication», because they are based on the principle of improving its quality, strengthen or expand specific actions at different stages of pathogenetic chain disease, that ultimately reflects the qualitative result of drug therapy — efficiency.

"The combined effect of medicines" understand introduction to the body as a combination drug (complex composition), and the simultaneous introduction of a few simple (containing one active substance) drugs or their use for each other against the backdrop of previous drug.

Consistent application of drugs in a particular time interval requires a well-considered theoretical studies with subsequent analysis and study of their possible interactions.

Примером современных комбинированных лекарственных препаратов для лечения различных простудных заболеваний могут служить «Колдрекс», «Pafein», «Фервекс» и другие аналогичные лекарственные системы. Their compositions are chosen on the basis of sound scientific experiment and optimum efficiency of treatment of such clinical manifestations, as a general weakness, fever, headache, cold, cough, shortness of breath due to blockage of the nasal passages.

Since the pathogenesis viral respiratory infections is a complex integrated process, then the drug should have several medicinal effects. In other words, in a combined product should be composed of substances, operating in various parts of pathogenetic chain and address the underlying symptoms of colds. So, the composition of the tablets "Coldrex includes:

• paracetamol (It has analgesic and antipyretic action);
• phenylephrine hydrochloride (acts on α₁-adrenoreceptory, causes vasoconstriction of the mucous membranes of the spit, helping to relieve edema, Remove rinorei and normalization of nasal breathing);
• caffeine (has a tonic effect, improves well-being, and it also has weak analgesic, potenziruet the paracetamol);
• terpin hydrate (It has anti-inflammatory action, contributes to the decomposition of secret bronchi, releases from the blockage of the airway, eases breathing);
• vitamin C
  (activates the immune system, normalizes capillary permeability, reducing the intensity of lipid peroxidation).

Multiple schema scientifically composition combined medicines for external use can be illustrated by example "Levosina", designed for the treatment of infected wounds.

On the basis of the pathogenesis of the course of the wound process, When the wound is characterized by the presence of dead tissue, microbial contamination, inflammatory process, ointment should possess antimicrobial, anti-inflammatory, nekrolitičeskim (If necessary, and anesthetic) action, have high ro activity. In ointments "Levosin" all the components in a directional impact on various factors of the pathogenesis of the first phase of the wound:

• chloramphenicol provides a wide range of antimicrobial action practically against all aerobic pathogens purulent infection;
• sulfadimetoksin provides antimicrpobial effect against Staphylococcus gnoerodnyh, some strains of Proteus, dysenteric bacteria, intestinal sticks and blue-green pus;
• trimekain provides quick anesthetic vffekt;
• methyluracil protects the tissue cells from the damaging effects of substances, and normalizes metabolic processes in tissues, has a positive effect on the wound-healing processes;
• poliètilenoksidy determine the dehydrating and osmotic action, reduce the biological activity and stability of microbial cells to drug substances, increase the activity and extend the range of antiseptics, transport them deep into tissues, where are microbes.

The advantages of "Levosina" can be attributed to property samosterilizacii, as well as the ability to "mothball" the wounds, that allows you to defer processing until surgery 24-48 hours.

The ointments of combined effects could include "Levomekol′", «Iruksol», «Nitacid», «Gioksizon», «Streptonitol», «Miramistin», «Èfkamon», sulphur-Salicylic and many others.

The trend towards the use of combined drugs is increasing all the time and explains the limited effectiveness of monotherapy, as well as the following strategic objectives of modern drug therapy:

• get higher collateral or synergistic effect;
• lower side undesirable effects (one of the components of the composition may reduce some of the metabolic disturbances, due to another component;
• reducing the content of active substances in the product;
• expand the scope of use of combined drugs, whom- that are more effective, easy-to-use, and also have a lower cost compared to the cost of a few simple medicines.