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Co-formulating pharmacologic enhancers?
Mar 27, 2000

Dear doctors,

I've read of combinations of 2-3 nucleosides in a single

tablet, combivir and trizivir. I was then wondering, if it

made sense to combine chemicals known to enhance the action

of nucleosides with the pertinent nucleoside, so you might have hydroxyurea/DDI, resvastrerol(sp?)/DDI or mycophenylate/ABC in one pill? Do these enhancers have troublesome interactions with other retrovirals, or are medicines like these being currently looked at?

Intuitively it would feel as if having fewer different kinds of pills would make adhering to regimens easier. A "nucleoside" pill like resvastrerol/DDI/FTC and EFV would sound like a potent, easy once-daily regimen in just two pill bottles, and both nucleosides would be "boosted".

Cheers, and keep up the very interesting forum!

Response from Dr. Cohen

You are absolutely right, co-formulating can really make things easier for patients to stick with regimens and avoids errors. There is a lot of interest in this but here are some of the limitations.

Business. If different companies make the drug, it is unlikely that agreements will be reached for co-formulating. Why no "Zerivir" i.e. D4T and 3TC, since these are prescribed together more often than any other pair.

Safety. The combination at fixed dose has to be carefully studied and this is often not the case. Also, if one of the drugs is often dose adjusted, this is a problem.

Lack of data. Mycophenolate -- abacavir research for instance is in its infancy.

Pharmacology. You have to prove to the FDA that the two drugs together are equivalent. You have to be able to make a pill that is smaller than your head.

All of these are barriers, but not reasons not to go after these approaches.

Thanks



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