Combination therapy is the opposite of monotherapy and refers to a course of treatment that includes several different therapeutic options or agents at the same time, in order to be able to combat several factors of a disease.

Especially for the treatment of HIV patients, combination therapy plays a role, in which case a highly active, antiretroviral therapy is mentioned, which stops the multiplication of the virus, so that the progression of the disease prevents or at least kidnapped and thus the life of the Patients can extend. Combination therapies are usually associated with a much higher rate of side effects than monotherapies, with each agent being precisely tested for their interactions and general compatibility in advance.

What is the combination therapy?

Combination therapy is a treatment that simultaneously follows more than one therapeutic principle. These are usually drug treatments that focus on more than one drug.

Medicine understands the combination therapy as a treatment that simultaneously follows more than one therapeutic principle. These are usually drug treatments that focus on more than one drug. This type of drug delivery can involve two different drugs or a combination drug that carries more than one drug.

The opposite of such a treatment is called monotherapy and is limited to an active ingredient. Combination therapies can be differentiated into several subforms. The best known are triple and quadruple therapy. While three drugs are used in triple therapy, quadruple therapy also includes four drugs. For the first group, the Helicobacter pylori eradication for the most complete elimination of the Helicobacter bacterium is one of the best known examples.

In addition, the life-prolonging HIV therapy is sometimes a triple and sometimes even a quadruple therapy. The greatest advantage of any combination therapy is the simultaneous effect on various disease parameters. On the other hand, the biggest disadvantage compared to monotherapy is the mostly high side effects of the treatment.

Function, effect & goals

Combination therapy can simultaneously positively influence several factors of a disease. Which drugs can be combined in the course of such a measure, decides the particular disease, but also the change and side effects of each drug are important here.

Combination therapy plays an important role in the treatment of HIV patients in current medicine. The most effective form of treatment in the fight against the HIV virus currently corresponds to a highly active antiretroviral therapy, which is based on at least three different drugs. All three drugs contain antiretroviral, ie viral blocking agents. Normally, two nucleoside reverse transcriptase inhibitors are used and combined with a non-nucleoside reverse transcriptase inhibitor or protease inhibitors.

Often the effectiveness of the latter is additionally raised by a boost. This combination can limit the growth of the virus so much that HIV can no longer be directly detected and the life of the patient can be prolonged by a permanent, albeit not always complete, recovery of immune functions. Many typical symptoms of HIV decline in the course of therapy and the risk of progression of the disease is minimized.

Similar to this combination therapy, three different drugs are also used in helicobacter pyori eradication. Amoxicillin is usually combined with clarithromycin and proton pump inhibitors in the course of this measure, but the combination of amoxicillin, metronidazole and proton pump inhibitors is also conceivable. A third route is the concomitant administration of metronidazole, clarithromycin and proton pump inhibitors. In addition to these combination therapies, for example, epilepsy, blood pressure disorders or type II diabetes are often resorting to combination therapies.

However, combination therapies may also be useful for diseases such as hepatitis C, ADHD, cardiac arrhythmia and complex tumors. In general, the principle applies: the more complex and versatile the disease, the more useful a form of therapy with multiple active substances, since complex diseases usually contain many different factors that can be countered by a single active ingredient usually insufficient.

Risks, side effects & dangers

Each combination therapy can only be carried out with careful attention to drug interactions. In addition, combination therapies often have significantly higher side effects than monotherapy. Therefore, the attending physician must determine in advance the relationship of benefit and risk for the individual case with the patient.

In triple therapy for HIV sufferers, for example, the benefits are generally much higher than the risks. Most patients tolerate the therapy method that has been in place since 1996 very well over many years. Nevertheless, side effects such as bloating, vomiting or diarrhea may occur for this treatment. There may also be a slight increase in liver function as some of the drugs have inherited liver toxicity, but in very rare cases they actually cause liver damage.

Also, kidney dysfunction is conceivable and neuropathies, sleep disorders and nightmares may occur in the course of treatment. Allergies and fat distribution disorders are among the most common side effects. Of course, the list of these side effects can not be applied to combination therapies to other diseases that involve completely different drugs and thus effects on the body.

The enumeration is therefore intended merely to illustrate generally increased side effects in combination therapies. Especially when a combination therapy is used over a longer period of time, patients often develop resistance to one of the active ingredients used. Therefore, research is constantly being conducted into the search for other active ingredients for each combination therapeutic pathway, which can be combined without risk.

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