Pill burden

Pill burden is a term that refers to the number of tablets, capsules or other dosage forms that a patient takes on a regular schedule.

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Higher pill burden decreases compliance with drug therapy, due to the need to take a large quantity of pills on a regular basis. It also increases the possibility of adverse medication reactions ("side effects") and drug-drug interactions due to polypharmacy. High pill burden has also been associated with increased risk of hospitalization, medication errors, and increased costs both for the pharmaceuticals involved and for the treatment of adverse events. Finally, it is source of dissatisfaction to many patients.

High pill burden is commonly associated with antiretroviral drug regimens to control HIV, but can be seen in other patient populations. For instance, an adult with multiple chronic conditions such as diabetes, hypertension, hypercholesterolemia, osteoporosis, constipation and clinical depression can often be prescribed more than a dozen different medications daily. Because chronic conditions tend to accumulate in the elderly, pill burden is a particular issue in geriatrics.

Methods to reduce pill burden

Reducing pill burden is recognized as a way to improve medication compliance. Common approaches to reducing pill burden may include selecting fixed dose combination drug products, products with long-acting active ingredients, and sustained release/extended release formulations when appropriate.

Some combinations of drugs may be available in certain strengths as a single pill, called a fixed dose combination. One notable example of a fixed dose combination drug product is the antiretroviral drug product Atripla, which combines 3 drugs (efavirenz + emtricitabine + tenofovir) into one pill.

The selection of long-acting active ingredients over short-acting ones may also reduce pill burden. For instance, ACE inhibitors are used in the management of hypertension. Both captopril and lisinopril are examples of ACE inhibitors. However, lisinopril is dosed once a day, whereas captopril may be dosed 2-3 times a day. Assuming that there are no contraindications or potential for drug interactions, using lisinopril instead of captopril may be an appropriate way to limit pill burden.

Similarly, sustained release/extended release drug formulations reduce pill burden by reducing the dosing frequency. The same active ingredient is present in both the immediate-release form and the sustained release form.