PEBC Theme of the Week: Long-Acting + Short-Acting Combos
Have you ever seen two formulations of the same medication prescribed for a patient? Doctors can fine tune medication action by prescribing a combination of long-acting and short-acting formulations.
Here are some examples to think about!
1) Intensive Insulin Regimens: Glucose levels are constantly fluctuating according to daily activities including eating, sleep and exercise. Intensive insulin regimens combine long-acting basal insulins (ex. Lantus) which work at the background throughout the day, with short-acting insulins (ex. Humalog) for mealtime glucose spikes.
2) Bronchodilators: For COPD, the long-acting agent (ex. tiotropium) provides bronchodilation for roughly 24 hours, whereas the short-acting agent (ex. salbutamol) provides instant relief of breathlessness.
3) Antipsychotics: Extended-release (XR) and immediate-release (IR) quetiapine can be combined for some patients who feel more symptoms at certain points of the day than others.
4) Parkinson’s Disease: Use of controlled-release (CR) and immediate-release (IR) levodopa-carbidopa can lead to better control of motor movements, balancing dyskinesia and wearing off phenomenon.
5) Opioids: Patients do not like to take many pills to achieve pain relief. Patients can take less pills with the CR version and manage their breakthrough pain successfully with the IR version.
6) Attention Deficit Hyperactivity Disorder: one disadvantage of long-acting stimulants is wearing off during the evening because of their duration of action (at best 12 to 16 hours). For this reason, patients are given an immediate-release stimulant (dextroamphetamine, methylphenidate) to take in the afternoon/evening to help with activities, while minimizing insomnia.