Prescription drugs combination therapies

These findings precipitated the widespread use of a fenfluramine-phentermine combination therapy that came to be known as Fen-Phen. The combined use of the two anorexigens had never been approved by the FDA, nor had the longterm safety of the therapy ever been established. Nevertheless, weight loss clinics specializing in Fen-Phen therapy were established throughout the country. In 1996, the FDA narrowly approved the more potent, less adverse-effect-prone (+)stereoisomer of fenfluramine, dexfenfluramine, for less-than-l-yr use in the treatment of obesity. The New York Times reported that in 1996, 18 million prescriptions had been written for fenfluramine alone or in combination with phentermine and that about 6 million Americans took the drug (37). 

Essential hypertension is a symptom of modem society, and its treatment accounts for a sizeable portion of global prescriptions. As a result, there is a great interest in reported ethnic and racial differences reported in the literature. The use of appropriate therapy in Black patients has been best studied. As monotherapy, calcium channel blockers and diuretics appear to be most effective in Blacks, whereas P-blockers and ACE inhibitors produce smaller reductions in blood pressure (Kiowiski et al, 1985 Freis, 1986 Hall, 1990). However, this may more reflect the lower plasma renin, salt and water retention and intercellular sodium and calcium in Blacks, compared to other groups (Kiowiski et al., 1988). There are individual exceptions amongst patients and among drugs, even within these classes for example labetalol, a combined a-blockers and P-blockers, can be equally effective in both African-Americans and Caucasians and, as mentioned previously, the Chinese appear twice as sensitive to propranolol as Caucasians (Oster etal., 1987 Zhou etal., 1990). 

---