When Are Two Pills Better Than One?

You’ve almost certainly seen marketing for medications that combine two different kinds of medicine into one tablet or pill. A common example is over-the-counter cold medication that combines a fever reducer with a decongestant, which can be argued makes sense. If you have both a fever and a stuffy nose, you can see the logic. It’s convenient and it may be cheaper to buy a single product that combines two medications than buying the two medications separately.

But how often does that make sense? For example, it’s pretty easy to find over-the-counter medications like Advil (ibuprofen) and Tylenol (acetaminophin) at very low prices. But GlaxoSmithKline (GSK) is selling a product that combines both these medications into a single pill under it’s Advil brand name. We recently found it at Walmart, where you can get 144 coated caplets made with 125 mg of ibuprofen and 250 mg of acetominophen each for $17.98, which is about $0.125 per pill.

What would we need to do to duplicate that dosage with separate ibuprofen and acetaminophen pills to find that cost? We found we couldn’t find the specific amount of each medication in a single pill, but what if we had a precision pill cutter? What would it take to divide up the pills to get these specific dosage amounts?

Starting with the 100 coated caplets with 200mg of Advil-branded ibuprofen we can get at Walmart for $9.98, we could divvy up the caplets and remake them to have 125 mg of ibuprofen each and have the equivalent of 160 pills that would cost a little under $0.062 each.

We can do something similar with the containers of regular strength Tylenol with 100 tablets of 325 mg acetaminophen that we can also buy at Walmart for $6.97. Pulling out our precision pill cutter again to remake these tablets into pills with a dose of 200 mg acetaminophen each, we would have 162-and-a-half pills, each costing a little under $0.043.

The cost for our equivalent pills of 125 mg of ibuprofen and 200 mg of acetaminophen works out be about $0.105 when buying each medication separately. That’s 16% lower than the $0.125 per pill cost of the “dual action” pills that GSK markets. This is also using the brand-name version of these medications. We could almost certainly get the cost even lower by switching to generic sources. But it also means that at a minimum, GSK is pocketing an extra two cents a pill according this math!

Let’s keep in mind there’s nothing special about the dual action pill that either makes it work better or easier to take than the single-action pills. That point is driven home by Dr. Josh Bloom of the American Council on Science and Health, who gives a bit of history and describes what studies say about how effective the medication is:

In 2020, Glaxo-SmithKline received FDA approval to sell Advil Dual Action, a combination of ibuprofen and acetaminophen in one pill containing 125 mg of ibuprofen (1) and 250 mg of acetaminophen. The directions tell you to take two caplets every eight hours (no more than six per day), making the combined daily dose 750 mg of ibuprofen and 1,500 mg of acetaminophen. In a press release, GSK writes: [my emphasis]

The submission in support of today’s approval of Advil Dual Action was based on data from seven clinical studies, three of which were pivotal efficacy and safety studies in pain relief. The data supports a pain relief indication and demonstrates that the fixed-dose combination achieves superior efficacy compared to the individual monocomponents of ibuprofen (250mg) and acetaminophen (500mg) alone (as evidenced by appreciable improvements in acute pain symptoms across multiple pre-specified endpoints).

Sleaze alert!

GSK probably doesn’t want you to read or understand the paragraph above. Why? Because the company isn’t comparing the efficacy of Advil Dual Action to a combination of ibuprofen and acetaminophen pills taken together. The key word here is “alone.” When taken together, there is good evidence that the two drugs work better than either alone.

Ibuprofen plus paracetamol combinations provided better analgesia than either drug alone (at the same dose), with a smaller chance of needing additional analgesia over about eight hours, and with a smaller chance of experiencing an adverse event.

Derry, et. al, Cochrane Library 24 June 20 https://doi.org/10.1002/14651858.CD010210.pub2

However, the company does not compare the combination of the two drugs to its product; it just compares its product to both alone. Will the same doses of the two separate pills together work as well? Bet the house on it.

A two-cent a pill savings may not sound like much. For you, every time you buy 50 of the dual action pills instead of the single-action versions, it’s an extra dollar out of your pocket without much of any additional benefit. Multiply you by millions of others like you who might buy these dual action pills, and you’ll find its very big money for GSK.

Unless the convenience is worth the extra price you’re paying, odds are this is a case where two pills are better than one.

Image credit: Microsoft Copilot Designer. Prompt: “A pill cutter splitting one pill into two pills.”