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COMBINED EFFECT
OF DRUGS
Dr S P Dhanya
Combined effect of drugs
Synergism Antagonism
+ =Effect of
drug A
Effect of
drug B
Effect of drug A+B
Additive synergism
+ =
1 1
2
Aspirin+
Paracetamol
+ <Effect of
drug A
Effect of
drug B
Effect of drug A+B
Supradditive synergism
+ =1 1
3
Cotrimoxazole
Only very small % reaches the
brain
Dopa
decarboxylase
Dopa
decarboxylase
Potentiation
+ >Effect of
drug A
Effect of
drug B
Effect of drug A+B
Antagonism
+ =Effect of
drug A
Effect of
drug B
No effect
D
r
u
g
a
n
t
a
g
o
n
i
s
m
Physical
Chemical
Physiological
Dispositional
Receptor
Physical antagonism
Activated charcoal and alkaloids
Chemical antagonism
Anatcids neutralize HCl
Physiological antagonism
Adrenaline 0.5ml of 1:1000-
******Anaphylaxis*****
Dispositional antagonisn
Affecting A D M E 
↓concentration at
target site
Digoxin(inotropic agent)
Decreased efficacy of digoxin
Rifampicin
Oral
contraceptive
Pills
For an acidic drug
(salicylate) poisoning
what should we do?
Receptor antagonism
Competitive Non-competitive
Receptor Interactions
Agonist Receptor
Agonist -Receptor
Complex
EFFECT
Receptor Interactions
Antagonist Receptor
Antagonist-Receptor
Complex
DENIED!
Atropine
NO
EFFECT
i) Competitive Antagonism
Competition between agonist &
antagonist for specific site or
receptor
Antagonism can be overcome
by  concentration of agonist
Surmontable antagonism
COMPETITIVE ANTAGONISM
Agonist - maximal response in higher concentration
Shifts to Log DRC to?
Which means?
Receptor Interactions
Antagonist Receptor
Antagonist-Receptor
Complex
ACh
Atropine
ACh
ACh
ACh
ACh
ACh
EFFECT
Competitive
antagonism
Morphine
Agonist Receptor
Antagonist
‘Inhibited’-Receptor
DENIED!
Non-competitive
Inhibition
iii) Non-competitive
(non-surmountable) Antagonism
Antagonist binds to allosteric
site of receptor
Unrelated to agonist
Bicuclline
Diazepam(agonist)
Flumazenil
Competitive
anatgonist
Non-Competitive
anatgonist
Non-competitive Antagonist
What is decreased?
DRC is flattened and maximum response is 
II) Irreversible Antagonist
Antagonist binds to receptor with
covalent bond-irreversible
Slow dissociation-pseudo-irreversibe
 max. response
COMPETITIVE NON COMPETITIVE
Surmountable Unsurmountable
Antagonist resembles
chemically with the agonist
Does not resemble
Bind with the same site Binds with another site
Maximum response
obtained by increasing the
dose
Maximum response
suppressed
Parallel rightward shift of
DRC
Flattening of DRC
Eg. Atropine on muscarinic
receptors
Eg. Bicuculine on
benzodiazepine receptors
Combined effect of drugs

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Combined effect of drugs