Effective medication management is a complex problem with many variables. To optimize patients' medications successfully, it is essential for healthcare providers to gain a comprehensive understanding of the whole picture and personalize prescribing.
According to the CDC, adverse drug events cause 1.5 million annual emergency department visits and almost 500,000 patient hospitalizations (1).
Responsible for 100,000 annual deaths, adverse drug events are the 4th leading cause of death in the United States (2).
The majority of these incidents could be prevented by proper medication management and personalized prescribing.
In order to effectively personalize prescribing for a patient’s unique situation, there are some key factors to consider.
#1 - Pharmacogenetics
Pharmacogenetics is the study of how an individual’s genes influence their body’s response to medications. Just like genetics determine unique physical traits like hair and eye color, they also impact how the body processes medications.
People can metabolize medications at different rates, from slower than average (poor metabolizers) to faster than average (rapid metabolizers). Pharmacogenetic (PGx) testing identifies these variations by analyzing specific genes (3).
It is estimated that more than 90% of the population carries at least one actionable genetic variant affecting drug metabolism (4).
The PREPARE (Pharmacogenomic Testing for Preventing Adverse Drug Reactions) study conducted across seven European countries found a 30% reduction in clinically relevant adverse drug reactions when pharmacogenetic-guided prescribing was implemented (5).
By personalizing medication choices to a patient's unique genetic profile through PGx testing, healthcare providers can optimize treatment and improve outcomes.
#2 - Drug Interactions
Drug interactions occur when medications, foods, beverages, or supplements combine to cause unexpected and potentially harmful side effects. These interactions can enhance or weaken a drug's intended effect, leading to adverse reactions, toxicity, or treatment failure (6).
To prevent harmful interactions, it's essential to provide a complete list of all prescription and over-the-counter medications, vitamins, and supplements to healthcare providers. Drug interaction checkers may be a helpful tool to identify potential interactions.
#3 - Phenoconversion
Phenoconversion, or metabolic inhibition and induction, occurs when external factors such as medications or food influence an individual's normal drug metabolism. While pharmacogenetic testing may indicate a person is a normal metabolizer for a specific enzyme, the introduction of certain substances can cause that enzyme to function abnormally.
This phenomenon, commonly referred to as a drug-drug-gene interaction, can temporarily alter a person’s response to a medication and impact medication efficacy and safety (7).
In a recent study assessing psychiatric patients, 42% of those with medication data experienced phenoconversion (8).
By identifying potential instances of phenoconversion, healthcare providers can optimize drug therapy and ensure medications work as intended.
#4 - Duplicate Therapy
Duplicate therapy occurs when two or more medications are prescribed to a patient for the same therapeutic intent.
Identifying and addressing these overlaps can help prevent adverse reactions and optimize treatment outcomes.
#5 - Base Drug Risk
Each medication has an inherent safety profile that represents the drug’s base drug risk. Careful consideration of these risks is essential when prescribing medications.
#6 - Anticholinergic Burden
Also known as ACB, the additive effect of a patient’s exposure to multiple medications, doses and duration of therapy can potentially produce negative and unintended outcomes.
#7 - Comorbidities
Comorbidities, or the presence of multiple medical conditions, can influence medication selection and effectiveness.
#8 - Demographic and Lifestyle Factors
A patient’s unique characteristics such as age, weight, diet and habits can all impact how medications work in their body.
It is important to evaluate these factors, and how they may influence the patient’s existing regimen when optimizing medications.
#9 - Medication Adherence
Medication adherence, or taking medication as prescribed, is crucial for optimal treatment outcomes. Open communication between patients and providers is essential to ensure medications are being used correctly.
An accurate and up-to-date medication list, including dosages and administration times, is fundamental to effective medication management.
Conclusion - How to Optimize Medication Management
By considering a comprehensive range of factors, including pharmacogenetics, drug interactions, and patient-specific characteristics, healthcare providers can gain a holistic understanding of a patient's medication regimen and personalize their medication management.
A collaborative partnership between patients and providers is essential for successful medication management. Open communication, adherence to prescribed regimens, and the use of available tools can help minimize adverse drug events and maximize therapeutic benefits.
By adopting a comprehensive and personalized approach to medication management, healthcare providers can optimize treatment plans, reduce adverse drug reactions, and ultimately improve patient outcomes.
References
Accessed July 11, 2024. https://www.fda.gov/drugs/drug-interactions-labeling/preventable-adverse-drug-reactions-focus-drug-interactions#:~:text=If%20these%20estimates%20are%20correct,%2C%20accidents%2C%20and%20automobile%20deaths.
Accessed August 1, 2024. https://www.cdc.gov/genomics-and-health/about/pharmacogenetics.html
Accessed July 25, 2024. https://ascpt.onlinelibrary.wiley.com/doi/10.1038/clpt.2013.229
Accessed July 31, 2024. https://pubmed.ncbi.nlm.nih.gov/36739136/
Accessed July 26, 2024. https://www.merckmanuals.com/home/drugs/factors-affecting-response-to-drugs/drug-interactions
Accessed July 31, 2024. https://www.mdpi.com/2077-0383/9/9/2890
Accessed July 31, 2024. https://www.nature.com/articles/s41380-024-02588-4#:~:text=Of%20all%20patients%20with%20medication,cohorts%20%5B50%2C%2051%5D.
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