Aug 2026· British Journal of Clinical Pharmacology· 0 citations· 38 references
Medicine
TL;DR
It is suggested that PGx information may have meaningful clinical utility for improving prescribing practices in acute care, however, interpretation in this population requires careful consideration of other factors such as nutritional status and inflammation that may modify pharmacogene activity.
Abstract
Aims
Safe prescribing and effective medication review during acute hospitalization depends on accurate information about liver and kidney function because these organs are responsible for the elimination of most medications. While estimates for kidney function are widely used, comparable markers of hepatic drug-metabolizing capacity are not routinely available. We evaluated the clinical relevance of pharmacogenomic (PGx) information for key pharmacogenes implicated in medication elimination in older adults presenting to the emergency department.
Methods
Fourteen pharmacogenes were analysed using the Personal Medicine Profile™ test. GeneYouIn PillCheck™ software performed genotype-to-phenotype translations, identified drug-gene interactions (DGIs) and generated a clinical decision report based on each patient's actual medication use.
Results
Among 125 acutely admitted older medical patients (median age 78.3 years; 10 medications; 7 chronic diseases), PGx testing identified 88 DGIs across 63 patients (50.4%). Of these, 46.5% were considered by clinical experts to be clinically relevant for the individual patient, affecting 33 patients (26.4%) in the total study population. Frequently implicated pharmacogenes included CYP2C19 (25.0%), SLCO1B1 (25.0%), CYP2D6 (20.5%), CYP2C9 (14.8%) and OPRM1 (6.8%), and frequently implicated medications included losartan (13.6%), pantoprazole (12.5%), simvastatin (12.5%), atorvastatin (11.4%) and metoprolol (11.4%).
Conclusion
With more than one-quarter of acutely admitted older medical patients having one or more clinically relevant DGIs, these findings suggest that PGx information may have meaningful clinical utility for improving prescribing practices in acute care. However, interpretation in this population requires careful consideration of other factors such as nutritional status and inflammation that may modify pharmacogene activity.
BACKGROUND
Since aging is associated with pharmacokinetic and pharmacodynamic changes, polypharmacy is particularly harmful in older adults. Meanwhile, clinical pharmacists contribute to safer prescribing by applying their clinical expertise during medication review. Therefore, this study aimed to characterize potential drug-related problems through the analysis of routine pharmaceutical interventions.
METHODS
Data were collected from the electronic health record between 2019 and 2025; potentially inappropriate medications and high-risk medications were identified. Drug-related problems were categorized according to the Pharmaceutical Care Network Europe classification.
RESULTS
Pharmacists performed 12,856 pharmaceutical interventions, of which prescribers accepted 65%. The mean patient age was 87.5 years (range, 65-113 years), and 60.2% of patients were female. Among all pharmaceutical interventions, 1779 involved a potentially inappropriate medication. The most frequent causes of drug-related problems were related to dose selection (39.8%), drug selection (14.3%), treatment duration (10.1%), and treatment safety (9.3%). The most commonly targeted drug categories were the nervous system (24.7%), the digestive tract and metabolism (21.5%), blood and hematopoietic organs (19.8%), and the cardiovascular system (13.6%).
CONCLUSIONS
Pharmaceutical interventions that prevent prescribing errors in older adults are essential in clinical practice. Understanding potential drug-related problems and the nature of pharmaceutical interventions can help ensure safe pharmacotherapy by alerting prescribers and caregivers to major medication-related risks.
Treatment-resistant mental health conditions are common in primary care and challenging for clinicians. Trial-and-error prescribing can prolong morbidity and increase adverse drug reactions (ADRs). Pharmacogenomic (PGx) testing enables individualised prescribing by identifying gene–drug interactions affecting psychotropic response. Thirty adults with treatment-resistant mental health conditions underwent PGx testing using a commercial panel (one lost to follow-up [n = 29]). Patients received PGx-guided treatment (n = 8) or standard care (n = 21). Phenotypes were assigned per CPIC and DPWG guidelines, with prescribing guided by clinical experience where guidelines were unavailable. Medication histories were reviewed for gene–drug concordance, ADRs, and treatment failures. Clinical improvement at eight weeks was defined as “marked” or “moderate” improvement and/or ADR resolution. Actionable genotypes were common, particularly CYP2D6 (27.5% poor/intermediate drug metabolising phenotype) and CYP2C19 (37.9%). Guideline-actionable gene–drug interactions occurred in 37% of patients, and eleven patients possessed actionable phenotype at multiple loci. Gene–drug interactions were identified in nine patients and guidance was fully implemented in six. Clinical benefit at 8 weeks was achieved in 6/8 patients with genotype-guided changes versus 8/21 receiving standard care. PGx-guided prescribing may support improved antidepressant response and tolerability while reducing trial-and-error prescribing for treatment-resistant patients in primary care.
Cristina Beer, Fiona Rae, Mikayla Watt et al.· International Journal of Mol...· 0 citations
Importance Pharmacogenomic (PGx) guidelines can improve medication efficacy and reduce toxicity, but their application in pediatric intensive care units (PICUs) remains largely unexplored. Objective To determine the frequency of medications with established PGx guidelines administered in the PICU and assess the capacity of exome sequencing to capture PGx phenotypes for these medications. Design Retrospective cohort study integrating electronic medical record and exome sequencing data. Setting Morgan Stanley Children's Hospital of NewYork-Presbyterian, a single center tertiary care children's hospital. Participants A total of 4,939 children admitted to the PICU (2020 - 2024), and 192 children admitted to the PICU who underwent exome sequencing for research purposes (2015 - 2023). Exposure Critical illness requiring PICU admission. Main Outcomes and Measures Frequencies of administration of medications with established PGx guidelines in the PICU and the proportion of individuals with exome sequencing with identifiable PGx phenotypes. Results Among 4,939 PICU patients, 37.2% (n=1,837) received at least one medication with established PGx guidelines and 14.4% (n=712) received two or more such medications. Twenty PGx genes were implicated; CYP2C9 was most common (17.3%, n=853). An estimated 8.2% of patients received medications for which PGx-guided recommendations would have altered clinical management. Among 192 patients who underwent exome sequencing, at least one metabolizer phenotype was identified in 62% (n=119). Conclusions and Relevance Many critically ill children receive medications with established PGx guidelines. This study highlights an opportunity for more personalized medicine for critically ill children admitted to a tertiary care hospital and assesses the strengths and weaknesses of exome sequencing to uncover pertinent PGx phenotypes.
BACKGROUND
Integration of pharmacogenomics (PGx) into clinical care has primarily occurred within academic medical centers. Clinical decision support (CDS) is vital to the incorporation of PGx into clinical care, however, efforts have not capitalized on the integration within community pharmacy settings.
OBJECTIVE
To describe the implementation efforts for community pharmacy CDS alerts and assess effectiveness.
METHODS
A retrospective manual chart review was conducted to evaluate the effectiveness of deploying PGx alerts across 14 community pharmacies within a single health system. A report was created to capture all PGx CDS alerts generated during the eight-month study period (October 2024-May 2025). Alerts were categorized as actionable when documentation was sparse for medication adjustments based on PGx results from the prescribing clinician upon transmission of the prescription to the community pharmacy.
RESULTS
A total of 74 alerts were generated, of which 36 were unique alerts. Thirty-eight alerts were excluded as duplicates when the pharmacist re-entered the dispensing function. Clinicians adjusted 17 chemotherapy prescriptions prior to order transmission. Additionally, five alerts for chemotherapy medications were considered not actionable as the patient had previously tolerated therapy. The remaining 13 alerts comprised of 11 for clopidogrel and 2 for tramadol. Pharmacists intervened in 8 of the 11 clopidogrel orders which resulted in 3 medication modifications. The overall alert acceptance was 23%.
CONCLUSION
This study describes one of the first institutions to deploy PGx alerts through the community pharmacy module across a health system's electronic health record. PGx alerts in the medication dispensing module provide an additional safeguard for precision medicine, enabling pharmacists to make targeted interventions and provide patient education. Continuous evaluation of PGx alerts affords opportunities for alert refinement and further optimizing patient care.
Amanda Massmann, Jordan F. Baye, Karly Blaalid et al.· Journal of the American Phar...· 0 citations
The integration of pharmacogenomics into routine healthcare has the potential to optimize individualized drug therapy, minimize preventable ADRs, and accelerate the transition toward precision medicine, ultimately improving clinical outcomes and healthcare quality.
Rayapudi Vasavi Sai Saraswati, U. M. Vattikuti, Arthika Chauhan Laudia et al.· International Journal of Cur...· 0 citations
Drug therapy safety aims at ensuring optimal medication while reducing errors and preventing avoidable patient risks. The transition from outpatient to inpatient care is especially vulnerable to medication-related problems (MRPs), including those related to transferring outpatient medication orders into electronic health records. This phase is particularly vulnerable for drugs with dose-dependent pharmacological effects, such as methotrexate (MTX).
Within the framework of INTERPOLAR (INTERventional POLypharmacy – drug interAction – Risks), clinical pharmacists regularly perform medication analyses as are routinely carried out across multiple departments of the Jena University Hospital (UKJ). Identified problems are addressed through interdisciplinary collaboration. The analyses rely on essential patient information, including medical history, diagnoses, clinical findings, and laboratory results, as well as current medications.
Medication analyses identified five cases within 5 months with MRPs related to MTX across departments during hospitalization at UKJ.
Although MTX-related MRPs are well known and despite established risk-minimization measures, failures still occur. The present case series highlights the need for regular active, interdisciplinary safety strategies. These should go beyond predominantly passive informative measures. Cooperation between treating physicians and clinical pharmacists should be strengthened and made standard practice, especially during hospitalization of patients with complex or potentially dangerous regimens. Drugs with complex or variable dosing schemes increase risk of MRPs. Early interdisciplinary collaboration among clinical pharmacists, physicians, and nurses helps to identify and prevent potential MRPs.
Franziska Janke, Christine Kessler, Michael Hartmann et al.· Journal of public health· 0 citations
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