Pharmacologist, patient safety and personalized medicine: Connect the dots

The world is rapidly shifting towards personalization—whether in content, commodities, or medical treatments. It is well established that not all treatments work for everyone. However, there is still significant work to be done by clinicians and clinical pharmacologists to optimize patient outcomes.

Rethinking Pharmacology Education

For MBBS students, pharmacology is often reduced to rote memorization of drug names, classifications, adverse effects, and dosages, with little emphasis on applied pharmacology and pharmacotherapeutics. Despite multiple medical specializations, prescribing medications remains a fundamental task for all clinicians. This is where collaboration between clinical pharmacologists and physicians becomes essential to ensure rational drug use and enhance patient safety.

Key Areas for Collaboration

Prescription Monitoring in Hospitals

Deploying clinical pharmacologists in hospitals to monitor prescriptions can significantly reduce risks associated with:

• Antibiotic resistance
• Irrational drug combinations (e.g., for pain management and respiratory illnesses)
• Polypharmacy and potential drug interactions
• Overdosing or subtherapeutic dosing (e.g., oncology regimens)

By proactively identifying and mitigating these risks, clinical pharmacologists can help prevent medication errors, reduce adverse drug reactions, and support clinicians in selecting the most appropriate treatments. Moreover, analyzing prescription patterns can aid in making informed decisions for hospital formularies, balancing cost-effectiveness and patient benefit.

Training on Adverse Event Science

Regular training sessions by clinical pharmacologists can enhance the ability of clinicians and paramedic staff to identify, report, and prevent adverse drug reactions (ADRs). Spontaneous ADR reporting is crucial for refining drug safety profiles and implementing risk minimization strategies. Understanding key drugs, their side effects, interactions, and potential for medication errors is particularly vital for high-risk patients. A few minutes spent reporting an ADR could prevent legal complications and, more importantly, save lives.

Establishing Therapeutic Drug Monitoring (TDM) Centers

Personalized antimicrobial dosing, especially for critically ill sepsis patients, is essential due to unpredictable pharmacokinetic variability caused by factors like age, comorbidities, disease predisposition, and extracorporeal therapies (e.g., ECMO). Standard antibiotic dosing often results in subtherapeutic levels, necessitating higher loading doses for hydrophilic antibiotics due to increased volume of distribution in sepsis patients.

Establishing TDM centers can facilitate personalized antimicrobial dosing using model-informed precision dosing (MIPD). By integrating patient-specific data with drug concentration measurements, clinical pharmacologists can support clinical decision-making, thereby reducing adverse effects such as nephrotoxicity and hepatotoxicity associated with high-end antibiotics like vancomycin and amphotericin.

Pharmacogenomics and Personalized Medicine

Many drugs, particularly those used in elderly populations, are metabolized via cytochrome P450 enzymes and are susceptible to drug interactions due to enzyme induction or inhibition. Depending on whether a patient is a poor or extensive metabolizer, the same drug can lead to toxicity or therapeutic failure.

Rapid pharmacogenomic testing centers can provide real-time insights into a patient's metabolizer status, enabling tailored treatments, particularly in neuropsychiatric and cardiovascular diseases. Additionally, gene mutation profiling can revolutionize preventive oncology and rare familial disease management, paving the way for gene and targeted therapies. Clinical pharmacologists can oversee these investigations to ensure effective implementation and monitoring.

Investigator-Initiated Studies (IIS)

Clinical pharmacologists can collaborate with clinicians, academia, government agencies, and the pharmaceutical industry to design and conduct Investigator-Initiated Studies. These studies can provide valuable insights into:

• Drug efficacy and safety in local populations
• Specialized groups (e.g., pregnancy registries, gender- or geography-specific subgroups)
• Epidemiological trends
• Drug repurposing opportunities

Generating and publishing evidence from such studies will contribute to the refinement of clinical trials and drug development strategies.

Conclusion

The intersection of clinical pharmacology and medicine holds immense potential to enhance patient safety and treatment efficacy. By fostering collaboration in areas such as prescription monitoring, adverse event training, therapeutic drug monitoring, pharmacogenomics, and research, we can move towards truly personalized and effective healthcare. The time to integrate drug expertise into treatment decisions is now—ensuring better health outcomes for all.