Abstract
Background: Polypharmacy is most prevalent among the elderly population and in particular among nursing home residents. The frequency of the use of drugs with pharmacogenomics (PGx)-based dosing guidelines for CYP2D6, CYP2C9, CYP2C19 and SLCO1B1 were measured among nursing home residents in the Capital Region of Denmark as well as drug–drug interactions. The aim was to evaluate the potential of applying PGx-test as a supportive tool in medication reviews. Methods: Drug use among nursing home residents during 2017–2018 in the Capital Region of Copenhagen, for drugs with PGx-based dosing guidelines available through the PharmGKB website, were measured. Drug–drug interactions were scored in severity by using drug interaction checkers. Results: The number of residents using drugs with PGx-based actionable dosing guidelines (AG) were 119 out of 141 residents (84.3%). Of these 119 residents, 87 residents used drugs with AG for CYP2C19, 47 residents for CYP2D6, and 42 residents for SLCO1B1. In addition, 30 residents used two drugs with an AG for CYP2C19, and for CYP2D6, it was only seven residents. The most used drugs with AG were clopidogrel (42), pantoprazole (32), simvastatin (30), metoprolol (25), and citalopram (24). The most frequent drug interactions found with warnings were combinations of proton pump inhibitors and clopidogrel underscoring the potential for phenoconversion. Conclusion: this study clearly showed that the majority of the nursing home residents were exposed to drugs or drug combinations for which there exist PGx-based AG. This indeed supports the notion of accessing and accounting for not only drug–gene but also drug–drug–gene interactions as a supplement to medication review.
Highlights
According to the World Health Organization (WHO), medication safety in polypharmacy, defined as the administration of multiple drugs at the same time, is one of the key global challenges for medication today [1]
The frequency of the use of drugs with pharmacogenomics (PGx)-based dosing guidelines for CYP2D6, CYP2C9, CYP2C19 and solute carrier organic anion transporter 1B1 (SLCO1B1) were measured among nursing home residents in the Capital Region of Denmark as well as drug–drug interactions
The aim of this study was to measure the frequency of the use of drugs with actionable dosing guidelines (AG) and non-actionable dosing guidelines (N-AG) for CYP2D6, CYP2C9, CYP2C19 as well as SLCO1B1 among nursing home residents in the Capital Region of Denmark in 2017–18 and to evaluate the potential of applying PGx-test for drugs with AG as a supportive tool in medication reviews
Summary
According to the World Health Organization (WHO), medication safety in polypharmacy, defined as the administration of multiple drugs at the same time, is one of the key global challenges for medication today [1]. The use of medication has been shown, paradoxically, to be tightly associated with an increase in the use of drugs following admission to nursing homes [8] Initiatives both internationally and in Denmark have been taken to support the best clinical management of patients with multi morbidity and polypharmacy [9,10,11], but they are often complicated, requiring multiple specialists being involved in care planning and execution [12]. Conclusion: this study clearly showed that the majority of the nursing home residents were exposed to drugs or drug combinations for which there exist PGx-based AG This supports the notion of accessing and accounting for drug–gene and drug–drug–gene interactions as a supplement to medication review
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