Precision medication: An illustrative case series guiding the clinical application of multi-drug interactions and pharmacogenomics

Abstract

Precision medication entails selecting the precise medication, dose, and timing of administration. Multi-drug interactions and genetics significantly affect precision medication. In this article, we present two simulated cases for real-world applications of precision medication. Clinicians may need to acquire additional skills to apply the principles illustrated by these cases.

Keywords: drug interactions; pharmacogenomics; phenoconversion; precision medication; precision medicine.

Figure 1

Chart information for Mr Bailey

Figure 2

Oral bioavailability and metabolic pathways for Mr Bailey's medication regimen. Abbreviations: F = absolute bioavailability; N/A = not available; U/D = undetermined. The color coding in the cells for CYP450 drug‐metabolizing isoenzymes indicates the affinity of the medication for this isoenzyme, as follows: = CYP weak affinity substrate, = CYP moderate affinity substrate, and = CYP strong affinity substrate. The percentages in the cells for CYP450 drug‐metabolizing isoenzymes indicate the extent this isoenzyme contributes to the overall metabolic clearance of the medication. ^aIndicates a prodrug

Figure 3

Chart information for Mr Howell

Figure 4

Oral bioavailability and metabolic pathways for Mr Howell's Medication Regimen. Abbreviations: F = absolute bioavailability; N/A = not available; U/D = undetermined. The color coding in the cells for CYP450 drug‐metabolizing isoenzymes indicates the affinity of the medication for this isoenzyme, as follows: = CYP weak affinity substrate, = CYP moderate affinity substrate, and = CYP strong affinity substrate. The percentages in the cells for CYP450 drug‐metabolizing isoenzymes indicate the extent this isoenzyme contributes to the overall metabolic clearance of the medication. ^aIndicates a prodrug