Precision drug dosing: A major opportunity for patients and pharmacists

Abstract

Precision medicine customizes drug treatment to an individual's disease and genetics in order to optimize therapeutic benefit and minimize risk. Surprisingly, drug dosing is generally not discussed as a component of precision medicine. Because dosing regimens are an independent factor modulating efficacy and toxicity, consideration should be given to the clinical significance of precision drug dosing (PDD) in patient care. Pharmacists routinely face dilemmas when they are asked for dosing recommendations for patients with characteristics that fall outside of those represented in the drug label (eg, morbid obesity, pregnancy, frailty, neonatal patients, or elderly patients). The necessary data and technology now exist to create and implement PDD software for high priority drug‐disease targets in order to assist pharmacists and prescribers in choosing the safest and most effective dose for every patient. Within 5 to 10 years, we believe this software will be available. This study discusses how pharmacists can participate in leading the implementation of these PDD tools to achieve effective and routine clinical use.

Model-Informed Precision Dosing of Vancomycin in Hospitalized Children: Implementation and Adoption at an Academic Children’s Hospital

“…As experts in the therapeutic use of medications, they have the appropriate skills and training in pharmacokinetics and TDM management to apply the understanding gained to guide dose decision-making within the context of the therapeutic goals for the patient (Carter, 2016). Clinical pharmacists also represent an engaged provider group in terms of valuing dose individualization for patients (Pearce et al, 2018). As a smaller provider pool (~60 at LPCH) compared to physicians (> 500 at LPCH), use of the MIPD CDS tool will be more frequent for any given provider allowing proficiency and expertise to develop.…”

“…Lastly, the burden of TDM management in the clinical setting often falls on clinical pharmacists, and therefore pharmacokinetic calculations are a pain point in their clinical workflow. CDS tools that facilitate more efficient workflow around pharmacokinetic calculations and interpretation will be valued and EHR integrated CDS dosing tools are desired by clinical pharmacists (Pearce et al, 2018). Several studies have shown pharmacist-led vancomycin dosing and monitoring initiatives result in improved achievement of therapeutic goals in patients (Cardile et al, 2015;Marquis et al, 2015;Momattin et al, 2015).…”