Personalized medications

The article by Michelle Fischbach and colleagues on pill-splitting in a long-term care facility accurately described my experience at a pharmacy serving many nursing and retirement homes.¹

There are at least 3 factors conspiring to defeat the “start low, go slow” strategy for administering medications in solid oral dosage form: pharmaceutical manufacturers, monographs in the Compendium of Pharmaceuticals and Specialties and the Ontario Drug Benefit Formulary.

Although pharmaceutical manufacturers produce drugs in discrete dosage units that will be effective in approximately 90% of the population, these dosage units are excessive for many young patients and may be inappropriate for frail elderly people. Most monographs in the Compendium of Pharmaceuticals and Specialties list the number of fixed-strength tablets or capsules that may be given in a 24-hour period. If an elderly 50-kg woman and a 100-kg man each consume one capsule they are certainly not getting the same dose. The presentation of dosage should include a measure of body weight or body surface area.

The Ontario Drug Benefit Formulary has taken on the role of paymaster for the pharmaceutical industry. Pharmacists are discouraged from finding creative ways to tailor medications to the specific needs of patients.

Recent advances in pharmacogenomics have produced much excitement concerning the future of personalized medicine. However, customized doses for elderly patients are needed today. The technology to deliver personalized medications is available now, but unfortunately it is seldom used by pharmacists or requested by physicians.

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Véronique Koo
Pharmacy Manager Pharmacy.ca Toronto, Ont.