Personalized medications

In an ideal world and using existing technology, every hospital, pharmacy and physician's office would be equipped with a database capable of computing suitable starting and maintenance doses for each patient's medications on the basis of the patient's age, body weight, surface area and creatinine clearance rate. The doses could subsequently be modified on the basis of therapeutic effect. This would allow physicians to prescribe and pharmacists to dispense essential therapies in a truly personalized and standardized manner. Effective disease management would thereby be maximized and adverse events would be curtailed. Pharmacogenomics may promise even further advances, but its practical applications will likely not be implemented in the near future.

Until the pharmaceutical industry manufactures medicines in formulations that allow for such customized dosing (especially very small doses); until hospitals, pharmacies and physicians' offices invest in the infrastructure and information systems required to implement such an undertaking; and until hospital and provincial drug formularies and funding guidelines are revamped to account for variations in dosing, pill-splitting will remain an unfortunate reality.¹ This is particularly true among community-dwelling and institutionalized elderly people who so often require the “start low, go slow” strategy.

Signatures

Michelle Litner (née Fischbach)
Baycrest Centre for Geriatric Care Toronto, Ont.

Jennifer Gold
Baycrest Centre for Geriatric Care Toronto, Ont.