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Polypharmacy and precision medicine

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Fujita, Kenji, Masnoon, Nashwa, Mach, John, O’Donnell, Lisa Kouladjian, Hilmer, Sarah N.·2023·Cambridge Prisms: Precision Medicine
DOI 10.1017/pcm.2023.10PMC PMC10953761
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Abstract

Precision medicine is an approach to maximise the effectiveness of disease treatment and prevention and minimise harm from medications by considering relevant demographic, clinical, genomic and environmental factors in making treatment decisions. Precision medicine is complex, even for decisions about single drugs for single diseases, as it requires expert consideration of multiple measurable factors that affect pharmacokinetics and pharmacodynamics, and many patient-specific variables. Given the increasing number of patients with multiple conditions and medications, there is a need to apply lessons learned from precision medicine in monotherapy and single disease management to optimise polypharmacy. However, precision medicine for optimisation of polypharmacy is particularly challenging because of the vast number of interacting factors that influence drug use and response. In this narrative review, we aim to provide and apply the latest research findings to achieve precision medicine in the context of polypharmacy. Specifically, this review aims to (1) summarise challenges in achieving precision medicine specific to polypharmacy; (2) synthesise the current approaches to precision medicine in polypharmacy; (3) provide a summary of the literature in the field of prediction of unknown drug–drug interactions (DDI) and (4) propose a novel approach to provide precision medicine for patients with polypharmacy. For our proposed model to be implemented in routine clinical practice, a comprehensive intervention bundle needs to be integrated into the electronic medical record using bioinformatic approaches on a wide range of data to predict the effects of polypharmacy regimens on an individual. In addition, clinicians need to be trained to interpret the results of data from sources including pharmacogenomic testing, DDI prediction and physiological-pharmacokinetic-pharmacodynamic modelling to inform their medication reviews. Future studies are needed to evaluate the efficacy of this model and to test generalisability so that it can be implemented at scale, aiming to improve outcomes in people with polypharmacy.

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  • Patients undergoing oral surgery frequently take multiple medications, especially older individuals or those with chronic systemic conditions like diabetes or cardiovascular disease.

    “Patients undergoing oral surgery frequently take multiple medications, especially older individuals or those managing chronic systemic conditions like diabetes or cardiovascular disease [1][2][3].”

    From Comparing Artificial Intelligence (ChatGPT, Gemini, DeepSeek) and Oral Surgeons in Detecting Clinically Relevant Drug–Drug Interactions in Dental Therapy (2025) · cites this paper as [3]

    The Future direction section says polypharmacy is highly prevalent in older adults, and the Ageing and Interactions sections link multiple medications with multimorbidity. The paper does not establish how frequently oral-surgery patients take multiple medications; its example of cardiovascular disease does not establish a frequency for that surgical population, and the cited passages do not address diabetes specifically. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Fujita, K., Masnoon, N., Mach, J., O’Donnell, L. K., & Hilmer, S. N.
Affiliations
The University of Sydney (AU)
Corresponding author
Hilmer, Sarah N.
ORCID
Venue
Cambridge Prisms: Precision Medicine
Publisher
Cambridge University Press (CUP)
Published
2023
Volume
1
Pages
e22-e22
ISSN
2752-6143 (ISSN-L)
DOI
10.1017/pcm.2023.10
PMC
PMC10953761
OpenAlex
W4323849809
Cited by
27
References
5
Citations by year
2026: 4 · 2025: 6 · 2024: 3 · 2023: 11 · 2022: 2 · 2014: 1
FWCI
1.03
Type
journal article
Language
en
Open access
Licence
Locations
  • Cambridge Prisms Precision Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Health and Medical Research Council
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
Keywords
polypharmacy, precision medicine, drug-drug interactions, pharmacogenomics, pharmacokinetics, pharmacodynamics, medication review, electronic health records, clinical decision support

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