Clinical Pharmacology plays a crucial role in the rationalisation of pharmacological treatments and prescriptive suitability in terms of efficacy and safety. The main purpose of this discipline is to harmonise and personalise complex specialist treatments with an overview that enables a rational pharmacological treatment plan to be established.
An increasing number of patients take a combination pharmacological therapy: 30% of patients > 65 years take an average of 5 drugs at the same time. This consequently increases the risk of toxicity due to drug interactions (Naples JG et al., J Am Geriatr Soc. 2016) which, in over 30% of cases, is the reason why patients in Western countries report to Accident and Emergency (Castro I et al., Int J Clin Pharm. 2013; Viktil KK et al. Br J Clin Pharmacol 2007), especially when undergoing treatment with cardiovascular drugs and for arterial hypertension (beta-blockers, diuretics, ACE inhibitors, calcium antagonists, alpha-antagonists, sartans, antiplatelet agents and anticoagulants), antibiotics, analgesics, antidiabetic drugs, drugs for the central nervous system (antidepressants, neuroleptics, benzodiazepines) (Gurwitz JH et al., JAMA 2003) and anticancer drugs.
According to the World Health Organisation (click to see site in ENG), at least 60% of adverse reactions are preventable, since they are due to incorrect prescription, dispensation or taking of drugs, genetic and environmental influences, the increasingly common self-medication by patients themselves, the increasing use of counterfeit or uncontrolled medicines available on the internet, and the interaction with other drugs, herbal products or simply foods.
The task of the clinical pharmacologist is to accurately assess the following aspects of drug therapy:
- Risk/evidence of expected or unexpected toxicity of pharmacological treatments (dose-dependent, dose-independent/idiosyncrasy)
- Drug interactions, which can be both pharmacokinetic, with particular regard to the absorption, metabolism, circulation and elimination of the drug, and pharmacodynamic, related to pharmacological targets
- Genetic assessment of the treatment targets or the factors involved in the absorption, transformation or elimination of the drug
- Therapeutic monitoring (dosage in biological fluids) of drugs that typically have a high risk of toxicity
The application of these aspects in clinical practice, in close collaboration with other medical specialists of various disciplines, is a useful tool for optimising the therapeutic response to a pharmacological treatment with a view to prescribing rational drug combinations, personalised for each patient, aimed at minimising the onset of preventable adverse reactions.
- Pharmacological-clinical assessment for drug interactions (pharmacokinetics, pharmacodynamics, pharmacogenetics), cardiac toxicity (baseline ECG, QTc evaluation);
- Prevention and assessment of possible adverse reactions to drugs; AGS Beers Criteria;
- Pharmacogenetic assessment;
- Drug-toxicological assessment for the use of drugs during pregnancy and breastfeeding;
- Therapeutic monitoring of drugs