Pharmacogenomic Drug-Gene Interactions in Geriatric Emergency Department Patients That Have Fallen

Background Pharmacogenomic assisted prescribing of medications utilizes individual genetic information to identify drug-gene interactions. We aimed to assess potential pharmacogenomic drug-gene interactions in geriatric emergency department (ED) patients that have sustained a fall. Methods This was a prospective study involving 25 older adult ED patients with fall related injury. Data collected included current medications, demographics and mechanism of injury. All patients provided a DNA sample for pharmacogenomic testing, MatchMyMeds (DNA Labs, Boca Raton, FL) which assessed genetic data for 23 enzyme systems and reports on potential drug-gene interactions for 134 medications. Each patients’ medications were reviewed against their pharmacogenomic report and categorized as Green (go), Yellow (caution) or Red (stop) based on their genetic information and published interactions by the Clinical Pharmacogenetics Implementation Consortium (CPIC), Dutch Pharmacogenetics Working Group (DPWG) and Food and Drug Administration-approved drug label information. The main study outcome was pharmacogenomic drug-gene interactions. Results Of the 25 patients enrolled (median age, 81 years, IQR: 76-85), 68% were female. Patients were taking a median of 8 medications (IQR: 5-11). The most common types were antihypertensives, statins, anticoagulants, and anti-platelet medications. Significant drug-gene interactions (Yellow or Red) were identified in 14/25 (56%) patients. Further, 6/25 (24%) had one or more potentially serious (Red) interactions identified. Conclusions In geriatric ED patients with a fall-related injury, a majority have a significant pharmacogenomic drug-gene interactions. DNA testing identifies these interactions and can assist with pharmacogenomic-guided medication prescribing which may decrease ADEs and improve clinical outcomes. Key Points Polypharmacy is associated with adverse drug events and fall-related injuries. Pharmacogenomic can identify drug-gene interactions in older ED adults that sustain a fall. Significant drug-gene interactions are common in older ED adults that sustain a fall. Pharmacogenomic-guided medication prescribing which may decrease ADEs and improve clinical outcomes