Work

Personalized Geriatric Pharmacotherapy: Pharmacogenomics, Polypharmacy, and Age-Related Pharmacokinetic and Pharmacodynamic Changes

Year: 2026

Type: article

Abstract: Aging induces profound physiological changes that alter drug disposition and response, narrowing therapeutic windows and increasing susceptibility to adverse drug reactions (ADRs). This review synthesizes current evidence on age-related pharmacokinetic and pharmacodynamic changes, with a focus on pharmacogenomic determinants of drug response in older adults. Progressive decline in renal function, hepatic metabolic capacity, and alterations in body composition collectively necessitate age-appropriate dose adjustments. Polypharmacy, prevalent in community-dwelling and hospitalized older adults, compounds these challenges through drug–drug and drug–drug–gene interactions. Pharmacogenomic testing—particularly for CYP2D6, CYP2C19, CYP2C9, and SLCO1B1—offers a promising strategy to personalize therapy, while deprescribing frameworks provide practical approaches to mitigate medication-related risks. This review presents a comprehensive framework for understanding the mechanistic basis of altered drug response in older adults and proposes actionable strategies for optimizing pharmacotherapy in this vulnerable population.

Source: International Journal of Molecular Sciences

DOI: 10.3390/ijms27219948

Authors: Anastasiia A. Buianova, Iaroslav V. Mironenko, Mikhail S. Arbatskiy, Alexey V. Churov

Language: English

Topic: Pharmacogenetics and Drug Metabolism

Subfield: Pharmacology

Field: Pharmacology, Toxicology and Pharmaceutics

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,499

Funder: Ministry of Health of the Russian Federation