Michael Awadalla

Medications for conditions like high blood pressure and high cholesterol are nothing new. Many have been around for years and have a good track record. So why are they less effective for some people? The problem is that people with multiple chronic conditions often have complex medication lists, which can leave patients at risk for reduced medication effectiveness and possibly harmful interactions.

Personalized medicine helps solve this problem by identifying how individual patients might react to certain medications based on their unique genetic makeup and drug routine. This approach guides pharmacists and prescribers in optimizing each patient’s med routine, improving outcomes and patient well-being.

Today, personalized precision medicine is used in some Program of All-Inclusive Care for the Elderly (PACE) organizations. PACE is a value-based care program serving older adults. Most are dually eligible for Medicare and Medicaid. And they often have multiple chronic conditions and take several medications.

Now imagine that a PACE participant taking multiple medications is prescribed codeine for pain relief, which has been effective for other patients. Their pain should go away, right?


Genes can profoundly impact how the patient reacts to codeine. This particular opioid needs a certain liver enzyme for it to be properly metabolized. Whether or not their enzyme is effective is determined by their genetic makeup. To understand our genes and how they might impact certain medications, clinical pharmacists use pharmacogenomic (PGx) testing. The results provide pharmacists with a genetic blueprint for spotting potential risks, which adds precision to the analysis.

So, if the patient has the right enzyme, the codeine should work as expected?

It depends. Some drugs compete for the same enzyme, including certain over-the-counter products. Say the patient is already taking an antihistamine. Depending on the antihistamine, it could block codeine’s metabolism, leaving the patient with continued pain. This pain might even inhibit their daily activities, which is not a good outcome. So, it’s important for medication routines to be personalized for each individual patient.

This may seem like a lot to unpack, but personalized precision medicine helps simplify care without trial and error. This means better outcomes.

Let’s look again at our hypothetical patient taking codeine. Without personalized medicine, it might seem logical that upping the dose would bring pain relief. But the antihistamine would still block codeine’s metabolism, and the patient could get worse-than-expected side effects, like tiredness and dizziness. This increases their risk of falling and breaking a leg or hip, possibly leading to an ER visit, hospitalization, surgery and even more medications.

But with personalized precision medicine, the pharmacist would know about the interaction with codeine and the antihistamine and have the tools needed to make an informed recommendation to the prescriber and patient. In this hypothetical scenario, the pharmacist may recommend a different medication for pain relief whose metabolism won’t be blocked by the antihistamine. As a result, the patient’s pain subsides, and they go back to their daily life.

Personalized precision medicine is key to helping older adults with chronic conditions age in place. According to McKinsey, the burden of chronic diseases has been rising globally and is projected to continue. This is especially important for programs like PACE that serve populations where chronic conditions are prevalent. Through personalized precision medicine, PACE programs can optimize medication routines, simplify care and help participants manage chronic conditions while living safely at home. That’s a good outcome.

Michael S. Awadalla is executive vice president office of applied pharmacotherapy at Tabula Rasa HealthCare.