Pharmacogenomic Drug-Gene Interactions in Geriatric Emergency Department Patients Who Sustained Falls: A Pilot Study

Pharmacogenomic-assisted prescribing of medications uses individual genetic information to identify drug-gene interactions. We aimed to assess potential pharmacogenomic drug-gene interactions in geriatric emergency department (ED) patients who sustained a fall.

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, which underwent pharmacogenomic testing by an accredited genetics lab, Each patient's medications were reviewed against their pharmacogenomic report and categorized as Green (continue to use), Yellow (use with caution) or Red (stop use) based on their genetic information and published interactions by the Clinical Pharmacogenetics Implementation Consortium, Dutch Pharmacogenetics Working Group, and US Food and Drug Administration-approved drug label information. The main study outcome was pharmacogenomic drug-gene interactions.

Of the 25 patients enrolled (median age, 81 years, IQR 76-85), 68% were female. Patients were taking a median of eight 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 patients (56%; 95% CI 35-76%). Further, 6/25 (24%; 95% CI 9-45%) had one or more potentially serious (Red) interactions identified.

We found that in geriatric ED patients with a fall-related injury, most had a significant pharmacogenomic drug-gene interaction. DNA testing identifies these interactions and can assist with pharmacogenomic-guided medication prescribing, which may decrease adverse drug events and improve clinical outcomes.