American and Select Global Populations Are at Increased Risk of Drug Over‐ and Undermedication and Adverse Side Effects
Irving Zucker, Alyssa N. ZuckerAim
To assess population differences in the safety and efficacy of prescription drugs across diverse population groups.
Methods
A narrative review based on a search of Web of Science and PubMed with terms including several pharmacokinetic and pharmacodynamic measures. The focus was on African Americans, Chinese, East Asians, Hispanics, Japanese, and Whites.
Results
Substantial differences in pharmacokinetic measures were detected in African Americans compared to White Americans for 52 drugs, including immunosuppressants, antidepressants, cancer drugs, antipsychotics, analgesics, anticoagulants, opioids, statins, and antibiotics. Similar differences were identified for 13, 28, 2, and 35 drugs administered to Hispanics, Chinese, East Asian, and Japanese subjects, respectively. Adverse drug reactions were more frequent for several non‐White populations.
Conclusions
Treatment efficacy for African Americans can be achieved by dose reductions for some drugs and increases for others. For Japanese and Chinese populations, systemic drug exposure was significantly greater than for White subjects, suggesting that patients from these populations should be started on lower doses than White patients. Studies sponsored by pharmaceutical companies often inappropriately conclude that dose adjustments are not required for different population groups. The failure to adjust for population differences in drug pharmacokinetics is a disservice to non‐White groups in need of urgent correction.