Precision dosing to avoid adverse drug reactions

Adverse drug reactions (ADRs) have traditionally been managed by trial and error, adjusting drug and dose selection reactively following patient harm. With an improved understanding of ADRs, and the patient characteristics that increase susceptibility, precision medicine technologies enable a proactive approach to ADRs and support clinicians to change prescribing accordingly. This commentary revisits the famous pharmacology–toxicology continuum first postulated by Paracelsus 500 years ago and explains why precision dosing is needed to help avoid ADRs in modern clinical practice. Strategies on how to improve precision dosing are given, including more research to establish better precision dosing targets in the cases of greatest need, easier access to dosing instructions via e-prescribing, improved monitoring of patients with novel biomarkers of drug response, and further application of model-informed precision dosing.