Impact of Gut Microbiota Alterations on ADRs in Adult Patients: Clinical Implications, Challenges, Drug Metabolism and Future Directions

Abstract

The human gut microbiota is a highly complex and dynamic ecosystem of microorganisms that have been implicated to play an important role in the metabolism of drugs and the causation of ADRs. This review provides an overview of the intricate interactions between gut microbiota and ADRs, focusing on microbial enzymatic activity and biotransformation, their influence on the efficacy and toxicity of drugs. These include altered drug metabolism, systemic toxicity, and susceptibility to increased adverse drug reactions identified as being brought about by dysbiosis; that is, an imbalance of the microbial community. Of course, dieting habits, as well as the incidence of chronic diseases, were significant factors modifying gut microbiota's composition and function, accounting for the drug response differences. The composition of the microbiota profoundly influences pharmacokinetics, defined as absorption, distribution, metabolism, and excretion (ADME), hence its consideration in pharmacotherapy. Pharmacomicrobiomics now provides promising approaches for tailoring drug therapy with the aim of maximizing safety and efficacy in personalized medicine, thus leading to better outcomes of therapy without burdening healthcare systems by ADRs. This review, therefore, highlights the potential of gut microbiota research in transforming drug development and clinical practice by leveraging advancements in microbiota profiling and multi-omics approaches.