How are drugs developed to target specific areas (pain/allergies/disease). How do you translate scientific body knowledge into a drug that targets that area. And how do scientists determine cross reactions to other drugs or conditions. Do they have to test every combo?
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Drugs generally are not designed to target a specific area. This is often the source of drug side effects – the drug target causes disease in one tissue or scenario, but is important for healthy function elsewhere, and the drug does not discriminate.
There are a couple of ways to define cross-reactions:
1. The most common cross-reactions with other drugs are caused by inhibiting the breakdown of the other drugs you’re taking. All drugs become harmful if taken at too high a dose, and the dose one takes on a daily basis is selected to achieve a balance of the amount coming in with the amount that is exiting the body. Some drugs will interfere with the mechanism by which another drug is eliminated, causing it to accumulate to abnormal levels. However, we understand most of the mechanisms through which drugs are eliminated, and we can test to see if a new drug interferes with those mechanisms – this allows us to predict cross reactions (e.g., if Drug X is eliminated by mechanism X, and Drug Y slows down mechanism X, you would expect Drug Y to cause excess accumulation of Drug X).
2. The less desirable mechanism is to see the cross-reactions in the real world in patients. When enough people have taken a drug, you can use anonymized medical records to determine if they have better or worse long-term outcomes (e.g., likelihood of dying from a disease). You can similarly see if there is an unexpected rise in health problems when two drugs are combined. Of course, this means bad things have happened to people, so the objective is to identify and remove these risks before the drug goes to people, or at least a broad population (hence the need for rigorous clinical trials before approving a new drug)
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