The Role of the Microbiome in Drug Response

Annu Rev Pharmacol Toxicol. 2020 Jan 6:60:417-435. doi: 10.1146/annurev-pharmtox-010919-023612. Epub 2019 Aug 6.


The microbiome is known to regulate many aspects of host health and disease and is increasingly being recognized as a key mediator of drug action. However, investigating the complex multidirectional relationships between drugs, the microbiota, and the host is a challenging endeavor, and the biological mechanisms that underpin these interactions are often not well understood. In this review, we outline the current evidence that supports a role for the microbiota as a contributor to both the therapeutic benefits and side effects of drugs, with a particular focus on those used to treat mental disorders, type 2 diabetes, and cancer. We also provide a snapshot of the experimental and computational tools that are currently available for the dissection of drug-microbiota-host interactions. The advancement of knowledge in this area may ultimately pave the way for the development of novel microbiota-based strategies that can be used to improve treatment outcomes.

Keywords: antipsychotics; cancer; drugs; metabolism; metformin; microbiome.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / microbiology
  • Drug-Related Side Effects and Adverse Reactions / epidemiology*
  • Drug-Related Side Effects and Adverse Reactions / microbiology
  • Humans
  • Mental Disorders / drug therapy
  • Mental Disorders / microbiology
  • Microbiota*
  • Neoplasms / drug therapy
  • Neoplasms / microbiology
  • Treatment Outcome