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Frontiers in Pharmacology

Review proposes a microbiome-aware oral formulation framework: excipient risk classification, nanocarrier design rules, and a tiered testing roadmap

This review integrates evidence on microbial drug metabolism, excipient–microbiome interactions, nanocarrier–microbiome interfaces, microbiota-responsive release mechanisms, and experimental models to propose an authors' evidence-informed framework for oral formulation design, comprising an excipient–microbiome risk classification, nanocarrier design rules, microbiota-responsive delivery decision logic, and a tiered testing roadmap, illustrated by clinically relevant examples such as digoxin inactivation by Eggerthella lenta, bacterial levodopa metabolism, and microbial beta-glucuronidase-mediated irinotecan toxicity.