The lack of data on the safety of medicines for indigenous people is putting their health at risk, experts say.
They say indigenous people can be on therapeutic drugs from a younger age and for longer than the average population.
They also point out there are known differences in both drug effectiveness and harm across ethnic groups.
Writing in the latest Medical Journal of Australia, Dr Tilenka Thynne, from Flinders Medical Centre, and Dr Genevieve Gabb, from the Royal Adelaide Hospital, say the potential for harm is real.
While attention is given to reporting the safety of medications in older people, children, and pregnant and breastfeeding women, there are no specific reporting requirements for ethnic groups, including indigenous Australians.
The median age of the indigenous population is 21.8 years, compared with 37.6 years for non-indigenous Australians.
"A younger group of people are exposed to drugs when starting cardiovascular screening and primary preventive treatment, leading to potentially longer cumulative lifetime exposure," they wrote.
Noting the known differences in drug effectiveness and harm across different ethnic groups, they say it may be inappropriate to generalise what little drug safety information is available.
They also noted recent cases of adverse drug reactions in indigenous Australians.
But they acknowledged it would be impractical and expensive to test drugs in indigenous populations before approval by the Therapeutic Goods Administration.
"It is in the post-marketing space that a comprehensive and pro-active approach to addressing drug safety in indigenous Australians is urgently needed," they said.
"The assessment and management of potential adverse drug reactions should be part of any comprehensive health care program.
"Aboriginal health care workers, like all health care professionals, need training in pharmacovigilance, the principles of drug safety, and the identification and reporting of adverse drug reactions."
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