Internal Medicine · 1 h ago
Review outlines individualized drug dosing for critically ill patients with obesity
A narrative review examines how obesity may alter drug distribution and clearance in critically ill patients and offers dosing recommendations for selected ICU medications. The authors emphasize that evidence specific to patients with extreme obesity in the ICU remains limited.
- Obesity can alter drug distribution and clearance.
- Choose weight descriptors carefully for dose calculations.
- Evidence specific to extreme obesity in ICU care is limited.
A literature search identified studies on pharmacokinetics and pharmacodynamics of medications in people with obesity, including general dosing principles and medication-specific assessments. The authors also searched bibliographies for additional relevant publications. No patient sample size or clinical trial was reported; this is a review intended to help ICU clinicians develop regimens for critically ill patients with extreme obesity.
The review describes how obesity-related changes in apparent volume of distribution and drug clearance can make it harder to achieve pharmacodynamic targets. It presents recommendations for selected ICU medications and a practical framework for deciding how to dose them, including choosing an appropriate weight for weight-based calculations and selecting doses for fixed regimens.
The authors stress that dosing should be individualized and suggest that consultation with a clinical pharmacist may help. Evidence is constrained by small numbers of patients with more extreme obesity, few ICU-specific studies and a lack of clinical outcome measurements. The review therefore offers guidance, but does not establish that its dosing strategies improve patient outcomes.
In practice
For critically ill patients with obesity, the review supports individualized medication dosing that accounts for changes in drug distribution and clearance, with careful selection of the weight descriptor used for weight-based doses and consideration of fixed-dose regimens. It also suggests clinical pharmacist input may be beneficial. These are review-based recommendations, not evidence of improved outcomes: studies specific to the ICU and to patients with extreme obesity are scarce, and clinical outcome measurements are limited. The review does not establish a single dosing approach for all medications or patients.
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Intensive Care Medicine: Principles of drug dosing for obese patients in the intensive care unit ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.