Dosing of medications in morbidly obese patients in the intensive care unit setting.
OBJECTIVE
To derive recommendations for the dosing of commonly used medications in the morbidly obese patient in the ICU.


METHODS
Articles were obtained through computerized searches involving MEDLINE. The bibliographies of retrieved publications and textbooks were reviewed for additional references.


METHODS
All studies involving the pharmacokinetics or pharmacodynamics of medications in obese subjects or patients.


METHODS
The emphasis was on studies involving morbidly obese patients but, in the absence of such data, investigations involving lesser forms of obesity were extracted.


RESULTS
There is a paucity of data upon which to make recommendations for dosing commonly used medications in the morbidly obese patient in the ICU, although recommendations were provided based on the available information.


CONCLUSIONS
There is clearly a need for more investigations involving dosing regimens of medications in the morbidly obese population. Until such studies are available, the clinician must try to derive the best dosing regimens for medications based on the limited pharmacokinetic data available for some agents and clinical judgement.
Erstad
Brian L
BL
Department of Pharmacy Practice and Science, College of Pharmacy, Tucson, Arizona 85721-0207, USA. erstad@pharmacy.arizona.edu
D000701:Analgesics, Opioid / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000925:Anticoagulants / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D000927:Anticonvulsants / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D001835:Body Weight; D002317:Cardiovascular Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods* / Q000592:standards; D004334:Drug Administration Schedule; D004347:Drug Interactions; D016903:Drug Monitoring / Q000379:methods* / Q000592:standards; D005343:Fibrinolytic Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008657:Metabolic Clearance Rate; D009767:Obesity, Morbid / Q000188:drug therapy* / Q000378:metabolism; D017410:Practice Guidelines as Topic; D019141:Respiratory System Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use
D000701:Analgesics, Opioid; D000890:Anti-Infective Agents; D000925:Anticoagulants; D000927:Anticonvulsants; D002317:Cardiovascular Agents; D005343:Fibrinolytic Agents; D005765:Gastrointestinal Agents; D019141:Respiratory System Agents