[Translated article] Drug dosing in obese critically ill patients, a literature review

• Published in: Farmacia hospitalaria 2024-12
• Main Authors: García-Díaz, Hector Carlos, Sánchez-Sancho, Pablo, Lalueza-Broto, Pilar, Nuvials, Xavier, Gorgas Torner, María Queralt, Doménech Moral, Laura
• Format: Article
• Language: English
• Subjects: Body weight; Critically ill; Dosificación de fármacos; Drug dosing; Enfermo crítico; Intensive care unit; Monitorización farmacocinética; Obese patient; Paciente obeso; Peso corporal; Therapeutic drug monitoring; Unidad de cuidados intensivos
• ISSN: 1130-6343
• DOI: 10.1016/j.farma.2024.11.008

Obesity constitutes a global public health problem, and knowledge about drug dosing in obese patients is limited. Clinical trials in critically ill patients rarely include obese individuals, resulting in a lack of specific dosing information in product data sheets. The aim of this literature review is to provide clinicians with efficient and safe guidelines for this group of patients. A multidisciplinary group composed of pharmacists specialised in hospital pharmacy and physicians specialised in intensive care medicine was formed. The therapeutic groups and, in depth, the most commonly used active ingredients in the intensive care unit were identified and reviewed. The bibliographic review was carried out using terms such as: “obese”, “overweight”, “critical illness”, “drug dosification”, and “therapeutic dose monitoring”. All the information was evaluated by the working group, which reached a consensus on dosing recommendations for each drug in obese critically ill patients. Eighty three drugs belonging to the following therapeutic groups were identified: antivirals, antibacterials, antifungals, immunosuppressants, antiepileptics, vasopressors, anticoagulants, neuromuscular blocking agents, and sedatives. A table with the consensus dosing recommendation for each of these was produced after review. Drug dosing in obese patients, both in critical and non-critical settings, remains an area with significant uncertainties. This review provides updated and exhaustive information on the dosing of the main therapeutic groups in obese critically ill patients, and is a useful tool for both physicians in critical care units and clinical pharmacists in their practice in this setting. La obesidad constituye un problema de salud pública global, y el conocimiento sobre la dosificación de fármacos en pacientes obesos es limitado. Los ensayos clínicos en pacientes críticos raramente incluyen individuos obesos, lo que resulta en la falta de información específica sobre la dosificación en las fichas técnicas de los productos. El objetivo de esta revisión bibliográfica es proporcionar a los clínicos pautas eficientes y seguras para este grupo de pacientes. Se conformó un grupo multidisciplinar compuesto por farmacéuticos especialistas en farmacia hospitalaria y médicos especialistas en medicina intensiva. Se identificaron y revisaron los grupos terapéuticos y, en profundidad, los principios activos más utilizados en la Unidad de Cuidados Intensivos. La revisión bibliográfica