Breakpoints #80 – Weighting on a Miracle: Understanding Unknowns of Dosing Children and Adults with Obesity
Jun 2, 2023
Dr. Amit Pai, a professor and chair of clinical pharmacy with expertise in pharmacokinetics, and Dr. Kate Kyler, an assistant professor of pediatrics focused on precision dosing in children, dive into the complexities of drug dosing for individuals with obesity. They discuss how obesity alters pharmacokinetics and the need for tailored dosing strategies, especially in pediatric populations. The conversation highlights the misconceptions around BMI and the pitfalls of traditional weight-based approaches, making a case for more effective therapeutic drug monitoring.
AI Snips
Chapters
Transcript
Episode notes
Obesity Alters Pharmacokinetics
- Obesity alters pharmacokinetics across absorption, distribution, metabolism, and elimination (ADME).
- Changes include delays in gastric emptying, altered volume of distribution, metabolism shifts, and variations in elimination processes.
Enzyme Activity Changes in Obesity
- CYP3A4 enzyme activity decreases while CYP2E1 activity increases in obesity.
- This opposing effect complicates dose adjustments for drugs metabolized by these enzymes.
Focus on High-Risk Patients
- Critically ill patients and drugs with narrow therapeutic windows need careful dose consideration in obesity.
- Adjust dosing cautiously, especially in pediatric patients with obesity to avoid therapeutic failures or toxicity.