ALTERED PHARMACOKINETICS AND DRUG DOSING IN OBESE PATIENTS: A TRADITIONAL REVIEW

Abstract

Objective: Obesity, with its growing global prevalence, is recognized as a significant risk factor for chronic diseases such as diabetes, dyslipidemia, and certain cancers. It also increases the risk of infections like bacteremia, surgical site infections, and soft tissue infections, thereby raising morbidity and mortality. In obese individuals, both adipose and muscle mass increase, but adipose tissue expands disproportionately, altering the volume of distribution (Vd) of drugs. This necessitates using specific body weight descriptors—ideal, total, adjusted, or lean body weight—for accurate dosing. No single descriptor suits all drugs; dosing should be drug-specific. For example, using ideal body weight for lipophilic drugs with a large Vd may lead to subtherapeutic levels, while using total body weight for hydrophilic drugs with a small Vd may cause toxicity. Obesity also alters hepatic and renal functions, impacting drug metabolism and clearance. These changes mainly affect drugs with high hydrophilicity or lipophilicity, notably antimicrobials and sedative-analgesics.Result and Discussion: This review discusses current evidence on pharmacokinetic alterations in obese patients and provides guidance on selecting appropriate weight descriptors to ensure optimal dosing in this population.