Drug dosing in hospitalized obese patients with COVID-19
By Jeffrey F. Barletta and Brian L. Erstad
Critical Care volume 26,
Article number: 60 (2022) Published: 14
March 2022
Obesity is highly prevalent in hospitalized patients
admitted with COVID-19. Evidence based guidelines are available for
COVID-19-related therapies but dosing information specific to patients with
obesity is lacking. Failure to account for the pharmacokinetic alterations that
exist in this population can lead to underdosing, and treatment failure, or
overdosing, resulting in an adverse effect. The objective of this manuscript is
to provide clinicians with guidance for making dosing decisions for medications
used in the treatment of patients with COVID-19. A detailed literature search
was conducted for medications listed in evidence-based guidelines from the
National Institutes of Health with an emphasis on pharmacokinetics, dosing and
obesity. Retrieved manuscripts were evaluated and the following prioritization
strategy was used to form the decision framework for recommendations: clinical
outcome data > pharmacokinetic studies > adverse effects > physicochemical
properties. Most randomized controlled studies included a substantial number of
patients who were obese but few had large numbers of patients more extreme
forms of obesity. Pharmacokinetic data have described alterations with volume
of distribution and clearance but this variability does not appear to warrant
dosing modifications. Future studies should provide more information on size
descriptors and stratification of data according to obesity and body habitus.
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