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Drug Dose Selection in Pediatric Obesity: Available Information for the Most Commonly Prescribed Drugs to Children

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Abstract

Obesity rates continue to rise in children, and little guidance exists regarding the need for adjustment away from total body weight-based doses for those prescribing drugs to this population of children. A majority of drugs prescribed to children with obesity result in either sub-therapeutic or supra-therapeutic concentrations, placing these children at risk for treatment failure and drug toxicities. In this review, we highlight available obesity-specific pharmacokinetic and dosing information for the most frequently prescribed drugs to children in the inpatient and outpatient clinical settings. We also comment on available dosing recommendations for drugs prescribed to treat common pediatric obesity-related comorbidities. This review highlights that there is no safe or proven ‘rule of thumb,’ for dosing drugs for children with obesity, and a striking lack of pharmacokinetic data to support the creation of dosing guidelines for children with obesity for the most commonly prescribed drugs. It is important that those prescribing for children with obesity are aware of these gaps in knowledge and of potential drug treatment failure or adverse events related to drug toxicity as a result of these knowledge gaps. Until more data are available, we recommend close monitoring of drug response and adverse events in children with obesity receiving commonly prescribed drugs.

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Authors and Affiliations

  1. Children’s Mercy Kansas City, 2401 Gillham Rd., Kansas City, MO, 64108, USA

    Kathryn E. Kyler, Jonathan Wagner, Chelsea Hosey-Cojocari & Valentina Shakhnovich

  2. University of Missouri Kansas City School of Medicine, Kansas City, MO, USA

    Kathryn E. Kyler, Jonathan Wagner & Valentina Shakhnovich

  3. Duke University Medical Center, Durham, NC, USA

    Kevin Watt

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  1. Kathryn E. Kyler
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  2. Jonathan Wagner
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  3. Chelsea Hosey-Cojocari
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Correspondence to Kathryn E. Kyler.

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VS receives funding support from the NASPGHAN Foundation and NCATS L40 TR000598.

Conflict of interest

KEK, JW, CH-C, KW and VS have no conflicts of interest to disclose.

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Kyler, K.E., Wagner, J., Hosey-Cojocari, C. et al. Drug Dose Selection in Pediatric Obesity: Available Information for the Most Commonly Prescribed Drugs to Children. Pediatr Drugs 21, 357–369 (2019). https://doi.org/10.1007/s40272-019-00352-8

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