Drugs & Therapy Perspectives

, Volume 34, Issue 7, pp 344–349 | Cite as

Appropriate drug dosages in obese patients

  • Sanja MirkovEmail author
  • Katherine A. Lyseng-Williamson
Therapy in Practice


Drug dosage recommendations in obese patients are largely lacking, as data on dosages are generally derived from clinical studies conducted in healthy subjects of average body weight. As morbid obesity (i.e. body mass index ≥ 40 kg/m2) is associated with comorbidities affecting drug pharmacokinetics, relatively few obese subjects are included in clinical studies. To insure optimal drug dosages in obese patients, efficacy and safety trials should provide subgroup analysis of data in patients with varying degrees of obesity. The body-size descriptor used to determine the optimal drug dosage in obese patients should be based on the pharmacological properties of the drug, the clinical context and other factors, and should be clearly specified (including the method of conversion from total body weight to the appropriate body-size descriptor).


Compliance with ethical standards

Conflict of interest

S. Mirkov and K.A. Lyseng-Williamson declare no relevant conflict of interest.


The preparation of this review was not supported by any external funding.


  1. 1.
    Pai MP. Drug dosing based on weight and body surface area: mathematical assumptions and limitations in obese adults. Pharmacotherapy. 2012;32(9):856–68.CrossRefGoogle Scholar
  2. 2.
    Jacques KA, Erstad BL. Availability of information for dosing injectable medications in underweight or obese patients. Am J Health Syst Pharm. 2010;67(22):1948–50.CrossRefGoogle Scholar
  3. 3.
    Erstad BL. Improving medication dosing in the obese patient. Clin Drug Investig. 2017;37(1):1–6.CrossRefGoogle Scholar
  4. 4.
    Ingrande J, Lemmens HJM. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010;105(Suppl 1):i16–23.CrossRefGoogle Scholar
  5. 5.
    Green B, Duffull SB. What is the best size descriptor to use for pharmacokinetic studies in the obese? Br J Clin Pharmacol. 2004;58(2):119–33.CrossRefGoogle Scholar
  6. 6.
    National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res. 1998;6(Suppl 2):51S–209S.Google Scholar
  7. 7.
    World Health Organisation. Obesity: preventing and managing the global epidemic: report of a WHO consultation (WHO Technical Report Series 894). Geneva: World Health Organization; 2000.Google Scholar
  8. 8.
    Barras M, Legg A. Drug dosing in obese adults. Aust Prescr. 2017;40(5):189–93.CrossRefGoogle Scholar
  9. 9.
    Polso AK, Lassiter JL, Nagel JL. Impact of hospital guideline for weight-based antimicrobial dosing in morbidly obese adults and comprehensive literature review. J Clin Pharm Ther. 2014;39(6):584–608.CrossRefGoogle Scholar
  10. 10.
    Xiong Y, Fukada T, Knibbe CAJ, et al. Drug dosing in obese children challenges and evidence-based strategies. Pediatr Clin N Am. 2017;64(6):1417–38.CrossRefGoogle Scholar
  11. 11.
    Longo C, Bartlett G, Macgibbon B, et al. The effect of obesity on antibiotic treatment failure: a historical cohort study. Pharmacoepidemiol Drug Saf. 2013;22(9):970–6.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Martin JH, Saleem M, Looke D. Therapeutic drug monitoring to adjust dosing in morbid obesity: a new use for an old methodology. Br J Clin Pharmacol. 2012;73(5):685–90.CrossRefGoogle Scholar
  13. 13.
    Erstad BL. Dosing of medications in morbidly obese patients in the intensive care unit setting. Intensive Care Med. 2004;30(1):18–32.CrossRefGoogle Scholar
  14. 14.
    Cheymol G. Effects of obesity on pharmacokinetics. Clin Pharmacokinet. 2000;39(3):215–31.CrossRefGoogle Scholar
  15. 15.
    Greenwalt M, Griffen D, Wilkerson J. Elimination of emergency department medication errors due to estimated weights. BMJ Qual Improv Rep. 2017; 27; 6(1). CrossRefGoogle Scholar
  16. 16.
    Institute for Safe Medications Practices (ISMP). 2018-2019 Targeted medication safety best practices for hospitals.: best practice 3. Horsham (PA): ISMP; 2018.Google Scholar
  17. 17.
    Pan SD, Zhu LL, Chen M, et al. Weight-based dosing in medication use: what should we know? Patient Prefer Adherence. 2016;10:549–60.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Ghobadi C, Johnson TN, Aarabi M, et al. Application of a systems approach to the bottom-up assessment of pharmacokinetics in obese patients expected variations in clearance. Clin Pharmacokinet. 2011;50(12):809–22.CrossRefGoogle Scholar
  19. 19.
    Painter SD, Ovsyannikova IG, Polanda GA. The weight of obesity on the human immune response to vaccination. Vaccine. 2015;33(36):4422–9.CrossRefGoogle Scholar
  20. 20.
    Neidich SD, Green WD, Rebeles J, et al. Increased risk of influenza among vaccinated adults who are obese. Int J Obes (Lond). 2017;41(9):1324–30.CrossRefGoogle Scholar
  21. 21.
    Gremese E, Carletto A, Padovan M, et al. Obesity and reduction of the response rate to anti-tumor necrosis factor α in rheumatoid arthritis: an approach to a personalized medicine. Arthritis Care Res. 2013;65(1):94–100.CrossRefGoogle Scholar
  22. 22.
    Clinical Excellence Commission. High-risk medicines management policy (document no. PD2015-029). North Sydney (NSW): Ministry of Health, NSW; 2015.Google Scholar
  23. 23.
    Falagas ME, Kompoti M. Obesity and infection. Lancet Infect Dis. 2006;6(7):438–46.CrossRefGoogle Scholar
  24. 24.
    Bertakis LD, Azari R. Obesity and the use of health care services. Obes Res. 2005;13(2):372–9.CrossRefGoogle Scholar
  25. 25.
    Pai MP. Anti-infective dosing for obese adult patients: a focus on newer drugs to treat methicillin-resistant Staphylococcus aureus acute bacterial skin and skin structure infections. Clin Ther. 2016;38(9):2032–44.CrossRefGoogle Scholar
  26. 26.
    Mahmood I. Prediction of clearance and volume of distribution in the obese from normal weight subjects. Clin Pharmacokinet. 2012;51(8):527–42.CrossRefGoogle Scholar
  27. 27.
    Bhat R, Mazer-Amirshahi M, Sun C, et al. Accuracy of rapid sequence intubation medication dosing in obese patients intubated in the ED. Am J Emerg Med. 2016;34(12):2423–5.CrossRefGoogle Scholar
  28. 28.
    Griggs JJ, Mangu PB, Anderson H, et al. Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2012;30(13):1553–61.CrossRefGoogle Scholar
  29. 29.
    Shem-Tov N, Labopin M, Moukhtari L, et al. Chemotherapy dose adjustment for obese patients undergoing hematopoietic stem cell transplantation: a survey on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Oncologist. 2015;20(1):50–5.CrossRefGoogle Scholar
  30. 30.
    Wanahita N, Messerli FH, Bangalore S, et al. Atrial fibrillation and obesity: results of a meta-analysis. Am Heart J. 2008;155(2):310–5.CrossRefGoogle Scholar
  31. 31.
    Stein PD, Beemath A, Olson RE. Obesity as a risk factor in venous thromboembolism. Am J Med. 2005;118(9):978–80.CrossRefGoogle Scholar
  32. 32.
    Kane-Gill SL, Wytiaz NP, Thompson LM, et al. A real-world, multicenter assessment of drugs requiring weight-based calculations in overweight, adult critically ill patients. Sci World J. 2013; 30. Scholar
  33. 33.
    Graves KK, Edholm K, Johnson SA. Use of oral anticoagulants in obese patients. JSM Atheroscler. 2017;2(4):1035.Google Scholar
  34. 34.
    Hurewitz AN, Khan SU, Groth ML, et al. Dosing of unfractionated heparin in obese patients with venous thromboembolism. J Gen Intern Med. 2011;26(5):487–91.CrossRefGoogle Scholar
  35. 35.
    Michota F, Merli G. Anticoagulation in special patient populations: are special dosing considerations required? Cleve Clin J Med. 2005;72(Suppl 1):S37–42.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of PharmacyUniversity of OtagoDunedinNew Zealand
  2. 2.SpringerAucklandNew Zealand

Personalised recommendations