Drug Dosing in the Critically Ill Obese Patient

Unfortunately, research related to drug dosing in overweight and obese patients has not kept pace with studies concerning the epidemiology and complications of obesity. The pivotal trials leading to drug approval typically include relatively few patients with extremes of weight relative to height. They usually focus on patients in non-ICU settings, and in some cases specifically exclude patients beyond a predefined weight. Furthermore, when the results of clinical trials are reported, patient weights are usually expressed in terms of summary statistics. Although patient weight is often the focus of discussions of drugs administered using weight-based dosing regimens, other factors such as height and body composition must be taken into account. As much as possible and practical, the way in which weight is estimated, measured, recorded, and utilized for drug dosing should be standardized to reduce variability that might lead to dosing errors.