Pharmacological Prescription Dilemmas in Obese Children and Adolescents

  • Patrícia Lipari Pinto Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte, EPE
  • Solange Alves Departamento de Farmacologia Clínica, Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte, EPE
  • Ricardo M. Fernandes Unidade de Alergologia, Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte, EPE. Unidade de Farmacologia Clínica, Instituto de Medicina Molecular, Universidade de Lisboa.
  • Helena Fonseca Unidade de Medicina do Adolescente, Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte, EPE

Abstract

Paediatric obesity is a serious public health concern.

We daily face the need to medicate obese children, whether in the context of acute or chronic diseases.

Prescribing in these patients becomes a real challenge as there are scarce specific recommendations available to optimise drug dosing. The main pharmacokinetic parameter which is altered in obesity is the volume of distribution, determined by the physiochemical properties of the drug, such as lipophilicity and protein binding.

There is no single size descriptor that is undeniably better for dosing drugs in obese patients. We searched for the terms children, pharmacokinetic, obesity, overweight, body mass index, lean body weight, ideal body weight and specific drugs in the PubMed, Medline and Cochrane databases between 2006 and 2016. A chart to identify the most adequate body size descriptor for different types of drugs is proposed, providing foundations for safer drug dose calculation. There is an urgent need to raise awareness for prescription rationality and harmonising the current existing guidelines.

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Author Biographies

Patrícia Lipari Pinto, Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte, EPE

Médica Interna de Pediatria. Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte, EPE

Solange Alves, Departamento de Farmacologia Clínica, Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte, EPE

Médica interna de formação específica de Farmacologia Clínica. Departamento de Farmacologia Clínica, Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte, EPE

Ricardo M. Fernandes, Unidade de Alergologia, Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte, EPE. Unidade de Farmacologia Clínica, Instituto de Medicina Molecular, Universidade de Lisboa.

Assistente Hospitalar de Pediatria e Professor Auxiliar. Unidade de Alergologia, Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte, EPE. Unidade de Farmacologia Clínica, Instituto de Medicina Molecular, Universidade de Lisboa.

Helena Fonseca, Unidade de Medicina do Adolescente, Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte, EPE

Assistente Hospitalar Graduada Sénior de Pediatria. Unidade de Medicina do Adolescente, Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria – Centro Hospitalar de Lisboa Norte, EPE

Published
2018-11-06
Section
Review articles