Nature Medicine | Spoonful of Medicine

Mysteries about drug metabolism in the obese weigh on doctors

By Alisa Opar

The surgery was a success, but a question loomed after the procedure: given that the patient was obese, what was the right antibiotic dose? “The thought was, well, she’s twice as big as a normal person, so we’ll give her twice the dose,” says Aaron Cook, a clinical pharmacy specialist at the University of Kentucky in Lexington. “For that drug, levofloxacin, there’s just no information to go on, no dosage recommendation for obese patients.”

The patient fared well, but such conundrums are becoming increasingly common as obesity rates rise around the globe. Just a month ago, researchers released new figures estimating that the US will see an additional 65 million obese individuals by 2030 (Lancet 378, 815–825, 2011). Already in the country approximately one in three adults and one in six children are obese—a condition that can precipitate heart disease, diabetes, respiratory failure and other illnesses that often require medication. But experts say that merely doubling the dose isn’t the solution because the physiological changes that accompany obesity, such as increases in the volume of blood pumped by the heart and fat mass, can in turn lead to changes drug absorption and metabolism.

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