Pharmacological Prescription Dilemmas in Obese Children and Adolescents

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.