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International Journal of Clinical Pharmacy

, Volume 33, Issue 6, pp 918–924 | Cite as

Drug dosing and monitoring in obese patients undergoing allogenic stem cell transplantation

  • Claudia LangebrakeEmail author
  • Friederike Bernhardt
  • Michael Baehr
  • Nicolaus Kröger
  • Axel R. Zander
Review Article

Abstract

Background The effects of physiological changes in patients with obesity on pharmacokinetic parameters and the time course of drug response, especially in the field of haematology/oncology, are poorly understood. For some antimicrobial drugs, dosing considerations exist, while for cytostatic drugs, dose modifications for obese patients are not consistently recommended. Glomerular filtration rate and renal perfusion appear to be similar in obese and normal weight individuals, thus elimination of hydrophilic and extensively renally cleared drugs mainly depends upon creatinine clearance. Aim of the review To provide information about drug dosing in morbidly obese patients undergoing allogenic haematopoietic stem cell transplantation and to develop dosing recommendations for those patients, based on literature data, pharmacokinetic properties and own experiences. Method A review on the literature on drug dosing in obese patients as well as on the pharmacokinetic properties of drugs which are supposed to be used in the field of stem cell transplantation was combined with own data on drug dosing and pharmacokinetic drug monitoring in a morbidly obese patient undergoing matched-unrelated allogenic peripheral blood stem cell transplantation. Results For hydrophilic and extensively renally cleared drugs (e.g. piperacillin/sulbactam, cotrimoxazole, fludarabine) standard dosages for adult patients or dosing based on ideal body weight (IBW) (e.g. aciclovir, methotrexate) can be used. For ciclosporin and digitoxin we could show that high initial doses are needed to achieve sufficient plasma concentrations. After steady state distribution was completed, maintenance doses comparable to normal weight patients are sufficient. Likewise, distribution of enoxaparin and phenytoin seems to take longer in obese patients. Dosing recommendations of 25 drugs that can be used in morbidly obese patients undergoing allogenic stem cell transplantation are given. Conclusions Pharmacotherapy in morbidly obese patients undergoing allogenic stem cell transplantation is possible, if pharmacokinetic properties of the drugs are considered and close monitoring of plasma concentrations is performed.

Keywords

Drug dosing Obesity Pharmacokinetics Stem cell transplantation 

Notes

Acknowledgments

We thank Dr. Hilke Andresen for the quantification of busulfan plasma concentrations.

Funding

No external funding.

Conflicts of interest

There are no conflicts of interest to declare.

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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Claudia Langebrake
    • 1
    • 2
    Email author
  • Friederike Bernhardt
    • 1
  • Michael Baehr
    • 2
  • Nicolaus Kröger
    • 1
  • Axel R. Zander
    • 1
  1. 1.Clinic for Stem Cell TransplantationUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.PharmacyUniversity Medical Center Hamburg-EppendorfHamburgGermany

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