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How can we greatest deal with infectious illnesses in folks with weight problems? Hospital pharmacist and Ph.D. researcher Koen van Rhee studied how weight problems impacts blood ranges of two generally used medicines. He additionally developed a technique for pharmaceutical firms to check new medicine on this affected person group.
When you find yourself in ache, you are taking two 500 mg paracetamol tablets 4 instances a day. That very same dosage applies to folks with extra weight. Another medicines, equivalent to antibiotics, are adjusted based mostly on body weight.
“The idea is that a heavier person sometimes needs more of a drug to reach the same concentration in the blood. But that’s not always the case,” Van Rhee explains. “Sometimes, bodyweight has little effect on how a drug is distributed or eliminated, while for other medicines, the impact is significant.” An incorrect adjustment could make a therapy much less efficient or trigger extra negative effects.
For a lot of medicines, it has not been correctly studied whether or not weight problems impacts how they work. In his Ph.D. analysis, Van Rhee centered on the antibiotic ciprofloxacin and the antifungal drug fluconazole. “With infectious diseases, it is crucial to get the dosage right immediately. For a condition like high blood pressure, it’s less of a problem if the dosage is adjusted later, but in a severe infection, there is usually no time for that.”
Adjusting dosage isn’t at all times mandatory
One placing discovering was that some medicines are incorrectly dosed based mostly on body weight. “We found that certain infection treatments are prescribed per kilogram of bodyweight, even though their breakdown is not affected by a higher weight. This means that some patients receive unnecessarily high doses, which can lead to side effects,” Van Rhee says.
Then again, there are medicines the place weight does matter, however the bundle insert doesn’t suggest an adjusted dose for folks with weight problems.
Why has this by no means been studied earlier than?
Pharmaceutical firms routinely take a look at how medicines work in teams equivalent to youngsters, aged, and other people with liver or kidney issues. Nonetheless, when registering new medicine, it isn’t but obligatory to systematically research the results of weight problems—though that is beginning to obtain extra consideration.
“One reason is that obesity was less common in the past,” Van Rhee says. “Now, 13% of the world’s population has obesity, so it has become an important issue to investigate.”
Sufferers who’ve had weight-loss surgical procedure: A particular analysis group
To measure how weight impacts drug focus within the physique, Van Rhee studied sufferers who had undergone weight-loss surgical procedure. “This group has a high bodyweight but is otherwise relatively healthy. This allows us to study the effects of obesity without interference from other conditions like kidney problems.” His analysis confirmed that ciprofloxacin, for instance, isn’t damaged down extra shortly in folks with weight problems, that means the usual dosage is protected.
Why weight problems impacts drug effectiveness in numerous methods isn’t at all times simple to foretell, Van Rhee says. “We know that obesity can influence how the body functions. However, the effects vary greatly between medicines, sometimes even among drugs that seem quite similar. That makes it difficult to come up with one general rule.”
Van Rhee argues that the influence of weight problems must be routinely studied in drug improvement. “We already do this for kidney and liver diseases, so why not for obesity?” In keeping with him, this does not should be a significant funding.
“Our computer simulations show that just six to 12 patients with obesity can already provide valuable insights into the correct dosage. That should be feasible for pharmaceutical companies. This way, we can ensure that everyone gets the right dose, regardless of bodyweight.”
Van Rhee will defend his thesis, titled “Unravelling the drivers of antimicrobial pharmacokinetic variability in individuals with obesity and hospitalised patients with multimorbidity,” on 19 February 2025. His supervisor at Leiden College is Professor Catherijne Knibbe.
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Weight problems and drugs: When does body weight matter? (2025, February 17)
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