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Are Prescription Drug Doses Based on Patient Weight?

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  • Written By: Mary McMahon
  • Edited By: O. Wallace
  • Last Modified Date: 17 November 2016
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All drug dosages must account for the weight of the patient, because weight plays a role in the distribution of the drug in the body's tissues. Prescription drugs are no exception to this rule, but many are designed to be suitable for patients in an “average” weight range, so that precise dosages do not need to be calculated. This is designed to make it easier for patients to use the drugs, and to make it easier for pharmacists to package them. In some cases, weight may be an important factor in the prescription, in which case the doctor will discuss it with the patient.

In the hospital, medical staffers can calculate drug doses very precisely. There are many drugs which are primarily used in the hospital, and they include dosage recommendations which usually indicate the weight of the patient in kilograms, as in “60 milligrams per kilogram.” When these drugs are prescribed, the doctor must do the math to calculate the dosage correctly, and the administering nurse or doctor may check the calculation to confirm that it is correct.

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In the case of prescription drugs, asking pharmacists to formulate precise drug doses is not always practical, and sometimes patients have difficulties adhering to a drug regimen if they are obligated to deal with calculations about drug dosage. Liquid medications can be more easily adjusted for patient weight, which is why many drugs for children come in liquid form, so that a doctor can prescribe “two teaspoons daily” or “10 cubic centimeters (CCs) twice a day.” This flexibility is key when one considers that the same drug might be used to treat infections in toddlers, young children, and adolescents: obviously, an adolescent dosage would be way too high for a toddler, while a toddler dosage would be useless for an adolescent.

Pills may also be periodically adjusted to accommodate patient weights which fall outside the normal spectrum. When patients are asked to take half a pill or a pill and a half a day, it reflects a desire on the part of the doctor to achieve drug doses which are as close as possible to the recommended amount. With some drugs, a pharmacist can also create a custom compound which does allow for very precise dosage calculations, but compounding pharmacists are increasingly rare.

There are two concerns with drug doses. The first is that in an unusually slender patient, a normal dosage might be too much, increasing the side effects for the patient and potentially contributing to patient discomfort. Slender patients may also be at risk for an overdose in some cases. In larger patients, the issue is that the drug may become too diluted, necessitating a dosage which is somewhat larger than that calculated to suit patients in the normal range.

Communicating with a doctor about how a drug is working is critical, as it is possible to adjust drug doses if a drug is not working for a patient. It is also important to follow directions from a prescribing doctor very closely, to ensure that the dosage is correct. Patients who are unclear about how to administer a drug should not be afraid to ask for a demonstration from their doctors.

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bythewell
Post 3

@Iluviaporos - I'm sure that for crucial drugs doctors are more discerning about body weight. I know I get weighed every time I go to the doctor, so they probably do take it into account to some extent when issuing medication.

This is something that people should probably keep in mind at home as well, since it's probably easy for someone who is very slender to take too many painkillers by accident.

lluviaporos
Post 2

@Fa5t3r - I've never thought about this before, but I wonder if it's possible that the so-called super-bug epidemic we're currently experiencing is due in part to this. I know that antibiotic resistant bacteria often evolve through people stopping their medication before the course is over, because it allows the stronger, more resistant organisms to survive and eventually dominate.

If some patients are being given doses of antibiotic that are too low for their body-weight then the same effect might be occurring. And considering how many people are supposed to be overweight at the moment in Western countries this could be happening on a huge scale.

Fa5t3r
Post 1

It is quite shocking how rarely doctors seem to take weight into account when prescribing standard medications. Ignoring a person's weight does not make it go away and it's hardly surprising that someone who might weigh more than twice the average (whether because they are tall, fat or muscular) will need twice the average dose of medication.

If they receive the wrong dose it can have serious complications for them, particularly if it's for something urgent like an infection or heart disease.

There are enough people outside the average range for this to be taken more seriously as a problem by the medical community. Frankly, I think the fact that it isn't is due to prejudice.

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