Je obezita a malnutrice u geriatrických pacientů problémem z hlediska dávkování analgetik?
Authors:
Eliška Dvořáčková
Authors‘ workplace:
Pracoviště klinického farmaceuta, Nemocnice Na Františku, Praha
; Oddělení klinické farmacie a farmakologie, Farmakologický ústav 1. LF UK a VFN v Praze
Published in:
Čas. Lék. čes. 2024; 162: 32-37
Category:
Review Articles
Overview
Both obesity and malnutrition in the elderly population are raising concerns. As majority of pharmacokinetic data are obtained from subjects with a healthy weight range in productive age, administration of correct dosing of drugs to obese elderly patients is quite challenging.
All phases of the pharmacokinetics of drugs (absorption, distribution, metabolism and elimination) are potentially affected by the effect of aging but also by obesity or malnutrition. These changes are often potentiated in the case of a combination of obesity and older age. The problem is also that not all drugs are affected in the same way, therefore it is necessary to know the influence of age and obesity on the kinetics of the particular substance being assessed. 50% of seniors suffer from pain at home and up to 80% during hospitalization. In addition to general knowledge about the effect of age but also obesity and malnutrition on the kinetics of drugs, this overview presents the pharmacokinetic changes of analgesics caused by both obesity and malnutrition.
Keywords:
obesity, malnutrition, older people, drug dosage, analgesics, pharmacokinetics
Sources
1. Ferraro KF, Su Y-P, Gretebeck RJ et al. Body mass index and disability in adulthood: a 20–year panel study. Am J Public Health 2002; 92: 834––840.
2. Malazonia M, Anuashvili A, Vashakmadze N et al. Assessment of nutritional status in the elderly, causes and management of malnutrition in the elderly. In: Corpas E (ed.). Endocrinology of Aging. Clinical aspect in diagrams and images. Elsevier, 2021: 651–687.
3. Semla TP, Steinman M, Beizer J et al.; American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2019; 67: 674–694.
4. O’Mahony D, Cherubini A, Guiteras AR et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med 2023; 14: 625–632.
5. Multiple Choice Questions. Continuing education in anaesthesia. Anaesth Crit Care Pain Med 2004; 4: 169–171.
6. Gouju J, Legeay S. Pharmacokinetics of obese adults: not only an increase in weight. Biomed Pharmacother 2023; 166: 115281.
7. Elias K, Hellström PM, Webb DL et al. Gastrointestinal physiology before and after duodenal switch with comparisons to unoperated lean controls: novel use of the smartpill wireless motility capsule. Obes Surg 2021; 31: 3483–3489.
8. Verdich C, Lysgård Madsen J et al. Effect of obesity and major weight reduction on gastric emptying. Int J Obes 2000; 24: 899–905.
9. Buchholz V, Berkenstadt H, Goitein D et al. Gastric emptying is not prolonged in obese patients. Surg Obes Relat Dis 2013; 9: 714–717.
10. Bluemel S, Menne D, Milos G et al. Relationship of body weight with gastrointestinal motor and sensory function: studies in anorexia nervosa and obesity. BMC Gastroenterol 2017; 17: 4.
11. Tosetti C, Corinaldesi R, Stanghellini V et al. Gastric emptying of solids in morbid obesity. Int J Obes 1996; 20: 200–205.
12. Oshikoya KA, Senbanjo IO. Pathophysiological changes that affect drug disposition in protein-energy malnourished children. Nutr Metab 2009; 6: 50.
13. Krishnaswamy K. Drug metabolism and pharmacokinetics in malnourished children: Clin Pharmacokinet 1989; 17: 68–88.
14. Lu CX, An XX, Yu Y et al. Pooled analysis of gastric emptying in patients with obesity: implications for oral absorption projection. Clin Ther 2021; 43: 1768–1788.
15. Steenackers N, Wauters L, Van Der Schueren B et al. Effect of obesity on gastrointestinal transit, pressure and pH using a wireless motility capsule. Eur J Pharm Biopharm 2021; 167: 1–8.
16. Washington CB, Duran GE, Man MC et al. Interaction of anti-HIV protease inhibitors with the multidrug transporter P-glycoprotein (P-gp) in human cultured cells: J Acquir Immune Defic Syndr 1998; 19: 203–209.
17. Strong DR, David SP, Johnstone EC et al. Differential efficacy of nicotine replacement among overweight and obese women smokers. Nicotine Tob Res 2015; 17: 855–861.
18. Kinirons MT, O’Mahony MS. Drug metabolism and ageing. Br J Clin Pharmacol 2004; 57: 540–544.
19. Abernethy DR, Greenblatt DJ. Ibuprofen disposition in obese individuals. Arthritis Rheum 1985; 28: 1117–1121.
20. Abernethy DR, Divoll M, Greenblatt DJ et al. Obesity, sex, and acetaminophen disposition. Clin Pharmacol Ther 1982; 31: 783–790.
21. McLachlan AJ, Pont LG. Drug metabolism in older people –a key consideration in achieving optimal outcomes with medicines. J Gerontol A Biol Sci Med Sci 2012; 67: 175–180.
22. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and clinical significance. J Parenter Enteral Nutr 2019; 43: 181–193.
23. Kok WE, Haverkort EB, Algra YA et al. The association between polypharmacy and malnutrition(risk) in older people: a systematic review. Clin Nutr ESPEN 2022; 49: 163–171.
24. Gonzalez MC, Correia MITD, Heymsfield SB. A requiem for BMI in the clinical setting. Curr Opin Clin Nutr Metab Care 2017; 20: 314–321.
25. Pilková A, Hartinger JM. Změny farmakokinetiky léčiv u obézních pacientů. Vnitr Lek 2020; 66: 465–471.
26. Han PY, Duffull SB, Kirkpatrick CMJ et al. Dosing in obesity: a simple solution to a big problem. Clinl Pharmacol Ther 2007; 82: 505–508.
27. Pai MP. Estimating the glomerular filtration rate in obese adult patients for drug dosing. Adv Chronic Kidney Dis 2010; 17: e53–62.
28. Khaled D, Mohamed O, Alaa I et al. Opioid free anesthesia versus opioid based anesthesia for hemodynamic stability in geriatric patients undergoing arthroscopic shoulder Surgery, a randomized comparative study. Egypt J Anaesth 2023; 39: 626–634.
29. Shibutani K, Inchiosa MA, Sawada K et al. Pharmacokinetic mass of fentanyl for postoperative analgesia in lean and obese patients. Br J Anaest 2005; 95: 377–383.
30. Heiskanen T, Mätzke S, Haakana S et al. Transdermal fentanyl in cachectic cancer patients. Pain 2009; 144: 218–222.
31. Pergolizzi J, Böger RH, Budd K et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an international expert panel with focus on the six clinically most often used World Health Organization step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract 2008; 8: 287–313.
32. De Hoogd S, Välitalo PAJ, Dahan A et al. Influence of morbid obesity on the pharmacokinetics of morphine, morphine-3-glucuronide, and morphine-6-glucuronide. Clin Pharmacokinet 2017; 56: 1577–1587.
33. Xia S, Choe D, Hernandez L et al. Does initial hydromorphone relieve pain best if dosing is fixed or weight based? Ann Emerg Med 2014; 63: 692–698.e4.
34. Swart LM, van der Zanden V, Spies PE et al. The comparative risk of delirium with different opioids: a systematic review. Drugs Aging 2017; 34: 437–443.
35. Freo U, Furnari M, Ambrosio F et al. Efficacy and tolerability of tapentadol for the treatment of chronic low back pain in elderly patients. Aging Clin Exp Res 2021; 33: 973–982.
36. Porażka J, Szałek E, Połom W et al. Influence of obesity and type 2 diabetes mellitus on the pharmacokinetics of tramadol after single oral dose administration. Eur J Drug Metab Pharmacokinet 2019; 44: 579–584.
37. Nightingale CE, Margarson MP, Shearer E et al. Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia. Anaesthesia 2015; 70: 859–876.
38. American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 2009; 57: 1331–1346.
39. Mian P, Allegaert K, Spriet I et al. Paracetamol in older people: towards evidence-based dosing? Drugs Aging 2018; 35: 603–624.
40. Nash E, Sabih A, Chetwood J et al. Drug‐induced liver injury in Australia, 2009–2020: the increasing proportion of non‐paracetamol cases linked with herbal and dietary supplements. Med J Aust 2021; 215: 261–268.
41. Reidy K, Kang HM, Hostetter T et al. Molecular mechanisms of diabetic kidney disease. J Clin Invest 2014; 124: 2333–2340.
42. Gaertner J, Stamer UM, Remi C et al. Metamizole/dipyrone for the relief of cancer pain: a systematic review and evidence-based recommendations for clinical practice. Palliat Med 2017; 31: 26–34.
43. Kötter T, Da Costa BR, Fässler M et al. Metamizole-associated adverse events: a systematic review and meta-analysis. PLoS One 2015; 10: e0122918.
44. Bäckström M, Hägg S, Mjörndal T et al. Utilization pattern of metamizole in northern Sweden and risk estimates of agranulocytosis. Pharmacoepidemiol Drug Saf 2002; 11: 239–245.
45. Zylber-Katz E, Granit L, Stessman J et al. Effect of age on the pharmacokinetics of dipyrone. Eur J Clin Pharmacol 1989; 36: 513–516.
46. Motter FR, Hilmer SN, Paniz VMV. Pain and inflammation management in older adults: a Brazilian consensus of potentially inappropriate medication and their alternative therapies. Front Pharmacol 2019; 10: 1408.
47. Willis JV, Kendall MJ. Pharmacokinetic studies on diclofenac sodium in young and old volunteers. Scand J Rheumatol 1978; 7: 36–41.
48. Goldwater R, Kramer WG, Hamilton DA et al. A phase I study evaluating the effect of age and weight on the pharmacokinetics of an injectable formulation of diclofenac solubilized with hydroxypropyl-β-cyclodextrin. Clin Pharmacol 2016; 8: 203–212.
49. Ribeiro H, Rodrigues I, Napoleão L et al. Non-steroidal anti-inflammatory drugs (NSAIDs), pain and aging: adjusting prescription to patient features. Biomed Pharmacother 2022; 150: 112958.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain managementArticle was published in
Journal of Czech Physicians
Most read in this issue
- Polypragmazie a jak jí předcházet
- Akatizie – častý, ale obtížně rozpoznatelný nežádoucí účinek?
- Geografie zdraví – průzkum prostorových nerovností ve zdraví v Česku
- Je obezita a malnutrice u geriatrických pacientů problémem z hlediska dávkování analgetik?