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ScientificWorldJournal. 2013 Nov 30;2013:909135. doi: 10.1155/2013/909135. eCollection 2013.

A real-world, multicenter assessment of drugs requiring weight-based calculations in overweight, adult critically ill patients.

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Department of Pharmacy, Translational Science Institute and Critical Care Medicine, Schools for Pharmacy and Medicine, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, PA 15261, USA ; Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
West Penn Allegheny Health System, The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
Banner MD Anderson Cancer Center, 2946 E. Banner Gateway Drive, Gilbert, AZ 85234, USA.
The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, NY 11201, USA.
Banner Good Samaritan Medical Center, Department of Pharmacy, 1111 E. McDowell Road, Phoenix, AZ 85006, USA.
Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, 75 DeKalb Avenue, Brooklyn, NY 11201, USA ; Kingsbrook Jewish Medical Center, 585 Schenectady Avenue, Brooklyn, NY 11203, USA.
Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA ; University of Pittsburgh, School of Pharmacy, 3501 Terrace Street, Pittsburgh, PA 15261, USA.


Prescribing appropriate doses of drugs requiring weight-based dosing is challenging in overweight patients due to a lack of data. With 68% of the US population considered overweight and these patients being at an increased risk for hospitalization, clinicians need guidance on dosing weight-based drugs. The purpose of this study was to identify "real-world" dose ranges of high-risk medications administered via continuous infusion requiring weight-based dosing and determine the reasons for dosing changes (ineffectiveness or adverse drug reactions). A prospective, multicenter, observational study was conducted in four intensive care units at three institutions. A total of 857 medication orders representing 11 different high-risk medications in 173 patients were reviewed. It was noted that dosing did not increase in proportion to weight classification. Overall, 14 adverse drug reactions occurred in nine patients with more in overweight patients (9 of 14). A total of 75% of orders were discontinued due to ineffectiveness in groups with higher body mass indexes. Ineffectiveness leads to dosing adjustments resulting in the opportunity for medication errors. Also, the frequent dosing changes further demonstrate our lack of knowledge of appropriate dosing for this population. Given the medications' increased propensity to cause harm, institutions should aggressively monitor these medications in overweight patients.

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