Dosing of medications in morbidly obese patients in the intensive care unit setting

Intensive Care Med. 2004 Jan;30(1):18-32. doi: 10.1007/s00134-003-2059-6. Epub 2003 Nov 19.


Objective: To derive recommendations for the dosing of commonly used medications in the morbidly obese patient in the ICU.

Data sources: Articles were obtained through computerized searches involving MEDLINE. The bibliographies of retrieved publications and textbooks were reviewed for additional references.

Study selection: All studies involving the pharmacokinetics or pharmacodynamics of medications in obese subjects or patients.

Data extraction: The emphasis was on studies involving morbidly obese patients but, in the absence of such data, investigations involving lesser forms of obesity were extracted.

Data synthesis: There is a paucity of data upon which to make recommendations for dosing commonly used medications in the morbidly obese patient in the ICU, although recommendations were provided based on the available information.

Conclusions: There is clearly a need for more investigations involving dosing regimens of medications in the morbidly obese population. Until such studies are available, the clinician must try to derive the best dosing regimens for medications based on the limited pharmacokinetic data available for some agents and clinical judgement.

Publication types

  • Review

MeSH terms

  • Analgesics, Opioid / pharmacokinetics
  • Analgesics, Opioid / pharmacology
  • Analgesics, Opioid / therapeutic use
  • Anti-Infective Agents / pharmacokinetics
  • Anti-Infective Agents / pharmacology
  • Anti-Infective Agents / therapeutic use
  • Anticoagulants / pharmacokinetics
  • Anticoagulants / pharmacology
  • Anticoagulants / therapeutic use
  • Anticonvulsants / pharmacokinetics
  • Anticonvulsants / pharmacology
  • Anticonvulsants / therapeutic use
  • Body Weight
  • Cardiovascular Agents / pharmacokinetics
  • Cardiovascular Agents / pharmacology
  • Cardiovascular Agents / therapeutic use
  • Critical Care / methods*
  • Critical Care / standards
  • Drug Administration Schedule
  • Drug Interactions
  • Drug Monitoring / methods*
  • Drug Monitoring / standards
  • Fibrinolytic Agents / pharmacokinetics
  • Fibrinolytic Agents / pharmacology
  • Fibrinolytic Agents / therapeutic use
  • Gastrointestinal Agents / pharmacokinetics
  • Gastrointestinal Agents / pharmacology
  • Gastrointestinal Agents / therapeutic use
  • Humans
  • Metabolic Clearance Rate
  • Obesity, Morbid / drug therapy*
  • Obesity, Morbid / metabolism
  • Practice Guidelines as Topic
  • Respiratory System Agents / pharmacokinetics
  • Respiratory System Agents / pharmacology
  • Respiratory System Agents / therapeutic use


  • Analgesics, Opioid
  • Anti-Infective Agents
  • Anticoagulants
  • Anticonvulsants
  • Cardiovascular Agents
  • Fibrinolytic Agents
  • Gastrointestinal Agents
  • Respiratory System Agents