How Does Weight Affect Volume Of Distribution Effect of obesity on the pharmacokinetics of drugs in humans Clin Pharmacokinet 2010 49 2 71 87 doi BSA ideal bodyweight IBW percent IBW adjusted bodyweight lean bodyweight LBW and predicted normal weight PNWT An understanding of how the volume of distribution V d of a drug changes in the obese is critical as this
The volume of distribution Vd is a pharmacokinetic parameter representing an individual drug s propensity to either remain in the plasma or redistribute to other tissue compartments By definition Vd is a proportionality constant that relates the total amount of drug in the body to the plasma concentration of the drug at a given time 1 2 3 The following equation can represent Vd Volume of distribution is important for determining the loading dose and clearance is important to determine the maintenance dose Body composition and drug clearance Body composition changes with total body weight Normal weight patients have a total body weight consisting of lean and adipose body weight in an approximate 4 1 ratio
How Does Weight Affect Volume Of Distribution
How Does Weight Affect Volume Of Distribution
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Volume of distribution is a pharmacokinetic concept which is used to describe the distribution of drugs in the body as relative to the measured concentration In brief it is the apparent volume into which the drug appears to be distributed when only the sample concentration is considered It is a purely theoretical volume which can substantially exceed the total body volume or potentially Effect on distribution Increased volume of distribution for lipid soluble drugs Increased accumulation of drugs in the fat compartment Blood flow in fat is poor in people of normal weight it is only about 5 of the total cardiac output In obese individuals blood flow to fat is even poorer
Obesity affects all four aspects of pharmacokinetics As drug administration based on total body weight can result in in underdosing or overdosing depending on the characteristics of the drug weight based dosing scalars must be considered Lean body weight is the optimal scalar for most IV opioids and anaesthetics In obese compared with normal weight individuals the total volume of distribution Vd is moderately increased aminoglycosides caffeine or similar H2 blockers neuromuscular blockers but the Vd corrected by kilogram of actual bodyweight is significantly smaller These drugs distribute to a limited extent in excess bodyweight
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TBW dosing in obese patients can result in excessively high remifentanil concentrations causing side effects such as apnoea chest rigidity bradycardia and hypotension Paracetamol Paracetamol Vd is increased in obesity and in males relative to females Clearance increases with body weight and therefore is much greater in obese patients and 2 1 Volume of Distribution The volume of distribution V d is the term used to relate the total amount of a drug in the body to the concentration of the drug in a given compartment The pharmacokinetic behaviour of most drugs is best described by a multi compartment model as opposed to the simpler model containing only one compartment
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