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Acyclovir dosing in obesity – Prospective, Controlled Study of Acyclovir Pharmacokinetics in Obese Patients

Participants were predominately clinical pharmacists. Antimicrobial dosing considerations in obese adult patients.

Matthew Cox
Friday, March 5, 2021
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  • There were no differences in receipt or type of IV hydration or concomitant nephrotoxic agents, other than receipt of vancomycin.

  • Show AMA citation.

  • Study Start Date :. A large scale, placebo-controlled, dose-ranging trial of peroral valaciclovir for episodic treatment of recurrent herpes genitalis.

INTRODUCTION

Read our disclaimer for details. Am Heart J. Quantification of lean bodyweight.

J Infect Dis — However, patients in both groups had comparable vancomycin dosing and trough concentrations. Doskng optimal model was utilized to generate simulated data for estimation of the individual patients' IC 50 s at steady state with h dosing intervals. Patients receiving acyclovir as standard of care will be enrolled into this study. Oxford University Press is a department of the University of Oxford. The purpose of this study was to determine the prevalence of and risk factors for acyclovir-associated nephrotoxicity in an adult population at the University of Mississippi Medical Center UMMC. View all jobs.

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Information from the Obesitty Library of Medicine To learn more about this study, you or your obesity may contact the study research staff using the contact information provided by the sponsor. J Antimicrob Chemother 44 — The absolute dose nonnormalized was utilized as the input variable for all analyses. Patients were identified through use of clinical decision support software TheraDoc. Included patients were analyzed to determine the frequency of IV acyclovir—associated nephrotoxicity.

Our study suggests that, in institutions that frequently utilize IV acyclovir, antimicrobial stewardship should target obese patients acycloivr concomitant vancomycin. Clin Infect Dis 58 — Categorical data were analyzed using the chi-square or Fisher exact test, and continuous data were analyzed using the Student t test or Mann-Whitney U test, as appropriate. Concomitant vancomycin receipt and obesity led to higher rates of toxicity.

References and Additional Reading

Get Email Updates. Contacts and Locations. Antimicrobial dosing considerations in obese adult patients. As always, reasonable clinical judgment is required in conjunction with this information. For general information, Learn About Clinical Studies.

For general information, Learn About Clinical Studies. The objective of this study was to acylcovir the currently recommended dosing strategy for i. The patients were divided into 2 groups: those who developed toxicity cases and those who did not controls. Abstract The current recommendations for intravenous i. Patient characteristics are listed in Table 1. Antimicrobial dosing considerations in obese adult patients: insights from the Society of Infectious Diseases Pharmacists.

Acyclovir was prepared in ml of 0. More on this topic Association Between Vancomycin Area Under the Curve and Nephrotoxicity: a single center, retrospective cohort study in a veteran population. Save this study. An abstract presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy in suggested that morbidly obese patients should be dosed according to IBW based upon excessive acyclovir concentrations in 7 morbidly obese vs 5 normal-weight patients utilizing ABW [ 4 ].

Estimated Enrollment :. Rasburicase Home Academy Blog About. Dosing of medications in morbidly obese patients in the intensive care unit setting.

Note that achievement of this target is based connection refused samples collected from blood and is likely different from Acgclovir parameters in other body compartments. This work was supported by internal funding. Blood samples were immediately placed on ice and subsequently centrifuged for isolation of plasma by the WVU Health Sciences Biospecimen Processing Core. Author information Article notes Copyright and License information Disclaimer.

Levothyroxine J Antimicrob Chemother. Conclusions: Intravenous dozing of acyclovir for herpes encephalitis poverty obesity connection refused variable, especially in obese patients, and does not reflect recommendations. The purpose of this page is to serve as a dynamic, growing repository of evidence-based recommendations regarding medication dosing in obese patients. Save this study. Federal Government.

Acyclovir pharmacokinetics. Both vancomycin receipt and obesity were independent risk factors for the development for acyclovir-associated nephrotoxicity, leading to numerically increased length of hospital stay and statistically increased length of stay after acyclovir initiation. Antimicrob Agents Chemother 19 — The current recommendations for intravenous i.

Estimated Primary Completion Date :. Casati A, Putzu M. Conclusions: Intravenous dosing of acyclovir for herpes encephalitis is variable, especially in obese patients, and does not reflect recommendations. Lean body mass is a major determinant of levothyroxine dosage in the treatment of thyroid diseases. Erstad BL.

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Clin Infect Dis 58 — Several important limitations exist in this study. August 25, Key Record Dates. Obesity is a major medical issue nationally, leading to health complications, morbidity, and mortality. Please check for further notifications by email. Am J Health Syst Pharm ; 66 : —

Obesity is a major medical issue nationally, leading to health complications, morbidity, and mortality. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. The only previous study evaluating dosing in MO patients was presented in abstract form in by Davis and colleagues Pharmacokinetics and tolerance of acyclovir, a new anti-herpesvirus agent, in humans. However, the effect of obesity has not been definitively defined, though several case reports have suggested that weight may be the culprit [ 1112 ]. On January 1,the Joint Commission released standards recommending antibiotic timeout at 48 hours as part of a targeted antimicrobial stewardship effort [ 15 ]. Systemic clearance was substantially higher in the obese than normal-weight patients mean,

Obseity vancomycin receipt and obesity were independent risk factors for the development for acyclovir-associated acyclovir dosing in obesity, leading to numerically increased length of hospital stay and statistically increased length of stay after acyclovir initiation. Sign In. Estimated Study Completion Date :. Acyclovir-induced acute renal failure and the importance of an expanding waist line.

Intensive Care Med. UK Department of Health. Therefore, doses based on total body weight are required to reach the same initial serum concentration Once at goal sedation, continuous infusions should use ideal body weight because midazolam clearance is not affected by total body weight. The dose of succinylcholine in morbid obesity. Dose using ideal body weight and consider less frequent dosing In a study of 6 obese and non-obese patients, methylprednisolone volume of distribution was unaffected by body size, but clearance was significantly reduced in patients with obesity.

Prepublished online Jan Clin Infect Dis 58 pbesity None of the patients in the study acyclovir dosing in obesity febrile or neutropenic or had any signs of viral infection at the time of sampling. National Institutes of Health U. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, andmetabolic risk factors.

Publication types

Blood samples were immediately placed on ice and subsequently centrifuged for isolation of plasma by the WVU Health Sciences Biospecimen Processing Core. Estimated Enrollment :. Patient characteristics are listed in Table 1. Health, United States, with special feature on prescription drugs.

They will have blood acyclovir dosing in obesity once prior to the first dose of acyclovir and 10 times thereafter, over a total time period of 12 hours. Additionally, risk factors for the development of nephrotoxicity, including the effect of obesity and dosing strategy, were assessed. The lower limit of quantitation for acyclovir was 0. To our knowledge, no pharmacokinetic analysis has validated this recommendation. Zovirax Acyclovir Sodium. On January 1,the Joint Commission released standards recommending antibiotic timeout at 48 hours as part of a targeted antimicrobial stewardship effort [ 15 ]. Acyclovir pharmacokinetics in morbid obesity, abstr

Casati A, Putzu M. Ten obese patients and 10 matched control non-obese patients will be enrolled. Layout table for location contacts Contact: Pam Bunner bunnerp wvumedicine. Results: A total of pharmacists participated in the survey, with

MeSH terms

Norepinephrine 9. Arch Neurol. Lastly, if you have primary literature regarding obesity dosing for a medication that ij not listed on this table, please contact me with the drug name and citation and I would be happy to add it to the list. Drug Intell Clin Pharm. Quantification of lean bodyweight.

National Library of Medicine U. Comparative evaluation of atracurium dosed on ideal body weight vs. Fondaparinux Ann Pharmacother. Listing a study does not mean it has been evaluated by the U.

Population pharmacokinetics of colistin methanesulfonate and acyclovir dosing in obesity colistin in critically ill patients from a multicenter study provide dosing suggestions for various categories of patients. Clin Pharmacol Ther. Results: A total of pharmacists participated in the survey, with Please refer to this study by its ClinicalTrials. Erstad BL. Warfarin Accessed July 16,

Most dossing do not have guidelines for morbidly obesity, forcing clinicians connection refused pursue in-depth literature searches in order to decide on a dose. Abstract Background: Dosing of intravenous acyclovir for herpes encephalitis in obese patients is recommended to be based on ideal body weight. Estimated Primary Completion Date :. Daptomycin 72. J Clin Endocrinol Metab.

Department of Health and Human Services. FDA Resources. August 25, Key Record Dates. Most medications do not have guidelines for morbidly obesity, forcing clinicians to pursue in-depth literature searches in order to decide on a dose. The equation is less commonly used than the Devine equation, 30 but is more accurate.

Unfortunately, published PK data specific to obese patients are limited. Prospective, controlled study of acyclovir pharmacokinetics in obese patients. Submit Cancel. Sign In or Create an Account. Acyclovir Zovirax prescribing information. The current recommendations for intravenous i.

An evidence-based drug dosing resource

Unfortunately, no data exist regarding the rates of nephrotoxicity between the potential dosing weights or the specific cause of nephrotoxicity in obesity adult population ie, direct toxicity from acyclovir vs a combination of risk factors. European Commission, Brussels, Belgium. While biomarkers and surrogate endpoints can direct dosing of certain agents, such as antihypertensives and lipid-lowering drugs, no such biomarkers exist for antimicrobials; thus, clinicians must rely on published PK and pharmacodynamic PD data.

Drug Information available for: Acyclovir Acyclovir sodium. Oseltamivir and oseltamivir carboxylate pharmacokinetics in obese adults: dose modification for weight is not necessary. Low-molecular-weight heparins in renal impairment and obesity: available evidence and clinical practice recommendations across medical and surgical settings. Voriconazole Drug Dosing in Obesity Reference Table.

Eligibility Criteria. Get Email Updates. Information from the National Library of Medicine To learn more about this adyclovir, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Patients receiving acyclovir as standard of care will be enrolled into this study. For bolus doses, use total body weight For continuous infusions, use ideal body weight In obese patients, lorazepam volume of distribution increases proportionally to body weight. Although this equation lacks scientific basis, its easy of use at the bedside and extensive use for a variety of medical applications has made it the standard method for estimating lean body mass. Steady-state plasma pharmacokinetics of oral voriconazole in obese adults.

Systemic clearance was substantially higher in the obese than normal-weight patients mean, Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. This single-dose pharmacokinetic study was conducted in an inpatient oncology population.

Phenytoin 219. Study record managers: refer to the Data Element Definitions if submitting registration or results information. Should dosing of rocuronium in obese patients be based on ideal or corrected body weight? Devine BJ.

Dvorchik BH, Damphousse D. Pharmacokinetics of intravenous linezolid in moderately to morbidly obese adults. The acyclovir dosing in obesity of daptomycin in moderately obese, morbidly obese, and matched nonobese subjects. Anesthesia in the obese patient: pharmacokinetic considerations. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Outcome Measures.

Obesity Pharmacol Ther. Dose using toal body weight Vancomycin dose should be adjusted based on vancomycin trough levels once at steady state usually doses. Dose using ideal body weight The use of ideal body weight has been shown to be associated with a more predictable muscle strength recovery within 60 minutes and a lack of need for antagonism compared to total body weight. Dose using ideal body weight and consider less frequent dosing In a study of 6 obese and non-obese patients, methylprednisolone volume of distribution was unaffected by body size, but clearance was significantly reduced in patients with obesity. Lean body mass is a major determinant of levothyroxine dosage in the treatment of thyroid diseases. Daptomycin 72.

Intensive Care Med. Drug Intell Clin Pharm. Therapeutic monitoring of vancomycin in adults summary of consensus recommendations from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Updated July 15,

There were no differences between groups in indication for acyclovir, infection site, time to baseline mentation, or time to lesion size reduction and lesion crusting. Volume 6. It should be noted that genital herpes is commonly treated with oral rather than i. Save this study. Advanced Search. Zovirax Acyclovir Sodium. Drug Intell Clin Pharm 8 —

  • More on this topic Association Between Vancomycin Area Under the Curve and Nephrotoxicity: a single center, retrospective cohort study in a veteran population. Outcome Measures.

  • No dosing change for obesity is required In a study of 20 obese patients, linezolid exposure AUC was no different between obese and non-obese patients. Federal Government.

  • However, patients in both groups had comparable vancomycin dosing and trough concentrations.

  • Average CL for NW patients in our study You have entered an invalid code.

  • Lastly, if you have primary literature regarding obesity dosing for a medication that is not listed on this table, please contact me with the drug name and citation and I would be happy to add it to the list.

All rights reserved. Devine BJ. As always, reasonable clinical judgment is required in conjunction with this information. Should dosing of rocuronium in obese patients be based on ideal or corrected body weight?

Estimated Enrollment :. FDA Resources. Dvorchik BH, Damphousse D. Pharmacokinetics of intravenous linezolid in moderately to morbidly obese adults. Devine BJ.

Serum and urine pharmacokinetics of tigecycline in obese class III and normal weight adults. Methylprednisolone Hide glossary Glossary Study record managers: refer to the Data Element Definitions if submitting registration or results information.

Warning You have reached the maximum number of saved studies Patient connection refused are listed in Table 1. No differences in vancomycin dosing or concentrations were observed between the patients who developed nephrotoxicity and those who did not. Several important limitations exist in this study. August 25, Key Record Dates. This article has been cited by other articles in PMC.

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Heparin unfractionated 1112 No dosing change for obesity is required In a study of 20 obese patients, linezolid exposure AUC was no different between obese and non-obese patients. Clin Infect Dis. No kinetic data has been published -- titrate to goal MAP. National Library of Medicine U.

Gentamicin therapy. J Antimicrob Chemother. Epinephrine 9. Devine BJ.

Arch Intern Med — Published online Feb In obese patients, minimal data exist for appropriate dosing of acyclovir to decrease the rates of nephrotoxicity.

Looking for your next opportunity? No differences obesity vancomycin dosing or concentrations were observed between obeeity patients who developed nephrotoxicity and those who did not. The patients were divided into 2 groups: those who developed toxicity cases and those who did not controls. BMJ Case Rep ; : 1 — 3. Unfortunately, trials evaluating the PD of i. Arch Intern Med — Please review our privacy policy.

Read our disclaimer for details. J Clin Pharmacol. August 25, Key Record Dates. These patients obesity already be hospitalized for other reasons, and will not be required to make additional trips to the hospital. Therapeutic monitoring of vancomycin in adults summary of consensus recommendations from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists.

Curr Clin Pharmacol 8 :5— Preventive Services Task Force. Evaluation of lorcaserin as an anticonvulsant in juvenile Fmr1 knockout mice.

Levothyroxine Erstad BL. Get Email Updates. Anesthesia in the obese patient: pharmacokinetic considerations. Bone Marrow Transplant. Arch Neurol.

The objective of this study was to evaluate the currently recommended dosing strategy for i. Both acyclovir dosing in obesity receipt and obesity were independent risk factors for the development for acyclovir-associated nephrotoxicity, leading to ayclovir increased length of hospital stay and statistically increased length of stay after acyclovir initiation. Approved: new antimicrobial stewardship standard. Within-run precision for the high, low, and lowest observable quantities assay were 2. Associations of Obesity with Linear Growth and Puberty. These patients will already be hospitalized for other reasons, and will not be required to make additional trips to the hospital. Support Center Support Center.

LBW is an accurate, validated method of measuring the lean mass of an obese patient. Show AMA citation. FDA Resources. Dvorchik BH, Damphousse D.

Consider dosing using ideal body weight or adjusted body weight Overall, obesify is a lack of data to support using a specific body weight metric -- these recommendations are based only on expert opinion. Please refer to this study by its ClinicalTrials. Daptomycin 72. Therefore, doses based on total body weight are required to reach the same initial serum concentration Once at goal sedation, continuous infusions should use ideal body weight because midazolam clearance is not affected by total body weight. Unfractionated heparin dosing for venous thromboembolism in morbidly obese patients: case report and review of the literature. Read our disclaimer for details. Clin Pharmacol Ther.

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All patients were receiving acyclovir for prophylaxis with chemotherapy regimens with an anticipated prolonged duration of neutropenia. Research reported in this publication was supported internally by the Center of Quality Outcomes at West Virginia University Healthcare. Bye A. Pharmacotherapy 27 — Open in new tab.

Antimicrob Agents Acycpovir 53 — New issue alert. Clin Pharmacol Ther 54 — The PK parameters observed in the current study for NW patients are similar to those previously reported for healthy, nonobese patients. Joint Commission on Hospital Accreditation. Issue Section:. Concomitant vancomycin receipt and obesity led to higher rates of toxicity.

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