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cthulu2016

(10,960 posts)
Mon Nov 25, 2013, 06:37 PM Nov 2013

Are small people seriously over-medicated? Big people under-medicated?

Looking that this (useful) thread, http://www.democraticunderground.com/10024091849 , about how emergency contraception pills lose efficacy when the patient is over a certain weight reminded me of a recent experience with a doctor where he looked me up and down when writing a prescription and wrote it for a little larger size, noting that the standard dosages of medication are for someone around 140 pounds. I'm 180-190, which is unexceptional for my height, so I am not used to thinking of myself as needing the jumbo size of things, but compared to the human adult average (men and women, all ethnicities) I'm pretty big.

I don't usually think in terms of, "all general observations about medications are made for someone clinically substansialy smaller than I am."

140 pounds sounds like about right for the adult human average. Since I am bigger than that "standard" size he felt that a bit more than the standard dose made sense... like 20mg of something vs. 15mg.

With so many people weighing 280 pounds or more, are they typically prescribed double the usual dose of things? I don't know, but I would guess that they are not.

This all probably doesn't come up as much as it should. Doctors may adjust for it, but we all know that OTC medicines typically do not.

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KittyWampus

(55,894 posts)
1. I saw the thread you reference. My first though- my pets' medication are all determined by weight.
Mon Nov 25, 2013, 06:42 PM
Nov 2013

How weird is it that human medicine doesn't take this into account.

Even over the counter flea treatment requires weight specificity.

tridim

(45,358 posts)
2. Based on the people I know, almost everyone is overmedicated.
Mon Nov 25, 2013, 06:44 PM
Nov 2013

But your question is certainly important, I guess I assumed it was already addressed.

cthulu2016

(10,960 posts)
3. Maybe it is an I'd never noticed.
Mon Nov 25, 2013, 06:51 PM
Nov 2013

For instance, say child X is doing well on 10mg of Ritilan, and child Y is doing well on 20mg of Ritlin.

Reading that in an article I would tend to think of child Y as being somehow more ADD. I would probably be less likely to think, "Child X might be a ninth grade girl and child Y might be a male senior who plays offensive tackle on the school's football team."

Because I am not sensitized to thinking of dosage as a funtion of weight because it isn't discussed much.

But just because I don't encounter it much doesn't mean it isn't addressed... a doctor knows what YOU weigh when writing a prescription and may well be taking it into account as a matter of course.

unblock

(51,974 posts)
4. well they certainly should pay attention to weight when dosing!
Mon Nov 25, 2013, 06:51 PM
Nov 2013

information on dosage per kg is readily available for doctors. if they ignore weight, in most cases they are being lazy at best and negligent at worst.

that said, many medications have a small starting dosage and you titrate up depending on the effectiveness and side effects for that particular patient, so this effectively takes into account all factors for that patient, weight included.


getting the dosage right the first time is usually more critical in a hospital setting, where they damn well better pay attention to weight.

Xithras

(16,191 posts)
5. The problem is that you may also double side effects.
Mon Nov 25, 2013, 07:04 PM
Nov 2013

Theoretically speaking, let's say that you have a drug that requires a 10mg dose to save heart function in a 140lb person, but that the medicine can cause liver damage if taken at higher doses. In order to save the same heart function in a 280lb person, the doctor would need to double the dosage to 20mg, but doing that he would push the drug well beyond its safe limits and start harming the liver.

Should he double the dosage?

This exact scenario actually exists for countless medications that are prescribed to us every day, and it's one of the many reasons that doctors try to convince their patients to lose weight. It's no secret that medications are less effective in overweight people, or that overweight people suffer more severe side effects from those medications if the dosages are increased to accommodate their weight.

Sheldon Cooper

(3,724 posts)
6. Med doses for small (as in young) children are generally based on their weight.
Mon Nov 25, 2013, 07:08 PM
Nov 2013

At least that's how I remember it from when my kids were babies and needed tylenol or something.

Hekate

(90,189 posts)
7. Things that make a difference: age, gender, weight, muscle mass. Wonder what I've missed?
Mon Nov 25, 2013, 07:11 PM
Nov 2013

Suddenly I realized, a year or so ago, that I am now in a more risky age-group for some of my medications. I was innocently looking up potential side-effects online, and there I was: "Not recommended for patients over 65." It was an antibiotic and I was feeling like hell, so I shook my head and downed the dose. But it really gave me pause. Has my doctor taken this into account? I mean, he knows my age, but is he paying attention?

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