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We need a drug formulary for obese people

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1356 (Published 16 March 2015) Cite this as: BMJ 2015;350:h1356
  1. Stephen Head, clinical director, Nottinghamshire Healthcare Trust, Edwinstowe Health Centre, Edwinstowe, Mansfield, Nottinghamshire NG21 9QS, UK
  1. shead{at}doctors.org.uk

Drugs are licensed in doses for patients of ideal weight, writes Stephen Head, and doctors need guidance on their effective and safe use in others

We have an obesity epidemic, with many people weighing well above what was considered when drugs were trialled. These patients may not receive the best care possible when it comes to drug treatment.

Recommended “adult doses” of drugs need to be effective and safe for slender, shorter than average people who might weigh, say, less than 45 kg. But is a dose range that is effective and safe for a 45 kg person also effective and safe for someone three times that weight?

We often impose restrictions on specific interventions in morbidly obese patients: for example, people with a body mass index greater than 40 may be advised to lose weight before joint replacement surgery, owing to increased risk and …

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