Optimizarea farmacoterapiei în obezitate: aspecte farmacocinetice şi farmacodinamice

Abstract

Introducere. Organizaţia Mondială a Sănătăţii a relatat că 40% adulţi sunt supraponderali, iar 13% obezi. Obezitatea induce modificări în parametrii fiziologici, care pot influenţa farmacocinetica (absorbţia, distribuţia, metabolismul, eliminarea) şi farmacodinamia medicamentelor (eficacitate şi toxicitate). Scop. Analiza articolelor ştiinţifice pentru determinarea impactului obezităţii asupra farmacocineticii, farmacodinamiei şi evidenţierea necesităţii optimizării far-macoterapiei. Material şi metode. Am realizat o revizuire sistematică narativă a literaturii ştiinţifice de specialitate folosind PubMed şi SCOPUS. Am inclus articole din ultimii cinci ani, în limba engleză, cu acces complet, studii clinice şi rapoarte de caz.

Introduction. The World Health Organization estimates that almost about 40% of adults are overweight, and 13% are already obese. Obesity induces changes in physiology, which directly influences pharmacokinetics (absorption, distribution, metabolism, elimination) and pharmacodynamics (efficacy and toxicity). Objective. analysis of scientific articles to determine the impact of obesity on pharmacokinetics, pharmacodynamics and highlighting the emergent need in pharmacotherapy optimization. Material and methods. We conducted a systematic narrative review of the scientific specialty literature using PubMed and SCOPUS databases. We included articles from the last five years, in English, with full access, clinical trials and case reports. The keywords used were: obesity, pharmacokinetics, pharmacodynamics, doses, pharmacotherapy. Results. Obesity influences the pharmacokinetics of drugs: at the absorption level, gastric emptying is slow, and a high-fat diet - modifies the bioavailability of the drug; distribution - increases the volume of distribution (Vd), for lipophilic substances it leads to a decreased plasmatic concentration; metabolism - obesity involves liver damage (steatosis, inflammation, fibrosis); renal elimination - increases glomerular filtration, but in case of comorbidities such as diabetes mellitus, renal failure may develop. Pharmacodynamics is influenced by dose adjustment, oscillating between therapeutic failure and drug toxicity. Conclusion. Obesity essentially changes the pharmacokinetics and pharmacodynamics of the drugs, which requires a personalized approach to pharmacotherapy, adapting the dosing regimen depending on physicochemical properties of the drug, body mass and hepatorenal status of the patient.