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Do obese people need more pain meds?

reptilesrreptiles Posts: 15
edited 06/11/2012 - 8:25 AM in Pain Medications
Greetings,

I was wondering if anyone knows of any references that support the position that obese patients taking oral opioids for chronic pain -- require an increase in dose or frequency.

Surely one wouldn't expect a 300 lb. individual to get the same pain relief as a 150 lb. person since the drug serum levels will never be equal.


Thanks!
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Comments

  • Why would you want to know that answer?a person weight has no barring on the dosage of the pain medicine they take...if you have a question like that ask your doctor....
  • Why would you want to know that answer?a person weight has no barring on the dosage of the pain medicine they take...if you have a question like that ask your doctor....
    Well, I have several doctors and there appears to be different opinions on the matter. In my case I gained 80 pounds after being immobile, eating poorly, and on Lyrica for 3 years.

    I also remember when I worked at a zoo, in the 1980's the vet and I would spend a great deal of time placing 160 motrins into a rhino's food (he had a bad knee.)

    I suspect there is a correlation between body weight and oral opioids, too.

    Thanks for your interest.
  • It's not the weight of the rhino that makes it require 160 motrins; it's the metabolic rate and excretion mechanism for the drug.

    My 130lb dog is on valium; he gets 120mg every 3 hours as needed. I'm quite a lot larger than my dog and when I'm on valium, I only get 5-10mg every 4-6 hours.




  • A lot of the medications that we take for back and back related problems, we used at work. I worked in mental heath. What we had to do at work was check blood pressure, weight and height every 2 weeks, because the weight could fluctuate either way rapidly. We had to make sure that they were taking the right dose for there weight, height and blood pressure.for example amitryptiyline and citolopram 20mg taken by a 300lb person and a 150lb person would not work the same, it would work on one but not the other.


    Angie
  • an obese person would require more medications than a "normal" size person, it would make no sense to me. My bottle of Tylenol says nothing about the increase of dosage for those who weigh X amount of pounds? Age yes, weight no. A rational doctor is going to tell you to lose weight. BTDT for my knees. Lose weight and your knees won't bother you at all, and if they still do THEN we will address the dosage of medication. 130# dog taking 12 10mg. Valium? I'll have to call my vet and think on that one.
  • there are many factors involved in determaning the dosage for a medication.

    age, weight, species, tolerances...ect--the list is almost as enless as the list of meds out there--if you have a question reguarding the dosage of a med that you are taking, your best bet is to talk to your doctor about it!
  • A relative of mine is obese and the doctor said he had to double his intake of medication and even OTC because the normal dosage wouldn't work for him. That's all I know about this issue.
  • The valium dosage for dogs is based on weight. Our orders are 2-3mgs per kg every 3 hours until Tonka's seizures stop, then .5mg per kg every hour as maintenance until we get him to the vet's office. Can you imagine the dose for a 300 pound human based on weight? 8}

    I can tell you from experience, when you take a 125mg valium prescription to the pharmacy to get it filled, they ALWAYS call the doctor and confirm it's not a mistake or an altered prescription. That dose just freaks them out. =))
  • Alot of medications that are given are by the person's weight. It's different for pain medications as every person has a different threshold for pain. Quite a job for the GP or Pain Management Dr.
    Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • I've never researched this topic indepth, but it seems to me that the obesity itself wouldn't be the problem with dosing the medications. Instead, it seems to me that the dosing difficulties would come from the high correlation between obesity and a variety of disease process that impact heart, liver, and kidney functions.

    Even if specific diseases aren't present, the higher percentage of body fat changes many basic hormonal responses within the body, which impacts the overall metabolic rate. For example, when women hit a certain percentage of body fat, they stop having menstrual periods. It's not their weight, per se, but rather the percentage of fat to lean muscle mass.

    Since pain medications are absorbed and then metabolized into other chemical compounds that act on the various receptors in our brains, if the liver, kidneys, circulation, and other metabolic processes aren't functioning normally as a result of obesity, then it stands to reason that dosing could be come a problem. But again, it's not obesity causing the problem directly, so it would certainly vary based on the individuals overall condition, rather than a simple weight issue.

  • Greetings,

    I have found several references and thought I'd post a couple here for those interested in this thread.

    I suspect obese people need more opiates than non-obese people (for the same indication/injury) because the obese have a higher base level of natural opiates.

    Quote: "Levels of endogenous opioids are increased in morbidly obese humans and obese rats." from http://ajrccm.atsjournals.org/cgi/content/full/162/3/1009

    And the specific ref I was looking for... "The use of oral opioids in obese patients may require an increase in dose or frequency due to an increased volume of distribution."

    from Journal of Oral and Maxillofacial Surgery, Volume 62, Issue 1, Pages 88-93 http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WKF-4B8K4BV-V&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=6d5bb2fd27b04bd7f53adb34788059fa

    Hope this is found useful by someone.

  • I seriously doubt either of your references would stand up to scrutiny and earn us fat folks an increased dose of pain meds.

    With the first reference - you should do a bit more research on endogenous opioids, because your reference actually supports the notion that morbidly obese people require a lower dose.

    With the second one - the article isn't actually accessible through the link you provided, and I ain't payin' $31.50 to read it. However, according to the title, that article is a study of office-based surgical procedures. Just taking the statement at face value - every doctor I've ever run across knows that patients taking oral opiates require higher doses of opiates for surgical procedures, whether they're obese or not. Comparing drug doses during surgical procedures to drug doses for long-term pain management is apples to oranges.

    Keep trying though! ;)
  • i asked the question to my doctor .his answer was ....
    the only time there is a weight to meds consideration is when .say a patient is brought in to the ER with acute pain the doctor will gauge the weight of the patient to the amount of the drug and the way the drug is administered IE .a 15 stone man with his leg hanging off after and RTA will require more drugs and delivered in a quicker way than an old lady {say 80years old}who is amasiated about 5 stone with a broken leg.the 15 stone man would have his drug given IV say 10///50mg morphine ..but the old lady may require only 5////15 mg morphine IM .to obtain the same relief.
    in chronic pain the doctor ..patient drug does is decided on firstly by consulting the patients requirement IE {patient with terminal cancer ////paitient with chronic back ache }both may be on the same drug but a different does..there is always an upper limit on drugs but one may grow tolerant to a drug and require more than another person with the same problem.the original question is a good one .but the answer varies somewhat due to various factors weight is not a major consideration its the reaction to the medication that is the main consideration.some chronic patients can get by on 5mg of oxycodone a day and another person would require 40mg 3 times a day to obtain the same relief.that's why we have doctors and they go to university for years!.so to conclude in emergency medical say the ER.a doctor would factor in a patient's weight age and previous medical conditions and injury before deciding what and how much and how its going to be administered .the thought behind that is to get the patient out of pain as quick and as safely as possible.but in chronic pain management when the patient reports that he/she has found the correct does of medication to control his of her pain .then that will also be correct for that patient .some may require more and some less ..its a balancing act between pain relief and side effects.
    the examples i have given regarding values of medication for conditions are for the purpose of explaining this question ..they are not actual doses and should not be used as a guide for self treatment .i am not a doctor .but this question cropped up with my own doctor {as i am overweight myself i thought that i would require more meds myself but as i have found out this is not always the case
    STRAKER
  • I fluctuate between 300 and 315. and i feel when the meds kick in. my buddy weighs 350 and he necks them by the 2s and 3s...DOSES! i think metabolism and tolorance is a big factor. he is a drug abuser so his tolorance is psycologicaly high so he can get his buzz on.

    me? meds have always been a tool, to get me able to what i need to do, no more no less, ime in it for the semblance of functionality i used to have.

    I think some people mentally exagerate their syptoms all out of proportion to the isssue( this is from negative feedback from some people near me) no reflection on anyone here K?
    Well that was a penny extra, but no, i dont think obese people need more meds.
  • Obese people don't need more pain peds they should really try and lose some weight and take the strain off their back and other body parts just taking in less calories can make them lose weight without any exercise or special diet program like the www.noway.com one i'm on, but i do exercise and losing a few pounds a week.

    Post edited to remove URL. Solicitation at Spine-Health is not permitted

    Ron DiLauro, Spine-Health Administrator 01/11/10
  • and when I first started taking Norco, Flexeril and Mobic, they knocked me on my butt.

    I think weight comes in to play with extremely fast acting meds. When having surgery, weight plays a huge part on how much anesthesia they give you. Also, for IV administered meds. Meds like that hit your blood stream much faster than a pill digesting in your stomach. It's just different. Over the counter meds should not be compared to IV administered meds, right?

    I can guarantee you that there are much smaller people on this this board than me. And for those smaller people who take much stronger meds than me, I guarantee you their meds would knock me out as well.

    Back in the day, before my chronic issue, and was overweight, I could take a Tylenol like any other normal sized person and still get the same result as them.

    Interesting post, but I think in the beginning of med usage, everyone is pretty much the same.

    Caity
  • Greetings,

    I did get my meds adjusted when my doctor looked into the issue. He was unaware of allometric dosing.

    Now that my pain is better controlled, I tend to move around more and my weight is slowly decreasing.

    Sorry if I got some people here upset with my original request. And I'm sorry the link I posted for an article was restricted... I logged on from school and apparently my school's domain has access, so I didn't notice it was a subscription service.

    Although I was just asking for known opioid references, not opinions or taking a survey.

    Regards,

    R
  • Welcome back :H I'm glad your pain went down and that you're lighter and more active again.
  • I'm sorry that so many people simply gave you their best "guess" rather than the information you asked for, including advice to lose weight rather than adjust dosage.

    Why bother to post if you have no clue what the answer is? That has always baffled me.

    In any event, am glad you found that weight does indeed influence the correct dose of many prescriptions including narcotics. It is especially important in narcotic antagonists such narcan or partial antagonists such as the drug Relistor, for opioid induced constipation as well as many other medications.

    In the case of children, not only is weight figured into optimum dosage but also has a great deal to do with safe dosage.

    The correct figure for optimal morphine or methadone dosage is 10mg per 70Kg of body weight. I don't know what the correct numbers are on the other narcotics but can be easily found on the net with just a bit of research. Best of luck.
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