Table 3.

Drugs commonly prescribed for obesity co-morbid conditions

Condition	Drug/drug class	Summary of evidence
Diabetes mellitus/insulin insensitivity/obesity	Metformin	Increased clearance in patients with obesity, leading to lower systemic exposure; dose escalation may be warranted [96]
Hypertension	Calcium channel blockers	Single small study showed children with obesity may require higher doses to achieve optimal BP control [86]. No studies evaluating drug distribution in children with obesity
	β-Blockers	No specific studies identified. In adults, possible increased Vd in patients with obesity, especially in lipophilic drugs [21]. However, β-blockers preferentially bind lean body tissues, suggesting dosing based on lipophilicity of drugs alone is not adequate
	ACE inhibitors (ACEi) or angiotensin receptor blockers (ARBs)	No pharmacokinetic studies exist. Single study with very small sample size demonstrated no therapeutic difference for pts with obesity [85]
Gastroesophageal reflux disease	Proton pump inhibitors	Data only available for pantoprazole: LBW [89, 90] Decreased CL/F; thus, no empiric dose escalation warranted, if using fixed dosing [91]
	Histamine H2 receptor blockers (e.g., ranitidine)	No specific studies identified
Hypercholesterolemia	Statins	Few pediatric studies suggest correlation between BMI and drug exposure, but results are mixed [81, 82]

BMI body mass index, CL/F apparent total clearance of the drug from plasma, LBW lean body weight, Vd volume of distribution