Availability of information for dosing commonly used medications in special ICU populations

Abstract

Specific Aims: Product labeling was reviewed to determine if sufficient information is available to appropriately calculate dosing regimens for special intensive care unit (ICU) populations including extremes of body habitus, patients on hemodialysis, continuous renal replacement therapy (CRRT), and extracorporeal membrane oxygenation (ECMO).

Methods: The 100 most commonly used injectable medications in the adult ICUs of an academic medical center in Southern Arizona were evaluated. Any information related to adult weight-based dosing, weight descriptors, dosing of patients with extremes of weight (body mass index of <18.5 or >40 kg/m2), and dosing of patients on hemodialysis, CRRT, or ECMO was extracted from Food and Drug Administration product labeling. Information was evaluated with a dosing usefulness score of 0-3; a score of 2 or greater was considered minimally adequate for dosing special ICU populations.

Main Results: Of the 100 medications evaluated, 47 had weight-based dosing of which 30% had reference to a specific weight descriptor. Fifteen medications had dosing information for patients with extremes of body habitus (3 underweight, 12 obese, and 2 extreme obesity), of which 8 scored >2 (2, 6, and 1 in the respective categories). Of the 42 medications with hemodialysis dosing information, 53% had a usefulness score >2. Of the 3 medications with CRRT dosing information, 1 had a score >2. ECMO dosing information was available for 2 medications with one score >2.

Conclusion: Information from product labeling involving commonly used ICU injectable medications is limited and generally inadequate for calculating an appropriate dose for special ICU populations.