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Implications of obesity for drug administration and absorption from subcutaneous and intramuscular injections: A primer.
Erstad, Brian L; Barletta, Jeffrey F.
  • Erstad BL; Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA.
  • Barletta JF; Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale, AZ, USA.
Am J Health Syst Pharm ; 79(15): 1236-1244, 2022 Jul 22.
Article in English | MEDLINE | ID: covidwho-1692258
ABSTRACT

PURPOSE:

To discuss the potential implications of obesity for drug administration and absorption from subcutaneous (SC) and intramuscular (IM) injection sites.

SUMMARY:

The SC and IM routes are useful for the parenteral administration of medications to optimize pharmacokinetic properties such as time to onset and duration of effect, for cost considerations, or for ease of administration, such as when intravenous access is unavailable. The choice of SC or IM injection depends on the specific medication, with SC administration preferred for products such as insulin where a slower and more sustained response is desirable, while IM administration is usually preferred for products such as vaccines where more rapid absorption leads to a more rapid antibody response. Obesity has the potential to influence the rate and extent of absorption, as well as adverse effects, of medications administered by the SC or IM route through changes in SC tissue composition and depth or by inadvertent administration of IM medications into SC tissue because of improper needle length. Potential adverse effects associated with IM or SC injections in addition to pain, bruising, and hematoma formation include sciatic nerve injury, particularly with IM injection in the upper outer quadrant of the buttock; bone contusion or rarely osteonecrosis if the IM injection is excessively deep; and granulomas, fat necrosis, and calcification with SC injection.

CONCLUSION:

Issues related to medication absorption in obese patients are likely to become more prominent in the future with increasing approvals of a wide range of biotherapeutic agents administered by SC injection. Studies should be directed toward these and other agents to assist with dosing decisions in this challenging population.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Subcutaneous Tissue / Insulin Topics: Vaccines Limits: Humans Language: English Journal: Am J Health Syst Pharm Journal subject: Pharmacy / Hospitals Year: 2022 Document Type: Article Affiliation country: Ajhp

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Subcutaneous Tissue / Insulin Topics: Vaccines Limits: Humans Language: English Journal: Am J Health Syst Pharm Journal subject: Pharmacy / Hospitals Year: 2022 Document Type: Article Affiliation country: Ajhp