Most Prescription Meds Lack Dosing Guidelines for Obese Kids

 

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HASHIMOTO’S LAB RESULTS | NO MEDICATION? KETO / CARNIVORE DIET

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From the Pediatric Trials Network: Studying obesity and drug dosing in children

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Medications in Kids

Video taken from the channel: University of California Television (UCTV)


 

Pediatric Medicines Prescribing Drugs “Off Label”

Video taken from the channel: Science Magazine


TUESDAY, Jan. 30, 2018 (HealthDay News)—Obesity can change how prescription drugs work, but many medications used to treat children don’t say so on their labels, researchers report. Most Prescription Meds Lack Dosing Guidelines for Obese Kids | HealthyWomen. Most prescription drugs lack dosing guide for obese children providing dosing guidelines for children with obesity,” the study’s lead author, Dr.

Janelle Vaughns, said in. Few Prescription Meds Have Dosing Guidelines for Obese Kids. TUESDAY, Jan. 30, 2018 Obesity can change how prescription drugs work, but many medications used to treat children don’t say so on their labels, researchers report.

Federal lawmakers offered drug manufacturers incentives to study how drugs affect kids, but many have not provided safety guidelines for those who are obese, the researchers. TUESDAY, Jan. 30, 2018 (HealthDay News) — Obesity can change how prescription drugs work, but many medications used to treat children don’t say so on their labels, researchers report. Federal lawmakers offered drug manufacturers incentives to study how drugs affect kids, but many have not provided safety guidelines for those who are obese, the researchers.

Obesity rates continue to rise in children, and little guidance exists regarding the need for adjustment away from total body weight-based doses for those prescribing drugs to this population of children. A majority of drugs prescribed to children with obesity result in either sub-therapeutic or supra-therapeutic concentrations, placing these children at risk for treatment failure and drug. The U.S. Food and Drug Administration (FDA) has approved most weight-loss medications only for adults. The prescription medication orlistat (Xenical) is FDA-approved for children ages 12 and older.

Can medications replace physical activity and healthy eating habits as a way to lose weight?Because morbid obesity in kids is a relatively new phenomenon in our country and globally, there are no formal guidelines to aid with dosing. In this scenario, most doctors extrapolate from guidelines written for lean patients.

Because anesthetic drugs are so strong, it is essential to use the correct dose in all patients,” she says. Most medications do not have guidelines for morbidly obesity, forcing clinicians to pursue in-depth literature searches in order to decide on a dose. The purpose of this page is to serve as a dynamic, growing repository of evidence-based recommendations regarding medication dosing in obese patients. • The lack of observed adverse events/deficiencies and the potential cost savings associated with “partial” dosing should not be the impetus to continue less than optimal dosing. Note: These recommendations are general ranges and a patient’s clinical condition and organ function should be taken into account.

TUESDAY, Jan. 30, 2018 (HealthDay News) — Obesity can change how prescription drugs work, but many medications used to treat children don’t say so on their labels, researchers report. Federal lawmakers offered drug manufacturers incentives to study how drugs affect kids, but many have not provided safety guidelines for those who are obese.

List of related literature:

The majority have not been approved by the U.S. Food and Drug Administration (FDA) for use in children; their use is usually considered “off-label,” Pediatric cardiologists have experience with these drugs, and there are well-recognized standards regarding dosing.

“Nelson Textbook of Pediatrics E-Book” by Robert M. Kliegman, Bonita F. Stanton, Joseph St. Geme, Nina F Schor, Richard E. Behrman
from Nelson Textbook of Pediatrics E-Book
by Robert M. Kliegman, Bonita F. Stanton, et. al.
Elsevier Health Sciences, 2011

Certain medications may require weight-based dosing similar to pediatric drug dosing.

“Pharmacology for the Prehospital Professional” by Jeffrey S. Guy
from Pharmacology for the Prehospital Professional
by Jeffrey S. Guy
Mosby/Elsevier, 2009

Pediatric and elderly considerations are similar to those for adults in that greater sensitivity to medications is likely, and dose adjustments downward are recommended; there are a few exceptions in which children metabolize the drugs more quickly than adults, and therefore may need higher doses per kg of weight.

“Advanced Practice Psychiatric Nursing: Integrating Psychotherapy, Psychopharmacology, and Complementary and Alternative Approaches” by Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN
from Advanced Practice Psychiatric Nursing: Integrating Psychotherapy, Psychopharmacology, and Complementary and Alternative Approaches
by Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN
Springer Publishing Company, 2012

Similarly, a markedly obese child must not be given a larger dose simply on the basis of increased weight.

“A Practice of Anesthesia for Infants and Children E-Book: Expert Consult: Online and Print” by Charles J. Cote, Jerrold Lerman, I. David Todres
from A Practice of Anesthesia for Infants and Children E-Book: Expert Consult: Online and Print
by Charles J. Cote, Jerrold Lerman, I. David Todres
Elsevier Health Sciences, 2012

Fatand lipid-soluble medications require higher weight-based doses in older adults because of their higher body fat percentage and increased fat distribution.

“Nancy Caroline’s Emergency Care in the Streets” by American Academy of Orthopaedic Surgeons (AAOS), Nancy L. Caroline
from Nancy Caroline’s Emergency Care in the Streets
by American Academy of Orthopaedic Surgeons (AAOS), Nancy L. Caroline
Jones & Bartlett Learning, 2017

Because gastrointestinal symptoms are common in overweight and obese children, clinicians should avoid this deadly combination and alert parents, children, and adolescents to avoid accepting prescriptions for this drug.

“Primary Care of the Child With a Chronic Condition E-Book” by Patricia Jackson Allen, Judith A. Vessey, Naomi Schapiro
from Primary Care of the Child With a Chronic Condition E-Book
by Patricia Jackson Allen, Judith A. Vessey, Naomi Schapiro
Elsevier Health Sciences, 2009

Overweight children accounted for one-third of admissions, and the results of this study suggest that these patients are at greater risk for errors in dosing than are children of age-and sexappropriate weight,” wrote J.L. Miller and colleagues, University of Oklahoma.

“Issues in Pharmacology, Pharmacy, Drug Research, and Drug Innovation: 2011 Edition” by Q. Ashton Acton, PhD
from Issues in Pharmacology, Pharmacy, Drug Research, and Drug Innovation: 2011 Edition
by Q. Ashton Acton, PhD
ScholarlyEditions, 2012

These medications are possible candidates for pediatric obesity if efficacy and safety data become available.

“Handbook of Obesity Treatment, Second Edition” by Thomas A. Wadden, George A. Bray
from Handbook of Obesity Treatment, Second Edition
by Thomas A. Wadden, George A. Bray
Guilford Publications, 2019

This situation is especially troubling because the medication is a nonprescription product, and pediatricians often provide parents with dosing instructions in milligram amounts rather than a per tablet dose.

“Medication Errors” by Michael Richard Cohen, American Pharmacists Association
from Medication Errors
by Michael Richard Cohen, American Pharmacists Association
American Pharmacists Association, 2007

dosing for pediatric patients should be based on the child’s weight.

“Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX Examination” by Linda A. LaCharity, Candice K. Kumagai, Barbara Bartz
from Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX Examination
by Linda A. LaCharity, Candice K. Kumagai, Barbara Bartz
Elsevier/Mosby, 2013

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
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Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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30 comments

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  • No Thyroid here and WISH 20 yrs ago I knew then what I do now. The only treatment was to radiate it then take a pill the rest of my life. As for the women who said you’ll have a heart attack from eating natural foods I wonder if she might be in line at MickeyD’s or KFC………..Keto 3 yrs and started a Carnivore cut last week for 6 weeks. I dropped 6.4 lbs in one week. I’m of a normal weight but seems my body was holding on to some inflammation I was unaware of.

  • Wow! Your lipid panel is amazing! You’re also half my age but yikes!! That is such a testimony!! I love this. You guys are the best for sharing your lives and proving that lamestream medicine is so far off. Thank you ����

  • Sir, first of all I would like to say thanks for the explanation about stop taking thyroid medication… My story begins here, I was carrying my second baby, at four months of my pregnancy I started to take 100 micrograms thyroxin tablet with my doctor’s advice.. after delivery I had been given with 50 micrograms (with 40 days stoppage period after delivery), also she( the doctor ) told that I have to take the medicine for the life time… For 2 and half years I am taking thyroid medication without fail, at present I consulted with thyroid specialist doctor, he told to stop taking tablet for 6weeks, then after taking thyroid test I have to consult with him, now 2weeks completed, I feel some throat pain slightly and then and there feeling tiredness, give some suggestions…

  • I am really struggling with the symptoms, but getting anyone to listen to me seems impossible unless I have a lot of money to pay them! I tell them I have lost an entire head of hair and they look at my hair and say your hair is fine. Well DUH! I had 4-5 times the amount of hair as a normal person before I started. I haven’t broken a barrette or ponytailer in years because of my hair loss! My hair is super thin for me, not for the rest of the world but I am the only one who matters in this analysis! I have lost a good portion of my eye brows, and the doctors just shrug, I have had depression and anxiety for years as all this has been happening and I am in so much pain it is not even funny. Oh and I can’t lose weight even on strict carnivore with no dairy (dairy is evil to my body, I don’t cheat on this). I have an appt. with a new DO hoping she will listen to me about the amount of pain I am in and how I can’t get anything done. I am now out on disability because I can’t show up to work daily. I got to a chiropractor probably 4 times a week trying to minimize my pain. I refuse to take the pain meds they want to give me as they are addicting. When my mom was alive she was convinced I had a thyroid issue (she had one since she was a child) my cousin has had a major one, so it seems to be a family issue, but no one will listen to me! At one point I ended up in a psych ward because of the mental issues that were being caused by this! I really don’t know what to do? I am hoping this new doctor will listen to me, but God knows I am asking for a miracle. I went with a DO hoping they would listen better than an MD. We will see! Most functional doctors charge an arm and a leg to see you and the rest won’t listen to you! Sorry, but I am having a particularly hard week this week!

  • i did a partial thyroidoctomy (cut off half) and i take a 50ùg dose of levothyroxine. Now after 7 years my doctor told me to try not to take levothyroxine for 2 weeks and do a blood test to see if i don’t need it anymore. His decision is not based on a blood test or anything (last time i did a test was 6 years ago). So i’m concerned whether to do it or no and whether it is dangerous or not

  • Love your videos! Great labs! Im really trying to do ketovore <3 I love what i eat in a day videos for ideas. I dont care for seafood so im trying to find a balance of foods

  • I’m using medicine from last 1yr.. Bt now my thyroid is under controlled bt my Dr suggests me to continue medication,, so in that case can I stop talking medication?

  • Do u 4C Hemp (1ce regulated) along with a combination of more natural verses synthetic elixirs, as a fix, “for some” with thyroid disease???

    I currently started a powder, containing Hemp & natural supplements for RA, in the hope of getting away from my Hydroxychloroquine, to lesson my chance of permanent eye damage, especially since I already have Irisitis and wish that a one step formula will be in the works to replace my �� mg, due to “some” iodine treatment.

    Synthetic everything has always been a tricky venture for me.

  • Hi Doctor, thank you very much for your valuable information. i am 51 year old lady, 2013 in my blood report found that i am having thyroid doctor told me to take medicine, but my friends told me not take medicine in the starting stage,if you take medicine then lifelong you have to take, so control your thyroid with your food habits. i was not serious about my thyroid problem (my big mistake). November 2018 i started doing intermittent fasting, 2 months back i done just normal blood checkup, doctor told me you have thyroid and liver problem, doctor suggested to take medicine, but i didn’t ( another mistake). i was googled and find out that coffee is good for liver function, then i started to take 5 cups of filter coffee without sugar and milk. after 2 weeks from 145 pounds i became 130 pounds, i was so happy but every day i have throat pain, felt very unhealthy and i don’t feel hungry etc.
    Then started to google it about thyroid, i found coffee is bad for thyroid!! i stop taking coffee and tea. Past 2 weeks over i am taking Levothyroxine Sodium 50 MCG tablet 8 in the morning. After taking the medicine i will eat my breakfast 12 pm sometimes 2 pm. is this good or bad for the health? if it is bad then in intermittent fasting time when can i have my thyroid medicine? Please advice me Doctor.
    Thanks

  • umm, depends

    if you been taking 150 to 200 mcg of Levothyroxine, there’s a high chance you have end stage hashimotos.

    150 to 200 mcg is the dosage typical of thyroidectomy patients.

    150 to 200 mcg, depends on your body weight. 150 for light people, 175 for most, 200 for heavy weight.

    and sometimes no, 175 to 200 mcg may be an over-dosed at one stage of the disease and you can wean yourself off be reduce down to 75 to 50 mcg to shift the HPT axis.

    it’s similar to t1 diabetics. Honeymoon period of t1 diabete means less insulin required,
    i suppose most hashimotos patients are in the honeymoon phase equilavent of hypothyroidism,
    but most t1 diabetics are not, requiring maxed insulin doses.

  • Just got my blood test results today. Trygl 38
    Hdl 117, Ldl 179. Glucose 76. Not gonna lie hitting TOTAL over 300 got me a little ����. Should I be worried? Im gonna get hit with an insurance “risk” charge.

  • I got a question….

    Is having a TSH in the high range of normal (like between 3 to 5)…. is a TSH of that level possible purely by bad habits (poor diet and no exercise) and no auto-antibodies (or maybe very little-bit of antibodies). Or yeah, he’s got antibodies but mostly cause of the junkfood from his poor diet…

    or is the person just screwed in that situation. He’s got hashimotos, he already lost some of the thyroid cells, Nothing he can do to recover that thyroid function no matter what….. even i he fixes his diet and exercise, his TSH will forever be in the 3-5 range and never ever reach optimal status? Only option is stem cell therapy?

    and it’s true. a TSH of.4-2.5 is the most Ideal. Everyone with a TSH above 2.5 or above 3 is Hypothyroid…. forever slow, lazy, sluggish. Forever needing to take levothyroxine (but in the really low doses of like 12.5 to 25 mcg) to regain their metabolism and think clearly…. They lost some of their cells through Hashimotos and that is it. Nothing will get better even after remission, it will get worse. Once Autoimmunity hits. It’s game over. Check mate. Nothing in the body regenerates except liver and scar tissue….

  • Hello Dr. Westin Childs,

    I was on Thyroid for 7 years. When i was 17 years old, my First dosage was.150mcg, then bumped up to.175mcg. I was eating.175 mcg for roughly 6 years. Then i was told by the doctor that i had to eat thyroid medication for life. So i got upset and figured out ways to get off thyroid. What i did is i weaned off of them and de-stressed out a little bit. Later on i went down to.150 mcg, then.1

    but i weaned myself off them… I do not know if i had Hashimotos because i didn’t get any testing for antibodies…..

    now i hadnt been on consistent thyroid meds for around 17 months

    currently, i did 2 blood tests. My TSH came as a 4.66, then later as a 4.12. These are within the “normal” range of their 0.8 to 5.6 scale…. Doctors say i don’t need thyroid medication but as you can see, 4.66 and 4.12

    i also did my T4 test with the 4.12. My T4 is 10 within the scale of 8 to 21….

    I’m a 25 year old male off of Thyroid Medication…
    any advice on how to bring my thyroid stats as close to optimal at this point.

    I’m off thyroid meds but i do feel tired, slow and lazy alot. Anything i can change in my habits to improve my thyroid function? I dont know if Hashimotos had any part in this..

  • I have watched a lot of your videos and looked all over online but can’t find the answer to this: I had a full thyroidectomy and won’t have medical 90 days, I am out of my Levothyroxine. What will/can happen? -thank you

  • How do I know what labs that I need to ask for when getting labs done? I haven’t had any labs in years as the doctors were wanting to add statins.

  • WARNING: Topamax will make people spacey as Dr. Weiner states. I lost 10 lbs while on Topamax for a short time, but I also lost my ability to cook and drive safely. Reason why I lost a few pounds is because I’d make a plate of food then put it in the microwave and forget to get it out, then a hours later I’d be hungry and make a plate of food to only find I didn’t remember to get my first plate of food out of the microwave to eat. I was on Topamax for Trigeminal face nerve pain which it helped, but acouse the risk was greater than the reward.

  • Endro did a sono on my thyroid told me mine is gone…my hair is falling out taking 75mcg i think its the meds causing my hair to fall out like crazy

  • That’s great that you are able to go off of thyroid meds! Our whole family, husband, 6 kids, and I have Hashimoto’s. I went for years without a diagnosis. Even after I suffered a miscarriage and the doctor ran thyroid labs with a resulting TSH over 6, at the time the lab showed a TSH of 10 or under as normal, I was told my thyroid was fine! I’m glad that most doctors know better now and more labs have lowered the normal range for the TSH but you still have to have your own knowledge because still too many doctors have little education when it comes to thyroid health.

  • Hi,,so I got off my thyroid med a while back and went straight to natural thyroid capsules from a health store for about a year now. Do you believe some of these are good And I’m supposing my thyroid is dependent on it? I was put on ” 65 “.If blood test aren’t so accurate then what would be the next way to test?I went to my general doctor he ran blood test and the numbers were at where he prescribed me at a 65 dose.Do I need a specialist instead to get a more accurate specific test?

  • just been to my thyroid doc and asked if food had any affect on hashimoto aaaaaaaand his answer was? NO, makes no difference.for some strange reason my “hasimoto” acted up and i wanted to slap him upside the head realy bad.why bother asking.he did have a “good” piece of advise “to eat less salt”, that was when my “hasimoto” acted up the second time. dear lord, why bother going?

  • Any method of weight loss has the same principles of consistency whether it’s nutrition exercise or a magic pill whatever method has to be continued, in order to maintain the lower set point. People who don’t struggle with weight don’t worry about this because their set point is genetic and therefore fixed. I thought that after I lost the weight the first time I could eat whatever I wanted like my friend who never seemed to gain any fat with no exercise or diet regime, but no, genetics are predetermined. No one told me about resting metabolic rate or the laws of thermodynamics are more individualised depending on the person’s biology in the beginning No one told me that I had to continue the method of whatever helped me to lose weight in the first place. But it does not stop me from trying again.

  • Thank you for sharing your journey and results. It gives me encouragement since I have hypothyroidism. No one can argue with hard numbers! Good for you ��

  • Do you have a written list of lab numbers that would be what you consider good? This would be super helpful in looking at my own numbers especially since most of us don’t have a doc that thinks like you do!!����

  • After 35 years on Thyroxine, my thyroid is now shriveled so much it can’t be found on an ultrasound. So I very much doubt it will magically come back. If I had been given iodine and other supps way back in The beginning, I believe it could have started working again. But thanks to the medical profession, it’s stuffed, I’m fat, and I’ve had 35 years of being TIRED!

  • Do you think its possible to slowly come off t3 with t4 then eventually drop the t4? Assuming the patient had good thyroid levels before treatment

  • For those wondering, it is possible. I have been on 75 to 100 mcgs daily of Cytomel (T3) for twenty years! I got sick of the run around trying to get brand name…Express Scripts trying to change my doctor’s prescription. I went rogue and weaned myself off altogether. I control the heart palps and anxiety with magnesium, which also helped with a strange throat pressure. For the fluid retention, I use taurine, potassium and whole food b vitamins. I use Nordics Natural cod liver oil for A,D3 and omega3. I use iodine in the form of Lugguls: 2 drops a day. I went Paleo-ish Auto-immune diet. I started using minerals from Dr. Dean called ReMyte, when I began Root Cause Protocol.

    Six months later, Im alive, so I’m assuming my thyroid system has come back online. My complaint is just weight gain of 20 pounds then I stayed level. Occasionally, I feel the throat sensation…with caffeine or stress. Then, I up magnesium& potassium. My pluses: Energy is no worse. I feel steady. Sleep is fine with melatonin. My hair, which was always fine and woefully thinning, is actually better than when I was on meds. I haven’t been back to my doctor so he doesnt know. I intend to stay off prescription meds. (I’m female age 51.) Good luck to anyone who wants to try.

  • I read many great reviews on the net about how Custokebon Secrets will help you lost a lot of fat. Has anybody tried using this popular fat burn diet plan?

  • Yes, I too am guilty of jumping through diet plan to others as well, I think that I need to have tried every fat loss system that was available, but eventually not one of them made it easier for me to reduce and keep the weight off. I ended up trying for the very last time using the Custokebon Secrets because my cousin who told me unbelivable things about it and so far to date I have successfully dropped 17 pounds within 4 weeks!

  • Is Custokebon Secrets useful to lost a ton of weight? We have learn many good things about Custokebon Secrets (do a google search).

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