Dosage Precision in the ICU: Variability Between Males and Females

Authors

  • Sucheta Meshram
  • Nayana Sabu

Keywords:

Critical care, Pharmacokinetics, Sex differences, Precision dosing, ICU, Pharmacodynamics

Abstract

Background: Precision in drug dosing is crucial in intensive care unit (ICU) settings to achieve optimal therapeutic outcomes and minimize adverse drug reactions. Despite advancements in critical care pharmacotherapy, sex-based differences in drug pharmacokinetics (PK) and pharmacodynamics (PD) remain underappreciated.

Objective: This comprehensive review aims to synthesize the evidence on sex-specific variability in drug dosing in critically ill patients and recommend strategies for individualized pharmacotherapy in the ICU.

Methods: An extensive literature search was conducted using PubMed, Embase, and Scopus databases. Studies on sex differences in ICU pharmacology, PK/PD variations, and clinical outcomes were reviewed.

Results: Significant gender differences exist in drug absorption, distribution, metabolism, and excretion. These variations influence the dosing of sedatives, analgesics, vasopressors, and antimicrobials. Physiological factors, hormonal influences, and genetic polymorphisms further modulate these differences.

Conclusion: Integrating sex-specific factors into ICU drug dosing algorithms is essential for precision medicine. Future research should focus on clinical trials stratified by sex to refine dosing recommendations.

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References

Soldin OP, Mattison DR. Sex differences in pharmacokinetics and pharmacodynamics. Clin Pharmacokinet. 2009;48(3):143-157.

Zucker I, Prendergast BJ. Sex differences in pharmacokinetics predict adverse drug reactions in women. Biol Sex Differ. 2020;11(1):32.

Beier K, et al. Gender-specific considerations in intensive care. Crit Care Clin. 2020;36(4):599-618.

Waxman KJ, et al. Individualized dosing in ICU patients. J Crit Care. 2022;67:153-161.

Anderson GD. Sex and genetic differences in drug metabolism. Trends Pharmacol Sci. 2008;29(8):373-379.

Gandhi M, Aweeka F, Greenblatt RM, Blaschke TF. Sex differences in pharmacokinetics and pharmacodynamics. Annu Rev Pharmacol Toxicol. 2004;44:499-523.

Tannenbaum C, et al. Sex, gender, and drug response: pharmacokinetics and pharmacodynamics. Biol Sex Differ. 2017;8(1):24.

Mauvais-Jarvis F. Sex differences in metabolic homeostasis, diabetes, and obesity. Biol Sex Differ. 2015;6:14.

Morgan ET, et al. Regulation of drug-metabolizing enzymes and transporters in infection, inflammation, and cancer. Pharmacol Rev. 2008;60(2):247-260.

De Vries ST, et al. Sex differences in adverse drug reactions reported to the national pharmacovigilance center in the Netherlands. Br J Clin Pharmacol. 2019;85(7):1507-1515.

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Published

2025-08-04

How to Cite

1.
Meshram S, Sabu N. Dosage Precision in the ICU: Variability Between Males and Females. J Neonatal Surg [Internet]. 2025Aug.4 [cited 2025Sep.23];14(8S):1049-51. Available from: https://www.jneonatalsurg.com/index.php/jns/article/view/8726