Author Question: Drug Dosing in Super Human Metabolism

Racheal Asks:

I’d love to hear your thoughts on the topic of medicine and dosage within the context of someone with super-human levels of heightened metabolism. Obviously, the concept pushes the question dangerously towards completely fictional answers, but I’m hoping for any input you have at least in the abstract. For instance, would you give the patient more concentrated doses, more frequent doses, larger doses?  What kind of medicines would be prescribed/would correlate with the metabolism bit in context of painkillers and treatment of a gunshot wound?

Jordyn Says:

Regarding your question surrounding metabolism– I think both could be true that the patient may need to receive higher doses and be dosed more frequently depending on the half life of the drug. Fentanyl and Versed could be two of the drugs given for chest tube placement– one for pain and one so the patient doesn’t remember the procedure. These would be given if the patient is fairly stable with good blood pressure. You could look up these drugs and see how fast the peak. Peak time is when the patient will be under the full effects of the medication. From that, you could put in whatever metabolism rate you wanted (2X, 3X or faster) and be able to determine how much more quickly they would need to be redosed on the medication. Also, you could look at the drugs half-life. Half-life is when 50% of the drug is metabolized by your body. You could look at this number, factor in their sped up metabolism rate, to also know how frequently they might need the drug.

You can ususally research this on-line fairly easily by searching for drug information sheets. I’ve included one here for Fentanyl.

I thought this would be a great question to run by Sarah Sundin who is a fabulous author and real life pharmacist. I hope you check out her wonderful historical novels set during WWII.

Sarah Says:

A higher metabolism would lead to a higher clearance — shortening the half-life of the medication. That would mean increasing the frequency for dosing from every twelve hours to every eight hours or every six hours. Often that means an increase in dose as well. Of course, we have to clarify “metabolism.” Some drugs are cleared by the kidneys (renally) and some are cleared by the liver (hepatically) and most are a combination of both. Whatever function you speed up for your character would have to match the primary method by which that medication is cleared.

To research how a drug is metabolized in the body you would search for “pharmacokinetics of Fentanyl” as an example. These articles would help you determine by what method in the body the drug is cleared.

Hope this helps and good luck with your story!