II. Physiology: Pharmacokinetics

  1. Absorption
    1. Alcohol absorption is greater in women (same amount of Alcohol results in higher blood Alcohol level)
    2. Lower gastric pH decreases absorption in women (e.g. Ketoconazole)
    3. Slower gastrointestinal transit time decreases absorption in women
      1. Examples: Metoprolol, Theophylline, Verapamil
    4. Women should wait longer to eat after taking medications directed to be on an empty Stomache
      1. Examples: Amoxicillin, Levothyroxine, Tetracycline
  2. Distribution
    1. Women have lower Body Mass Index and results in lower medication loading doses
      1. Examples: Antiarrhythmics, Aminoglycosides, Digoxin
    2. Women have higher body fat amounts
      1. Lipophilic medications have longer duration of action (e.g. Benzodiazepines, neuromuscular blockers)
      2. Hydrophilic medications have smaller volumes of distribution and reach high concentrations faster (e.g. Alcohol, Fluoroquinolones)
  3. Metabolism
    1. Phase I: Women require less Warfarin per week (by as much as 4.5 mg per week) than men due to differences in metabolism
    2. Phase 2: Typically slower in women for medications such as Acetaminophen, Digoxin, Levodopa
  4. Excretion
    1. Glomerular Filtration Rate is as much as 25% slower in women
    2. Renal excreted medications such as Digoxin, Methotrexate, Aminoglycosides, Fluoroquinolones are cleared more slowly in women

III. Physiology: Pharmacodynamics - Specific differences among medication classes

  1. Psychiatric medications
    1. Women respond better to Selective Serotonin Reuptake Inhibitors than Tricyclic Antidepressants
    2. Women respond more to typical Antipsychotic Medications (e.g. Haloperidol) than men
  2. Opioid Analgesics
    1. Women have a greater Opioid response for both analgesia and Sedation than men (start with dose 30-40% lower than for men)
  3. Cardiovascular medications
    1. Aspirin has poor platelet inhibition, CVA and MI prevention in women compared with men
    2. Digoxin is associated with increased mortality in women (target a lower dose if used in women)
    3. Beta Blockers lower Blood Pressure and Heart Rate to a greater extent in women than men (especially during Exercise)

IV. Adverse Effects

  1. QT Prolongation
    1. Women have a longer QT Interval than men at baseline

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