Fig. 1
Overview of the influence of obesity on the efficacy of antimigraine drugs. Absorption: Gut permeability is increased and gastric emptying is accelerated in obesity, however more evidence regarding the effect of this on bioavailability is warranted. Distribution: Highly lipophilic drugs could be largely distributed in adipose tissue in obesity; Obesity may impair cardiac function, reducing tissue perfusion. Metabolism: CYP3A4 and CYP2C19 both show reduced activity in obesity. MAO activity might be increased, however more scientific research is needed to confirm this in humans; Obesity can alter liver blood flow. Elimination: Obesity is associated with an initial increase in renal excretion, followed by decreased renal excretion due to chronic kidney disease at later stages; Phase II conjugation can increase in obese morbid obesity