Oral drug dosing following bariatric surgery: General concepts and specific dosing advice.
Jurjen S KingmaDesirée M T BurgersValerie M MonpellierMarinus J WiezerHeleen J Blussé van Oud-AlblasJanelle D VaughnsCatherine M T SherwinCatherijne A J KnibbePublished in: British journal of clinical pharmacology (2021)
Bariatric or weight-loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism and/or elimination of drugs may be altered. The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide guidance for dosing of commonly used drugs in this special population. Upon oral drug administration, the time to maximum concentration is often earlier and this concentration may be higher with less consistent effects on trough concentrations and exposure. Additionally, prescription of liquid formulations to bariatric patients is supported by some reports, even though the high sugar load of these suspensions may be of concern. Studies on extended-release medications result in an unaltered exposure for a substantial number of drugs. Also, studies evaluating the influence of timing after surgery show dynamic absorption profiles. Although for this group specific advice can be proposed for many drugs, we conclude that there is insufficient evidence for general advice for oral drug therapy after bariatric surgery, implying that a risk assessment on a case-by-case basis is required for each drug.
Keyphrases
- weight loss
- bariatric surgery
- end stage renal disease
- roux en y gastric bypass
- risk assessment
- gastric bypass
- obese patients
- newly diagnosed
- chronic kidney disease
- ejection fraction
- physical activity
- body mass index
- peritoneal dialysis
- type diabetes
- emergency department
- drug induced
- stem cells
- patient reported outcomes
- ionic liquid
- glycemic control
- coronary artery disease
- bone marrow
- climate change
- acute coronary syndrome
- percutaneous coronary intervention
- drug administration
- replacement therapy