Influence of Bariatric Surgery on the Use and Pharmacokinetics of Some Major Drug Classes
First Online: 22 February 2013 DOI:
10.1007/s11695-013-0882-6 Cite this article as: Yska, J.P., van der Linde, S., Tapper, V.V. et al. OBES SURG (2013) 23: 819. doi:10.1007/s11695-013-0882-6 Abstract
The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharmacokinetics of some frequently used drugs. A PubMed literature search was conducted. Literature was included on influence of bariatric surgery on pharmacoepidemiology and pharmacokinetics. Drug classes to be searched for were antidepressants, antidiabetics, statins, antihypertensive agents, corticosteroids, oral contraceptives, and thyroid drugs. A reduction in the use of medication by patients after bariatric surgery has been reported for various drug classes. Very few studies have been published on the influence of bariatric surgery on the pharmacokinetics of drugs. After bariatric surgery, theoretically, reduced drug absorption may occur. Correct dosing and choosing the right dosage form for drugs used by patients after bariatric surgery are necessary for optimal pharmacotherapy. Therefore, more clinical studies are needed on the influence of bariatric surgery on the pharmacokinetics of major drugs.
Keywords Bariatric surgery Pharmacoepidemiology Pharmacokinetics Drug class References
Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557–67.
Leff DR, Heath D. Surgery for obesity in adulthood. Br Med J. 2009;339:740–6.
Samuel I, Mason EE, Renquist KE, et al. Bariatric surgery trends: An 18-year report from the International Bariatric Surgery Registry. Am J Surg. 2006;192:657–62.
Padwal R, Brocks D, Sharma AM. A systematic review of drug absorption following bariatric surgery and its theoretical complications. Obes Rev. 2010;11:41–50.
MacGregor AMC, Boggs L. Drug distribution in obesity and following bariatric surgery: A literature review. Obes Surg. 1996;6:17–27.
Malone M. Altered drug disposition in obesity and after bariatric surgery. Nutr Clin Pract. 2003;18:131–5.
Miller AD, Smith KM. Medication and nutrient administration considerations after bariatric surgery. Am J Health Syst Pharm. 2006;63:1852–57.
Segal JB, Clark JM, Shore AD, et al. Prompt reduction in use of medications for comorbid conditions after bariatric surgery. Obes Surg. 2009;19:1646–56.
Cunningham JL, Merrell CC, Sarr M, et al. Investigation of antidepressant medication usage after bariatric surgery. Obes Surg. 2012;22:530–5.
Voelker M, Foster TG. Nursing challenges in the administration of oral antidepressant medications in gastric bypass patients. J Perianesth Nurs. 2007;22:108–24.
Seaman JS, Bowers SP, Dixon P, et al. Dissolution of common psychiatric medications in a Roux-en-Y gastric bypass model. Psychosomatics. 2005;46:250–3.
Roerig JL, Steffen K, Zimmerman C, et al. Preliminary comparison of sertraline levels in postbariatric surgery patients versus matched nonsurgical cohort. Surg Obes Relat Dis. 2012;8:62–6.
Hamad GG, Helsel JC, Perel JM, et al. The effect of gastric bypass on the pharmacokinetics of serotonin reuptake inhibitors. Am J Psychiatry. 2012;169:256–63.
Scheen A-J, De Flines J, De Roover A, et al. Bariatric surgery in patients with type 2 diabetes: Benefits, risks, indications and perspectives. Diabetes Metab. 2009;35:537–43.
Renard E. Bariatric surgery in patients with late-stage type 2 diabetes: Expected beneficial effects on risk ratio and outcomes. Diabetes Metab. 2009;35:564–8.
Ferrannini E, Mingrone G. Impact of different bariatric surgical procedures on insulin action and β-cell function in type 2 diabetes. Diabetes Care. 2009;32:514–20.
Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: Systematic review and meta-analysis. Am J Med. 2009;122:248–56.
Dixon JB, Le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet. 2012;379:2300–11.
Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308:1122–31.
Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–84.
Brancatisano A, Wahlroos S, Matthews S, et al. Gastric banding for the treatment of type 2 diabetes mellitus in morbidly obese. Surg Obes Relat Dis. 2008;4:423–9.
Dorman RB, Serrot FJ, Miller CJ, et al. Case-matched outcomes in bariatric surgery for treatment of type 2 diabetes in the morbidly obese patient. Ann Surg. 2012;255:287–93.
Pournaras DJ, Aasheim ET, Søvik TT, et al. Effect of the definition of type II diabetes remission in the evaluation of bariatric surgery for metabolic disorders. Br J Surg. 2012;99:100–3.
Jurowich C, Thalheimer A, Hartmann D, et al. Improvement of type 2 diabetes mellitus (T2DM) after bariatric surgery—who fails in the early postoperative course? Obes Surg. 2012;22:1521–6.
Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316–23.
Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. NJEM. 2012;366:1577–85.
Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. NJEM. 2012;366:1567–76.
Malone M, Alger-Mayer SA. Medication use patterns after gastric bypass surgery for weight management. Ann Pharmacother. 2005;39:637–42.
Segato G, Busetto L, De Luca M, et al. Weight loss and changes in use of antidiabetic medication in obese type 2 diabetics after laparoscopic gastric banding. Surg Obes Rel Dis. 2010;6:132–7.
Maciejewski ML, Livinston EH, Kahwati LC, et al. Discontinuation of diabetes and lipid-lowering medications after bariatric surgery at Veterans Affairs medical centers. Surg Obes Rel Dis. 2010;6:601–7.
Nocca D, Guillaume F, Noel P, et al. Impact of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on HbA1c blood level and pharmacological treatment of type 2 diabetes mellitus in severe or morbidly obese patients. Results of a multicenter prospective study at 1 year. Obes Surg. 2011;21:738–43.
Narbro K, Ågren G, Jonsson E, et al. Pharmaceutical costs in obese individuals. Comparison with a randomly selected population sample and long-term changes after conventional and surgical treatment: The SOS intervention study. Arch Intern Med. 2002;162:2061–9.
Potteiger CE, Paragi PR, Inverso NA, et al. Bariatric surgery: Shredding the monetary weight of prescription costs in the managed care arena. Obes Surg. 2004;14:725–30.
Nguyen NT, Varela E, Sabio A, et al. Reduction in prescription medication costs after laparoscopic gastric bypass. Am Surg. 2006;72:853–6.
Makary MA, Clarke JM, Shore AD, et al. Medication utilization and annual health care costs in patients with type 2 diabetes mellitus before and after bariatric surgery. Arch Surg. 2010;145:726–31.
Klein S, Ghosh A, Cremieux PY, et al. Economic impact of the clinical benefits of bariatric surgery in diabetes patients with BMI ≥ 35 kg/m
. Obesity. 2011;19:581–7.
Ghiassi S, Morton J, Bellatore N, et al. Short-term medication cost savings for treating hypertension and diabetes after gastric bypass. Surg Obes Relat Dis. 2012;8:269–74.
Neovius M, Narbro K, Keating C, et al. Health care use during 20 years following bariatric surgery. JAMA. 2012;308:1132–41.
Padwal RS, Gabr RQ, Sharma AM, et al. Effect of gastric bypass surgery on the absorption and bioavailability of metformin. Diabetes Care. 2011;34:1295–300.
Skottheim IB, Stormark K, Christensen H, et al. Significantly altered systemic exposure to atorvastatin acid following gastric bypass surgery in morbidly obese patients. Clin Pharmacol Ther. 2009;86:311–8.
Skottheim IB, Jakobsen GS, Stormark K, et al. Significant increase in systemic exposure of atorvastatin after biliopancreatic diversion with duodenal switch. Clin Pharmacol Ther. 2010;87:699–705.
Schachter M. Chemical, pharmacokinetic and pharmacodynamic properties of statins: An update. Fundam Clin Pharmacol. 2005;19:117–25.
Donadelli SP, Salgado W, Marchini JS, et al. Change in predicted 10-year cardiovascular risk following Roux-en-Y gastric bypass surgery: Who benefits? Obes Surg. 2011;21:569–73.
Hodo DM, Waller JL, Martindale RG, et al. Medication use after bariatric surgery in a managed care cohort. Surg Obes Rel Dis. 2008;4:601–7.
Crémieux PY, Ledoux S, Clerici C, et al. The impact of bariatric surgery on comorbidities and medication use among obese patients. Obes Surg. 2010;20:861–70.
Wójcicki J, Wojciechowski G, Wójcicki M, et al. Pharmacokinetics of propranolol and atenolol in patients after partial gastric resection: A comparative study. Eur J Clin Pharmacol. 2000;56:75–9.
Valdivieso A, Calvo R, Gonzalez JP, et al. Influence of several surgical techniques in peptic ulcer disease on the oral kinetic of a basic drug. Acta Chir Belg. 1993;93:88–91.
Reddy RC, Baptist AP, Fan Z, et al. The effects of bariatric surgery on asthma severity. Obes Surg. 2011;21:200–6.
Sikka N, Wegienka G, Havstad S, et al. Respiratory medication prescriptions before and after bariatric surgery. Ann Allergy Asthma Immunol. 2010;104:326–30.
Merhi ZO. Impact of bariatric surgery on female reproduction. Fertil Steril. 2009;92:1501–8.
Gerrits EG, Ceulemans R, Van Hee R, et al. Contraceptive treatment after biliopancreatic diversion needs consensus. Obes Surg. 2003;13:378–82.
Merhi ZO. Challenging oral contraception after weight loss by bariatric surgery. Gynecol Obstet Invest. 2007;64:100–2.
Paulen ME, Zapata LB, Cansino C, et al. Contraceptive use among women with a history of bariatric surgery: A systematic review. Contraception. 2010;82:86–94.
Raftopoulos Y, Gagné DJ, Papasavas P, et al. Improvement of hypothyroidism after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2004;14:509–13.
Fazylov R, Soto E, Cohen S. Laparoscopic Roux-en-Y gastric bypass surgery on morbidly obese patients with hypothyroidism. Obes Surg. 2008;18:644–7.
Gniuli D, Leccesi L, Guidone C, et al. Thyroid function and insulin sensitivity before and after bilio-pancreatic diversion. Obes Surg. 2010;20:61–8.
Rubio IGS, Galrão AL, Santo MA, et al. Levothyroxine absorption in morbidly obese patients before and after Roux-en-Y gastric bypass (RYGB) surgery. Obes Surg. 2012;22:253–8.
Lizer MH, Papageorgeon H, Glembot TM. Nutritional and pharmacologic challenges in the bariatric surgery patient. Obes Surg. 2010;20:1654–9.
PubMed CrossRef Copyright information
© Springer Science+Business Media New York 2013