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The Effect of Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients on Pharmacokinetics of (Acetyl)Salicylic Acid and Omeprazole: the ERY-PAO Study

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Abstract

Background

Data on the absorption of orally administered drugs following Roux-en-Y gastric bypass (RYGB) surgery in obese patients are limited and inconclusive. As it is difficult to predict changes in absorption, studies on frequently used drugs in this population are necessary. Acetylsalicylic acid (ASA) and omeprazole are two commonly prescribed drugs in obese patients.

Methods

In this repeated measures study, omeprazole and salicylic acid (SA) serum concentrations were measured before and after RYGB in 34 morbidly obese subjects. Time to maximum concentration (Tmax), lag time (Tlag), maximum concentration (Cmax), and area under the serum concentration versus time curve (AUC) were calculated for both drugs to determine possible differences in drug absorption after the procedure.

Results

For SA, Tmax significantly decreased after RYGB, while both Cmax and AUC0–24 significantly increased. For omeprazole, both Tmax and Tlag significantly decreased after RYGB, while Cmax significantly increased. Mean AUC0–12 significantly decreased post-surgery. The difference in AUC0–12 before and after surgery varied between subjects.

Conclusions

Our study shows a faster absorption of both ASA and omeprazole after RYGB. The exposure to ASA is higher post-surgery, but the standard dose of 80 mg does not need to be modified, considering its range in effective dose. The exposure to omeprazole is, on average, decreased after surgery. Clinicians should be aware to increase the dose of omeprazole if symptoms suggest inadequate response.

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Acknowledgments

The authors would like to thank Central Hospital Pharmacy, The Hague, Medical Centre Haaglanden, The Hague, and the Dutch Obesity Clinic West, The Hague for funding this study, Henk Trumpie for the analysis of the samples, and Anne Hanschke, Piet Sturm, Yolanda Ooms, and Caroline Wiersma for their contribution in performing the study.

Author information

Authors and Affiliations

  1. Department of Clinical Pharmacy, Ikazia Hospital and Maasstad Hospital, Rotterdam, The Netherlands

    Lieke Mitrov-Winkelmolen

  2. Department of clinical pharmacy, BovenIJ Hospital, Amsterdam, The Netherlands

    Marie-Christine W. van Buul-Gast

  3. Dutch Obesity Clinic West, The Hague, The Netherlands

    Dingeman J. Swank

  4. Central Hospital Pharmacy, Medical Centre The Hague, The Hague, The Netherlands

    Hans W P M Overdiek

  5. Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands

    Ron H. N. van Schaik

  6. Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen Groningen, University of Groningen, Groningen, The Netherlands

    Daan J. Touw

Authors
  1. Lieke Mitrov-Winkelmolen
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  2. Marie-Christine W. van Buul-Gast
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Corresponding author

Correspondence to Lieke Mitrov-Winkelmolen.

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Funding

This study was funded by Central Hospital Pharmacy, The Hague, Medical Centre Haaglanden, The Hague, and the Dutch Obesity Clinic West, The Hague.

Conflicts of Interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval for the study was obtained from the local ethical committee of The Hague (METCZWH, The Hague, the Netherlands). The study was registered in the Dutch Trial Register (NTR3939).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

The ERY-PAO study was conducted at the department of clinical pharmacy, Central Hospital Pharmacy, Medical Centre The Hague, The Hague, The Netherlands and the Dutch Obesity Clinic West, The Hague, The Netherlands.

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Mitrov-Winkelmolen, L., van Buul-Gast, MC.W., Swank, D.J. et al. The Effect of Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Patients on Pharmacokinetics of (Acetyl)Salicylic Acid and Omeprazole: the ERY-PAO Study. OBES SURG 26, 2051–2058 (2016). https://doi.org/10.1007/s11695-016-2065-8

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  • DOI: https://doi.org/10.1007/s11695-016-2065-8

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