Obesity Surgery

, Volume 23, Issue 6, pp 819–825 | Cite as

Influence of Bariatric Surgery on the Use and Pharmacokinetics of Some Major Drug Classes

  • Jan Peter Yska
  • Susanne van der Linde
  • Véronique V. Tapper
  • Jan A. Apers
  • Marloes Emous
  • Erik R. Totté
  • Bob Wilffert
  • Eric N. van Roon
Review

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

  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 2.
    Leff DR, Heath D. Surgery for obesity in adulthood. Br Med J. 2009;339:740–6.CrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    MacGregor AMC, Boggs L. Drug distribution in obesity and following bariatric surgery: A literature review. Obes Surg. 1996;6:17–27.PubMedCrossRefGoogle Scholar
  6. 6.
    Malone M. Altered drug disposition in obesity and after bariatric surgery. Nutr Clin Pract. 2003;18:131–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Miller AD, Smith KM. Medication and nutrient administration considerations after bariatric surgery. Am J Health Syst Pharm. 2006;63:1852–57.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    Cunningham JL, Merrell CC, Sarr M, et al. Investigation of antidepressant medication usage after bariatric surgery. Obes Surg. 2012;22:530–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Voelker M, Foster TG. Nursing challenges in the administration of oral antidepressant medications in gastric bypass patients. J Perianesth Nurs. 2007;22:108–24.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    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.PubMedCrossRefGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    Dixon JB, Le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet. 2012;379:2300–11.PubMedCrossRefGoogle Scholar
  19. 19.
    Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308:1122–31.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. NJEM. 2012;366:1577–85.CrossRefGoogle Scholar
  27. 27.
    Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. NJEM. 2012;366:1567–76.CrossRefGoogle Scholar
  28. 28.
    Malone M, Alger-Mayer SA. Medication use patterns after gastric bypass surgery for weight management. Ann Pharmacother. 2005;39:637–42.PubMedCrossRefGoogle Scholar
  29. 29.
    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.CrossRefGoogle Scholar
  30. 30.
    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.CrossRefGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    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.PubMedCrossRefGoogle Scholar
  33. 33.
    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.PubMedCrossRefGoogle Scholar
  34. 34.
    Nguyen NT, Varela E, Sabio A, et al. Reduction in prescription medication costs after laparoscopic gastric bypass. Am Surg. 2006;72:853–6.PubMedGoogle Scholar
  35. 35.
    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.PubMedCrossRefGoogle Scholar
  36. 36.
    Klein S, Ghosh A, Cremieux PY, et al. Economic impact of the clinical benefits of bariatric surgery in diabetes patients with BMI ≥ 35 kg/m2. Obesity. 2011;19:581–7.PubMedCrossRefGoogle Scholar
  37. 37.
    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.PubMedCrossRefGoogle Scholar
  38. 38.
    Neovius M, Narbro K, Keating C, et al. Health care use during 20 years following bariatric surgery. JAMA. 2012;308:1132–41.PubMedCrossRefGoogle Scholar
  39. 39.
    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.PubMedCrossRefGoogle Scholar
  40. 40.
    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.PubMedCrossRefGoogle Scholar
  41. 41.
    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.PubMedCrossRefGoogle Scholar
  42. 42.
    Schachter M. Chemical, pharmacokinetic and pharmacodynamic properties of statins: An update. Fundam Clin Pharmacol. 2005;19:117–25.PubMedCrossRefGoogle Scholar
  43. 43.
    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.PubMedCrossRefGoogle Scholar
  44. 44.
    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.CrossRefGoogle Scholar
  45. 45.
    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.PubMedCrossRefGoogle Scholar
  46. 46.
    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.PubMedCrossRefGoogle Scholar
  47. 47.
    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.PubMedGoogle Scholar
  48. 48.
    Reddy RC, Baptist AP, Fan Z, et al. The effects of bariatric surgery on asthma severity. Obes Surg. 2011;21:200–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Sikka N, Wegienka G, Havstad S, et al. Respiratory medication prescriptions before and after bariatric surgery. Ann Allergy Asthma Immunol. 2010;104:326–30.PubMedCrossRefGoogle Scholar
  50. 50.
    Merhi ZO. Impact of bariatric surgery on female reproduction. Fertil Steril. 2009;92:1501–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Gerrits EG, Ceulemans R, Van Hee R, et al. Contraceptive treatment after biliopancreatic diversion needs consensus. Obes Surg. 2003;13:378–82.PubMedCrossRefGoogle Scholar
  52. 52.
    Merhi ZO. Challenging oral contraception after weight loss by bariatric surgery. Gynecol Obstet Invest. 2007;64:100–2.PubMedCrossRefGoogle Scholar
  53. 53.
    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.PubMedCrossRefGoogle Scholar
  54. 54.
    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.PubMedCrossRefGoogle Scholar
  55. 55.
    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.PubMedCrossRefGoogle Scholar
  56. 56.
    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.PubMedCrossRefGoogle Scholar
  57. 57.
    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.PubMedCrossRefGoogle Scholar
  58. 58.
    Lizer MH, Papageorgeon H, Glembot TM. Nutritional and pharmacologic challenges in the bariatric surgery patient. Obes Surg. 2010;20:1654–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jan Peter Yska
    • 1
  • Susanne van der Linde
    • 1
  • Véronique V. Tapper
    • 1
  • Jan A. Apers
    • 2
  • Marloes Emous
    • 2
  • Erik R. Totté
    • 2
  • Bob Wilffert
    • 3
    • 4
  • Eric N. van Roon
    • 1
  1. 1.Department of Clinical Pharmacy and Clinical PharmacologyMedisch Centrum LeeuwardenLeeuwardenThe Netherlands
  2. 2.Department of SurgeryMedisch Centrum LeeuwardenLeeuwardenThe Netherlands
  3. 3.Unit of Pharmacotherapy and Pharmaceutical Care, Department of PharmacyUniversity of GroningenGroningenThe Netherlands
  4. 4.Department of Hospital and Clinical Pharmacy, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands

Personalised recommendations