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Longitudinal Impacts of Gastric Bypass Surgery on Pharmacodynamics and Pharmacokinetics of Statins

Obesity Surgery volume 29, pages 2571–2583 (2019)Cite this article

A Correction to this article was published on 29 April 2019

This article has been updated

Abstract

Purpose

Undergoing Roux-en-Y gastric bypass (RYGB) is expected to affect orally administered drug absorption. Statins are commonly prescribed to patients with obesity for the prevention of atherosclerotic cardiovascular diseases by lowering cholesterol. This is the first longitudinal prospective study on impacts of RYGB on weight loss, pharmacodynamics, and pharmacokinetics of atorvastatin, rosuvastatin, and simvastatin, and their active metabolites, up to 1-year post-surgery.

Methods

Forty-six patients were recruited, five patients on atorvastatin, twelve on rosuvastatin, nine on simvastatin, and twenty on no statin. The concentrations of atorvastatin, rosuvastatin, and simvastatin with their active metabolites were monitored.

Results

Mean plasma concentrations of atorvastatin and metabolites and rosuvastatin normalized by the unit dose [(nM)/(mg/kg)] decreased by 3- to 6-month post-surgery. Conversely, simvastatin and its metabolite concentrations increased up to 6-month post-surgery, then declined to preoperative levels by 1-year post-surgery. The metabolisms of atorvastatin to hydroxyl-metabolites and simvastatin to simvastatin acid were decreased after RYGB. The weight loss and PD outcomes were comparable between statin and non-statin groups suggesting the key impacts were from RYGB. The discontinuation or reduction of dose of atorvastatin or rosuvastatin post-RYGB exhibited rebounds of LDL levels in some subjects, but the rebound was not apparent with patients on simvastatin pre-surgery.

Conclusion

Discontinuations of statin dosing post-RYGB require LDL monitoring and reducing the dose to half seems to have better results. Patients on statin treatment post-RYGB should be followed-up closely based on our pharmacokinetic findings, to ensure therapeutic effects of the treatment with minimal adverse effects.

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Change history

  • 29 April 2019

    In the original article the authors failed to include the following footnote:

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Funding

This work was supported by the Research Centers in Minority Institutions (RCMI) [grant number 5G12MD007605-23].

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Authors and Affiliations

  1. Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, 4849 Calhoun Rd., Houston, TX, 77204, USA

    Asma El-Zailik, Yang Wang & Diana S.-L. Chow

  2. Department of Pharmacy Practice and Clinical Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, 3100 Cleburne St., Houston, TX, 77004, USA

    Lily K. Cheung

  3. Department of Surgery, Houston Methodist Hospital, 6550 Fannin St., Houston, TX, 77030, USA

    Vadim Sherman

Authors
  1. Asma El-Zailik
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  2. Lily K. Cheung
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Correspondence to Asma El-Zailik.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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

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El-Zailik, A., Cheung, L.K., Wang, Y. et al. Longitudinal Impacts of Gastric Bypass Surgery on Pharmacodynamics and Pharmacokinetics of Statins. OBES SURG 29, 2571–2583 (2019). https://doi.org/10.1007/s11695-019-03885-6

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  • DOI: https://doi.org/10.1007/s11695-019-03885-6

Keywords

  • Roux en-Y gastric bypass
  • Statins
  • Active metabolites
  • Pharmacokinetics
  • Pharmacodynamics

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