1
|
Van Prooyen AM, Hicks JL, Lin E, Davis SS, Singh A, Harris DA, Falconer EA, Hechenbleikner EM. Evaluation of An Inpatient Pharmacy Consult on Discharge Medications in Bariatric Surgery Patients. J Pharm Pract 2021; 36:203-212. [PMID: 34227420 DOI: 10.1177/08971900211030238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the impact of an inpatient pharmacy consult on discharge medications following bariatric surgery. METHODS A pharmacy consult for discharge medication review for bariatric surgery patients was instituted at an academic medical center. The intervention included conducting a medication history, reviewing home medications for updates post-bariatric surgery, creating and documenting a discharge medication plan, and providing patient education. The impact of the intervention was evaluated by comparing medication classes, doses, and formulations prescribed during the intervention relative to a historical control group. RESULTS The study included 85 patients who received pharmacist intervention and 167 patients who did not receive pharmacist intervention following bariatric surgery. The prescription of an extended-release medication at discharge in the intervention group was reduced by 19.3% (28.7% vs. 9.4%, p = 0.0005). For patients on hypertension medications, 94.0% had their regimen reduced in the intervention group compared with 37.5% of patients in the control group (p < 0.001). Of patients on insulin at baseline, 87.5% of patients in the intervention group had dose reductions at discharge vs. 66.7% of patients in the control group (p = 0.37). No patients in the intervention group were discharged with oral antihyperglycemic medications or non-insulin injectable medications vs. 33.3% (p = 0.12) and 20.0% (p = 0.47), respectively, in the control group. Readmission rates at 30 days were insignificantly lower in the intervention group (3.5% vs. 4.2%, p = 1). CONCLUSIONS Clinical pharmacist involvement in the discharge medication reconciliation process for bariatric surgery patients reduced prescribing of unadjusted medication classes, doses, and drug formulations.
Collapse
Affiliation(s)
| | - Jessica L Hicks
- Department of Pharmacy, Emory University Hospital Midtown, Atlanta, GA, USA
| | - Ed Lin
- Division of General and GI Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Scott S Davis
- Division of General and GI Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Arvinpal Singh
- Division of General and GI Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - DeAngelo A Harris
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Elissa A Falconer
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | |
Collapse
|
2
|
Yska JP, Wanders JTM, Odigie B, Apers JA, Emous M, Totté ERE, Boerma EC, Ubels FL, Woerdenbag HJ, Frijlink HW, Wilffert B, van Roon EN. Effect of Roux-en-Y gastric bypass on the bioavailability of metoprolol from immediate and controlled release tablets: a single oral dose study before and after surgery. Eur J Hosp Pharm 2020; 27:e19-e24. [PMID: 32296500 DOI: 10.1136/ejhpharm-2018-001804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/12/2019] [Accepted: 01/17/2019] [Indexed: 11/04/2022] Open
Abstract
Objective Roux-en-Y gastric bypass (RYGB) surgery induces major changes in the gastrointestinal tract that may alter the pharmacokinetics of orally administered drugs. Results from pharmacokinetic studies are sparse. This study aimed to investigate the effect of RYGB on the bioavailability of metoprolol from immediate release (IR) and controlled release (CR) tablets in female patient volunteers before and after surgery. Methods An explorative, two-phase, single oral dose pharmacokinetic study of metoprolol in female patients undergoing RYGB was carried out. The dose was administered twice in each patient, 1 month before and 6 months after surgery. After intake of either 100 mg of metoprolol IR or CR tablet serum concentration-time profiles of metoprolol were determined. The endpoint was the ratio of AUCafter/AUCbefore of metoprolol. Results Twelve patients were included in the study (metoprolol IR: 7; metoprolol CR: 5). After intake of a metoprolol IR tablet major intraindividual and interindividual differences for area under the serum concentration versus time curve (AUC) of metoprolol before and after surgery were observed (range ratio AUC0-10 hours after/AUC0-10 hours before: 0.74-1.98). For metoprolol CR tablets a significant reduction in bioavailability of metoprolol was observed after surgery (range ratio AUC0-24 hours after/AUC0-24 hours before: 0.43-0.77). Conclusion RYGB may influence the bioavailability of metoprolol from an IR tablet. The magnitude of changes in bioavailability after RYGB requires close monitoring of patients using metoprolol IR tablets and dose adjustment if deemed necessary. RYGB clearly reduces the bioavailability of metoprolol from a CR tablet. After RYGB clinicians may consider to increase the dose according to clinical response.
Collapse
Affiliation(s)
- Jan Peter Yska
- Department of Clinical Pharmacy and Clinical Pharmacology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Jacquelien T M Wanders
- Department of Clinical Pharmacy and Clinical Pharmacology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Blessing Odigie
- Department of Clinical Pharmacy and Clinical Pharmacology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Jan A Apers
- Department of Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Marloes Emous
- Department of Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Erik R E Totté
- Department of Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Froukje L Ubels
- Department of Internal Medicine, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Herman J Woerdenbag
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherlands
| | - Henderik W Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Unit of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Eric N van Roon
- Department of Clinical Pharmacy and Clinical Pharmacology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands.,Unit of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
3
|
Montanha MC, Diniz A, Silva NMEN, Kimura E, Paixão P. Physiologically-Based Pharmacokinetic Model on the Oral Drug Absorption in Roux-en-Y Gastric Bypass Bariatric Patients: Amoxicillin Tablet and Suspension. Mol Pharm 2019; 16:5025-5034. [PMID: 31721592 DOI: 10.1021/acs.molpharmaceut.9b00870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The potential of a physiologically-based pharmacokinetic (PBPK) model to predict oral amoxicillin bioavailability, by considering the physiological changes after "Roux-en-Y gastric bypass" (RYGB) surgery in bariatric patients, was evaluated. A middle-out approach for parameter estimations was undertaken using in vitro, in situ, and in vivo data. The observed versus predicted plasma concentrations and the model sensitivity of the simulated parameters of AUC0-inf and Cmax of amoxicillin (AMX) were used to confirm the reliability of the estimation. The model considers that a drug-transporter (Transp) in the initial segments of the normal intestine plays a significant role in the AMX absorption. A lower fraction absorbed (Fabs) was observed in RYGB patients (54.43% for suspension and 45.21% for tablets) compared to healthy subjects (77.48% capsule). Furthermore, the tablet formulation presented a lower dissolved fraction (Fd) and Fabs compared to the suspension formulation of AMX in RYGB patients (91.70% and 45.21% versus 99.92% and 54.43%, respectively). The AUC0-inf and Cmax were sensitive to changes in Rtintestine, PeffAMX, and Transp for both healthy and RYGB models. Additionally, AUC0-inf and Cmax were also sensitive to changes in the tlag parameter for tablet formulation in RYGB patients. The PBPK model showed a reduction in AMX bioavailability as a consequence of reduced intestinal length after RYGB surgery. Additionally, the difference in the predicted Fd and Fabs between suspension and tablet suggests that liquid formulations are preferable in postbariatric patients.
Collapse
Affiliation(s)
- Maiara Camotti Montanha
- Universidade Estadual de Maringá, Postgraduate Program in Biosciences and Physiopathology (PBF), Maringá, Paraná, Brazil.,Universidade Estadual de Maringá, Clinical Research Centre and Bioequivalence Studies, Maringá, Paraná, Brazil
| | - Andréa Diniz
- Universidade Estadual de Maringá, Department of Pharmacy, Maringá, Paraná, Brazil
| | | | - Elza Kimura
- Universidade Estadual de Maringá, Clinical Research Centre and Bioequivalence Studies, Maringá, Paraná, Brazil.,Universidade Estadual de Maringá, Department of Pharmacy, Maringá, Paraná, Brazil
| | - Paulo Paixão
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
4
|
Hensel J, Selvadurai M, Anvari M, Taylor V. Mental Illness and Psychotropic Medication use Among People Assessed for Bariatric Surgery in Ontario, Canada. Obes Surg 2017; 26:1531-6. [PMID: 26450710 DOI: 10.1007/s11695-015-1905-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Studies completed outside of Canada have reported a high rate of mental illness and psychotropic medication use among bariatric surgery candidates with variable impacts on surgical and mental health outcomes. To our knowledge, there has been no published Canadian data on this issue. METHODS We conducted a secondary analysis of de-identified data from the Ontario Bariatric Registry for all individuals who completed both a baseline and psychological assessment between April 1, 2010, and February 9, 2015 (N = 10,698). We determined the rates of reported mental illness and psychotropic medication use overall and by fiscal year of assessment. RESULTS A past or present mental illness, most commonly depression, was recorded for 51 % of individuals. At baseline, 38 % were taking at least one psychotropic medication, most commonly antidepressants. Only a small proportion of the population were taking psychotropic medications known to be associated with high potential for weight gain. Although the prevalence of mental illness increased steadily from 35 % in 2010/2011 to 63 % in 2014/2015, there was no corresponding increase in reported medication use. Of those taking psychotropic medications, 13 % did not have a recorded history of mental illness. CONCLUSIONS Consistent with other international studies, our results indicate a high prevalence of mental illness and psychotropic medication use among people referred for bariatric surgery in Ontario, Canada. This supports that accurate screening practices, knowledge about how to manage psychotropic medication pre- and post-operatively and recognition for opportunities to change medications that may be associated with weight gain are required.
Collapse
Affiliation(s)
- Jennifer Hensel
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Melanie Selvadurai
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario, Canada
| | - Mehran Anvari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Valerie Taylor
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Excess Weight Loss and Cardiometabolic Parameter Reduction Diminished among Hispanics Undergoing Bariatric Surgery: Outcomes in More than 2,000 Consecutive Hispanic Patients at a Single Institution. J Am Coll Surg 2016; 222:166-73. [DOI: 10.1016/j.jamcollsurg.2015.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/19/2015] [Accepted: 10/19/2015] [Indexed: 11/23/2022]
|
6
|
Yska JP, van der Meer DH, Dreijer AR, Eilander W, Apers JA, Emous M, Totté ERE, Wilffert B, van Roon EN. Influence of bariatric surgery on the use of medication. Eur J Clin Pharmacol 2015; 72:203-9. [DOI: 10.1007/s00228-015-1971-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/23/2015] [Indexed: 11/30/2022]
|
7
|
Dillon C, Peddle J, Twells L, Lester K, Midodzi W, Manning K, Murphy R, Pace D, Smith C, Boone D, Gregory D. Rapid Reduction in Use of Antidiabetic Medication after Laparoscopic Sleeve Gastrectomy: The Newfoundland and Labrador Bariatric Surgery Cohort (BaSCo) Study. Can J Hosp Pharm 2015; 68:113-20. [PMID: 25964682 DOI: 10.4212/cjhp.v68i2.1436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients who have undergone bariatric surgery generally need fewer medications as they experience improvement in, or even resolution of, various medical conditions, including type 2 diabetes mellitus, hypertension, and dyslipidemia. Published data on changes in medication use after laparoscopic sleeve gastrectomy, a type of bariatric surgery that is growing in popularity, are limited. OBJECTIVE To determine whether patients took fewer medications for management of type 2 diabetes, hypertension, and dyslipidemia after laparoscopic sleeve gastrectomy, relative to preprocedure medications. METHODS In this prospective, single-centre cohort study, a nurse practitioner used standard medication reconciliation and study data-extraction forms to interview adult patients who had undergone laparoscopic sleeve gastrectomy and determine their medication use and pertinent demographic data. The data were analyzed using generalized estimating equations and standard statistical software. Outcome measures included changes in the use of antidiabetic, antihypertensive, and antilipemic medications at 1, 3, and 6 months after the surgery. RESULTS A total of 65 patients who underwent laparoscopic sleeve gastrectomy between May 2011 and January 2014 met the study inclusion criteria. Before surgery, the 30 patients with type 2 diabetes were taking an average of 1.9 antidiabetic medications. One month after the procedure, 15 (50%) had discontinued all antidiabetic medications, with a further decline at 3 and 6 months (p < 0.001 at each time point). Among the patients who were taking antihypertensives (n = 48) and antilipemics (n = 33) before surgery, the decline in use occurred at a more modest rate, with 6 (12%) and 2 (6%), respectively, discontinuing these medication classes within 1 month, and 12 (25%) (p = 0.001) and 8 (24%) (p = 0.015) having discontinued by 6 months. CONCLUSIONS These findings suggest that patients with a history of type 2 diabetes mellitus, hypertension, and/or dyslipidemia who undergo laparoscopic sleeve gastrectomy are less likely to require disease-specific medications shortly after surgery.
Collapse
Affiliation(s)
- Carla Dillon
- BScPharm, ACPR, PharmD, is with the School of Pharmacy and Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Justin Peddle
- BScPharm, PharmD, is with the School of Pharmacy, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Laurie Twells
- BA, MSc, PhD, is with the School of Pharmacy and Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Kendra Lester
- BSc, MSc, is with the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - William Midodzi
- PhD, is with the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | | | - Raleen Murphy
- NP, MSc(A), BSc, is with Eastern Health, St John's, Newfoundland and Labrador
| | - David Pace
- BSc, MBA, MD, FRCSC, is with Eastern Health and the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Chris Smith
- BSc(Hons), MD, FRCSC, is with Eastern Health and the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Darrell Boone
- BMedSc, MD, FRCSC, is with Eastern Health and the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Deborah Gregory
- BN, MSc, PhD, is with the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| |
Collapse
|
8
|
Medication use following bariatric surgery: factors associated with early discontinuation. Obes Surg 2015; 24:696-704. [PMID: 24234778 DOI: 10.1007/s11695-013-1131-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Medication discontinuation is a common result of bariatric surgery. The influence of individual patient characteristics and surgical outcomes on overall and specific medication discontinuation is not well understood. The purpose of the current study was to assess changes in medication use and identify individual characteristics and surgical outcomes associated with medication discontinuation among bariatric patients. METHODS The patients included in the current study received bariatric surgery from the Northern Colorado Surgical Associates of Fort Collins, Colorado, USA, between October 2007 and September 2010. Demographic, weight, health, and medication data from 400 patients with at least one 6- or 12-month post-operative appointment were extracted from the Bariatric Outcome Longitudinal Database. Multivariate regression analyses were used to investigate how patient factors affect total medication use over time, use of medications grouped by co-morbidity post-operatively, and use of specific medication classes post-operatively. RESULTS Baseline co-morbidities, particularly type 2 diabetes,male sex, and Roux-en-Y gastric bypass surgery were significantly associated with decreased total medication use following surgery.Weight loss, systemic disease, sex, baseline co-morbidities, surgical complications, and race were significantly associated with continued use of specific medications following surgery. CONCLUSIONS Bariatric surgery can help patients with certain characteristics discontinue medications but is not effective for all patients. Baseline health, sex, race, bariatric procedure,surgical complications, and post-operative weight loss may affect how bariatric patients' medication use changes preoperatively to post-operatively.
Collapse
|
9
|
Chen Y, Lubitz CC, Shikora SA, Hodin RA, Gaz RD, Moore FD, McKenzie TJ. Primary Hyperparathyroidism After Roux-en-Y Gastric Bypass. Obes Surg 2014; 25:700-4. [DOI: 10.1007/s11695-014-1444-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
Darwich AS, Rostami-Hodjegan A. Can We Rationalize Oral Drug Exposure Following Bariatric Surgery to Meet the Pharmacotherapeutic Needs of a Growing Patient Population? Commentary on: “Lithium Toxicity Following Roux-en-Y Gastric Bypass”. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.9960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adam S. Darwich
- Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, University of Manchester, Manchester, United Kingdom
| | - Amin Rostami-Hodjegan
- Centre for Applied Pharmacokinetic Research, Manchester Pharmacy School, University of Manchester, Manchester, United Kingdom
- Simcyp Ltd. (a Certara company), Blades Enterprise Centre, Sheffield, United Kingdom
| |
Collapse
|
11
|
Darwich AS, Pade D, Rowland-Yeo K, Jamei M, Asberg A, Christensen H, Ashcroft DM, Rostami-Hodjegan A. Evaluation of an In Silico PBPK Post-Bariatric Surgery Model through Simulating Oral Drug Bioavailability of Atorvastatin and Cyclosporine. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2013; 2:e47. [PMID: 23903405 PMCID: PMC3697036 DOI: 10.1038/psp.2013.23] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 03/13/2013] [Indexed: 01/12/2023]
Abstract
An increasing prevalence of morbid obesity has led to dramatic increases in the number of bariatric surgeries performed. Altered gastrointestinal physiology following surgery can be associated with modified oral drug bioavailability (Foral). In the absence of clinical data, an indication of changes to Foral via systems pharmacology models would be of value in adjusting dose levels after surgery. A previously developed virtual "post-bariatric surgery" population was evaluated through mimicking clinical investigations on cyclosporine and atorvastatin after bariatric surgery. Cyclosporine simulations displayed a reduced fraction absorbed through gut wall (fa) and Foral after surgery, consistent with reported observations. Simulated atorvastatin Foral postsurgery was broadly reflective of observed data with indications of counteracting interplay between reduced fa and an increased fraction escaping gut wall metabolism (FG). Inability to fully recover observed atorvastatin exposure after biliopancreatic diversion with duodenal switch highlights the current gap regarding the knowledge of associated biological changes.CPT: Pharmacometrics & Systems Pharmacology (2013) 2, e47; doi:10.1038/psp.2013.23; advance online publication 12 June 2013.
Collapse
Affiliation(s)
- A S Darwich
- Centre for Applied Pharmacokinetic Research, School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester, UK
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Darwich AS, Henderson K, Burgin A, Ward N, Whittam J, Ammori BJ, Ashcroft DM, Rostami-Hodjegan A. Trends in oral drug bioavailability following bariatric surgery: examining the variable extent of impact on exposure of different drug classes. Br J Clin Pharmacol 2013; 74:774-87. [PMID: 22463107 DOI: 10.1111/j.1365-2125.2012.04284.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Changes to oral drug bioavailability have been observed post bariatric surgery. However, the magnitude and the direction of changes have not been assessed systematically to provide insights into the parameters governing the observed trends. Understanding these can help with dose adjustments. WHAT THIS STUDY ADDS Analysis of drug characteristics based on a biopharmaceutical classification system is not adequate to explain observed trends in altered oral drug bioavailability following bariatric surgery, although the findings suggest solubility to play an important role. AIMS To identify the most commonly prescribed drugs in a bariatric surgery population and to assess existing evidence regarding trends in oral drug bioavailability post bariatric surgery. METHODS A retrospective audit was undertaken to document commonly prescribed drugs amongst patients undergoing bariatric surgery in an NHS hospital in the UK and to assess practice for drug administration following bariatric surgery. The available literature was examined for trends relating to drug permeability and solubility with regards to the Biopharmaceutics Classification System (BCS) and main route of elimination. RESULTS No significant difference in the 'post/pre surgery oral drug exposure ratio' (ppR) was apparent between BCS class I to IV drugs, with regards to dose number (Do) or main route of elimination. Drugs classified as 'solubility limited' displayed an overall reduction as compared with 'freely soluble' compounds, as well as an unaltered and increased ppR. CONCLUSION Clinical studies establishing guidelines for commonly prescribed drugs, and the monitoring of drugs exhibiting a narrow therapeutic window or without a readily assessed clinical endpoint, are warranted. Using mechanistically based pharmacokinetic modelling for simulating the multivariate nature of changes in drug exposure may serve as a useful tool in the further understanding of postoperative trends in oral drug exposure and in developing practical clinical guidance.
Collapse
Affiliation(s)
- Adam S Darwich
- Centre of Applied Pharmacokinetic Research, School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester, UK
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Influence of Bariatric Surgery on the Use and Pharmacokinetics of Some Major Drug Classes. Obes Surg 2013; 23:819-25. [DOI: 10.1007/s11695-013-0882-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
14
|
Preliminary comparison of sertraline levels in postbariatric surgery patients versus matched nonsurgical cohort. Surg Obes Relat Dis 2012; 8:62-6. [DOI: 10.1016/j.soard.2010.12.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/06/2010] [Accepted: 12/09/2010] [Indexed: 01/31/2023]
|
15
|
Malone M, Alger-Mayer SA, Polimeni JM. Antidepressant Drug Therapy Does Not Affect Weight Loss One Year after Gastric Bypass Surgery. Obes Surg 2011; 21:1721-3. [DOI: 10.1007/s11695-010-0351-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
16
|
Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient. Obes Surg 2010; 20:1654-9. [DOI: 10.1007/s11695-009-0050-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 11/30/2009] [Indexed: 12/16/2022]
|
17
|
Affiliation(s)
- Pam Sardo
- Pharmaceutical Products Division, Public Policy and Strategy, Clinical Evidence and Outcomes, Abbott Laboratories, Parker, TX
| | - Jodi H. Walker
- Department of Pharmacy, VA Healthcare Network Upstate New York, Bath, NY
| |
Collapse
|
18
|
Sugerman HJ. Quality assessment and improvement in bariatric surgery. Surg Obes Relat Dis 2006; 1:453-7. [PMID: 16925269 DOI: 10.1016/j.soard.2005.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Accepted: 07/07/2005] [Indexed: 10/25/2022]
|