It is important to let your doctor know if you are to have any scheduled a Weight Loss Surgery such as gastric bypass, “Roux-en-y,” lap sleeve or band procedure. Bariatric surgery allows for manipulation of the stomach and small intestine; medication absorption may be affected because of the change in the gastrointestinal system.
Of note, many medications are assimilated either in the belly or small intestines and absorption can be considered a problem. One factor is that if the size of the stomach is reduced there isn’t enough potential gastric acid to fully dissolve the medication. Other medications may be absorbed after they go through the stomach and into the first area of the small intestine called the duodenum.
It is the mix of the non-acidic or neutral environment of the tiny intestines along with specific digestive enzymes and protein coating the duodenum that allow absorption. Bariatric surgery techniques, the popular Roux-en-y procedure especially, bypass the duodenum completely, so certain medications might have difficulty being utilized. After bariatric surgery, many patients have the ability to discontinue medications for chronic conditions, such as diabetes and hypertension.
The good news is that a lot of patients after Roux en Y Gastric Bypass surgery require fewer medications, or at least reduced dosages of medications they needed prior to the surgery. However, drug therapy is often necessary for conditions unrelated to or not improved by weight loss. Chronic psychiatric conditions such as ADHD, stress, and depression may be among these conditions. Furthermore to drug absorption, drug distribution may also be affected following bariatric surgery.
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Obesity-related factors that can influence a medication distribution include increased bloodstream volume, cardiac output, lean muscle mass, organ size, and adipose mass. After bariatric surgery, these factors are anticipated to change and, therefore, may necessitate drug dosing adjustments. To raised to take care of these medications, it is essential to be aware of the changes in the anatomy and physiology of the GI tract pursuing bariatric surgery. If one is finding your way through bariatric surgery, it’s important to utilize your doctor to find alternatives.
If there’s a version of the medication that’s not prolonged release (known as Immediate Release or “IR”), switching to that often medication often works. When there is no IR version of the drug available, discuss alternatives with your doctor then. Very often there’s a similar IR drug that may be as clinically effective as the extended-release drug you’re on.
Consider crushing all medications and switching all sustained-extended release formulations to immediate-release dosage forms, when appropriate. Alternative medication dosage formulations such as liquid solutions or suspensions that will circumvent the need for tablet or capsule dissolution should also be considered. Ultimately, frequent and comprehensive therapeutic monitoring should be applied in order to ensure the right dosing and to minimize side effects. The medications that are most at risk of problems after gastric bypass surgery are the ones that are prolonged release, postponed release or enteric coated.