Adjusting medications after bariatric surgery

Avoid extended-release and enteric-coated medications, especially after bypass, absorption is unpredictable with the shortened intestine....
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition

More patients will need help adjusting medications after bariatric surgery. More of these procedures are being done to help patients lose weight, control diabetes, and improve cardiovascular risk. Gastric banding (Lap-Band) and the Roux-en-Y gastric bypass are the most common procedures. Banding uses an inflatable ring to squeeze the neck of the stomach to reduce stomach volume and restrict intake. Gastric bypass reduces the stomach size surgically AND bypasses part of the small intestine to limit nutrient absorption.

There are a number of things to keep in mind after surgery. Use liquid, crushable, or non-oral medications for weeks to months after surgery to allow healing. Recommend sugar-free liquids too much sugar can cause cramps and diarrhea. Avoid extended-release and enteric-coated medications, especially after bypass, absorption is unpredictable with the shortened intestine. Avoid or split larger pills to avoid blocking the band or stomach outlet. Avoid GI irritants, such as NSAIDs and oral bisphosphonates or corticosteroids. If an NSAID is absolutely necessary, suggest adding a proton pump inhibitor (PPI) to protect the small stomach pouch.

Monitor medication response to reduce or eliminate those no longer needed for diabetes, hypertension, etc. Blood glucose significantly improves shortly after surgery even before significant weight loss. Also suggest monitoring serum drug levels when possible to adjust critical medications such as immunosuppressives, anticonvulsants, etc. Recommend vitamins and minerals, especially vitamin B12, folate, thiamine, iron, calcium, and fat-soluble vitamins (A, D, E, and K). To improve absorption, recommend using calcium citrate (Cal-Mag) instead of calcium carbonate (Cal-Preg) and separating calcium and iron by 2 hours.

References