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Oral drug dosing following bariatric surgery - General concepts and specific dosing advices
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  • Jurjen Kingma,
  • Desirée Burgers,
  • Valerie Monpellier,
  • Marinus Wiezer,
  • Heleen Blussé van Oud-Alblas,
  • Janelle Vaughns,
  • Catherine Sherwin,
  • Catherijne Knibbe
Jurjen Kingma
Sint Antonius Hospital
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Desirée Burgers
Sint Antonius Hospital
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Valerie Monpellier
Nederlandse Obesitas Kliniek (Dutch Obesity Clinic)
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Marinus Wiezer
Sint Antonius Hospital
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Heleen Blussé van Oud-Alblas
Sint Antonius Hospital
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Janelle Vaughns
Children's National Health System
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Catherine Sherwin
Wright State University Boonshoft School of Medicine
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Catherijne Knibbe
Sint Antonius Hospital
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Abstract

Bariatric or weight-loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism, and/or elimination of drugs may be altered. The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide guidance for dosing of commonly used or high-risk drugs in this special population. Upon oral drug administration, the time to maximum concentration is often earlier and this concentration may be higher with less consistent effects on trough concentrations and exposure. Additionally, prescription of liquid formulations to bariatric patients is supported by some reports, even though the high sugar load of these suspensions may be of concern. Studies on extended release medications result in an unaltered exposure for a substantial number of drugs. Also, studies evaluating the influence of timing after surgery show dynamic absorption profiles. Although for this group a specific advice can be proposed for many drugs, we conclude that there is insufficient evidence for general advices for oral drug therapy after bariatric surgery implying that a risk assessment on a case-by-case basis is required for each drug.

Peer review status:ACCEPTED

11 Dec 2020Submitted to British Journal of Clinical Pharmacology
14 Dec 2020Submission Checks Completed
14 Dec 2020Assigned to Editor
17 Dec 2020Reviewer(s) Assigned
07 Jan 2021Review(s) Completed, Editorial Evaluation Pending
09 Jan 2021Editorial Decision: Revise Major
22 Feb 20211st Revision Received
23 Feb 2021Submission Checks Completed
23 Feb 2021Assigned to Editor
23 Feb 2021Review(s) Completed, Editorial Evaluation Pending
25 Feb 2021Reviewer(s) Assigned
11 Mar 2021Editorial Decision: Revise Minor
06 Apr 20212nd Revision Received
07 Apr 2021Submission Checks Completed
07 Apr 2021Assigned to Editor
07 Apr 2021Review(s) Completed, Editorial Evaluation Pending
09 Apr 2021Reviewer(s) Assigned
01 May 2021Editorial Decision: Accept