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MEDICATIONS After Bariatric Surgery

Bariatric surgery changes many aspects of one’s life, and medications are no exception. Most patients will be prescribed certain medications and supplements after their surgery, but the surgery can also affect what medications are safe to take for other reasons and how you take them.

The Type of Operation Matters
Because the Roux-en-Y operation bypasses the lower stomach and a majority of the small intestine, foods are slowly digested and only partially absorbed after this surgery. Some medications are not well absorbed, while others can irritate the small pouch and its connection to the Roux limb, causing marginal ulcers. Most importantly, patients are at risk for nutrient deficiencies, so appropriate supplementation is necessary.

The duodenal switch produces even more malabsorption and requires strict post-operative supplementation. These patients are specifically prone to protein deficiency, and they should take supplemental protein as well as vitamins and minerals.

Operations that restrict food intake without bypassing the bowel, such as gastric banding, sleeve gastrectomy and vertical banded gastroplasty, do not impair food absorption, so those patients do not require strict supplementation. They still need to take proton pump inhibitors (such as Nexium or Prilosec) to decrease reflux and protect the small gastric pouch. Due to rapid weight loss, ursodiol (Actigall) is also recommended to prevent gallstone formation.

Some medications are not recommended after bariatric surgery, but are not strictly prohibited for patients who have had restrictive operations (see table for details).
Nutrient Supplementation
After gastric bypass, patients are prone to deficiencies of the fat-soluble vitamins (A, D, E and K) and calcium. They also have an increased risk of anemia due to inadequate amounts of iron, vitamin B12 and folate. Because of these deficits, all gastric bypass patients should take a daily multivitamin and calcium supplements, and additional supplementation with iron, vitamin B12 and folate may be necessary.

Making the stomach smaller through bariatric surgery decreases gastric acid production, which affects the absorption of calcium and can increase the patient’s risk of osteoporosis. Calcium carbonate requires acid to be absorbed, but calcium citrate, which we recommend for supplementation, does not.

The duodenum is the primary site for absorption of iron and is bypassed in the Roux-en-Y procedure. Like calcium, iron requires acid to be absorbed, which is lacking in the small gastric pouch. Gastric bypass patients can take iron salts combined with ascorbic acid (vitamin C) to acidify the stomach and facilitate absorption.

Vitamin B12 absorption requires intrinsic factor, which is produced in the bypassed part of the stomach, as well as acid; a lack of these can lead to vitamin B12 deficiency and anemia. Appropriate supplementation can be achieved by taking an oral formulation (1000 g daily) or monthly injections.
Medications and Marginal Ulcers
Non-steroidal anti-inflammatory medications (NSAIDs), such as Advil, Motrin, Aleve, Excedrin and Celebrex, are used primarily to treat inflammation, fever and mild to moderate pain from headaches, arthritis, sports injuries and menstrual cramps. Taking NSAIDs after gastric bypass surgery significantly increases the risk of developing marginal ulcers at the connection between the stomach pouch and the Roux limb. Thus, gastric bypass patients should avoid these medications.

The same risk extends to the salicylates (i.e., aspirin), but the risks and benefits of daily aspirin therapy should be considered on an individual basis. Safer options for oral pain medications include acetaminophen and opioids (Percocet, Vicodin, Tylenol #3 and Tramadol).

Oral biphosphonates are another type of medication that may produce marginal ulcers in gastric bypass patients. These drugs inhibit the loss of bone mass associated with bone diseases like osteoporosis and Paget’s disease; commonly used biphosphonates include Actonel, Aredia, Boniva, Didronel, Fosamax, Reclast, Skelid and Zometa. However, there are alternative treatment options available, such as calcitonin salmon nasal spray, synthetic parathyroid hormone and Raloxifene.

Anti-acid medications (Nexium, Protonix or Prevacid) are prescribed to prevent ulcers in the gastric pouch. We recommend taking one of these for at least six months following any type of bariatric surgery.
Reduced Medication Effectiveness
The shorter intestinal length after gastric bypass or duodenal switch surgery can make extended-release drug preparations less effective. Some extended-release drugs include antidepressants (Wellbutrin XL), anxiolytics and sleep medications (Xanax XR), and anti-hypertensives (Toprol XL, Verapamil XL). Because these formulations are intended to be absorbed over 2-12 hours, the pills may pass through the gastrointestinal tract before absorption is complete.

This same principle also applies to delayed-release and enteric- or film-coated pills, which are coated with a material that prevents the medication from being released until the pill moves through the stomach to the small intestine. (Sometimes the abbreviation “EC is added to the name of a drug to indicate that it is enteric-coated.) Immediate-release dosage forms should be substituted, although they may need to be taken more often.

Oral contraceptives are another type of medication that may not be absorbed as effectively after surgery; thus, non-hormonal barrier contraception is recommended to prevent unwanted pregnancy for women who have had gastric bypass or duodenal switch operations.
Diarrhea, Constipation and Gallstones
Some patients experience mild gastrointestinal problems after surgery. Imodium AD is safe and effective for post-operative diarrhea, and mild gas pains can be treated with Gas-X.

Since bariatric patients consume less food, smaller amounts of stool are formed, which can lead to constipation. Some people find that taking two or three tablespoons of milk of magnesia every few days helps. Drinking plenty of water is very important, and nothing works well for constipation if water intake is poor. It is not uncommon for bariatric patients to have a bowel movement every two to three days once it is regulated.

Patients who continue to experience constipation can take a fiber supplement, like Metamucil or Fibercon, once they are on the pureed diet. Colace, a stool softener, is sometimes necessary for patients on pain medication to prevent constipation. Some patients are given Reglan and Zofran for nausea and to assist with bowel movements.

Rapid weight loss after bariatric surgery predisposes patients to gallstones. If you still have your gallbladder and the pre-operative ultrasound did not show gallstones, you should take Actigall for six months post-operatively to prevent them from forming.
Can I Resume My Diabetic and Water Pills?
Patients are usually instructed to resume most of their pre-operative medications. Those who are on diabetic medications will need to monitor their blood sugar closely at home. Some patients’ blood sugar decreases very quickly after surgery (even before any weight loss), and they will need less of their diabetic medications. The same applies to insulin, which should be given when blood sugar is under strict control and under the supervision of an endocrinologist or primary care physician.

Diuretics (water pills or Lasix) are frequently prescribed for patients with hypertension, edema and congestive heart failure. Many patients are instructed to hold off on resuming diuretics because it is important to avoid dehydration after gastric bypass surgery; this is usually decided on an individual basis.

Other antihypertensive medications are safe to use after gastric bypass. Typically, the dose decreases as patients lose weight and their hypertension improves. Consult your doctor to discuss changing doses and types of medication.
Should I Continue My Blood Thinner Medications?
Some patients take oral blood thinners like Coumadin for atrial fibrillation, blood clots and other cardiovascular conditions. Coumadin is typically stopped before surgery and replaced with heparin injections. Following surgery, Coumadin is gradually resumed, with heparin given at the same time to “bridge its anticoagulant effect. After this temporary period, patients should continue Coumadin therapy under strict control of INR. No major changes in Coumadin dosing are required after gastric bypass.
My Pills Are Too Big!
The opening produced by Roux-en-Y surgery is about 1.5 cm wide, and gastric banding also produces a small opening. Some pills (such as calcium, multivitamins and iron) are quite big and cannot go through this small connection easily. We advise patients to take these pills one at a time throughout the day, if possible. Very large pills can be cut in half or crushed—but only if they are not time-release medications (i.e., diabetes pills). Ask your doctors if the pills they prescribe can be safely crushed.

NSAIDs
The following drugs are NSAIDs or include NSAIDs in their formula and should not be taken after weight loss surgery:


Advil
Aleve
Amigesic
Anacin
Anaprox
Anaprox DS
Ansaid
Arthrotec
Ascriptin
Aspirin
Azolid
Bextra
Bufferin
Butazolidin
Cataflam
Celebrex
Clinoril
Combunox
Darvon
Daypro
Disalcid
Dolobid
EC Naprosyn
Ecotrin
Equagesic
Excedrin
Excedrin IB
Feldene
Ibuprofen
Indocin
Indocin SR
Indo-Lemmon
Indomethagan
Lodine
Lodine XL
Meclomen
Mictainin
Midol IB
Mobic
Motrin
Motrin IB
Nalfon
Nalfon 200
Naprapac
Naprelan
Naprosyn
Nupin
Orudis
Oruvail
Pamprin IB
Percodan
Ponstel
Relafen
Rexolate
Tab-Profen
Tandearil
Tolectin
Tolectin 600
Tolectin DS
Toradol
Uracel
Vicoprofen
Voltaren


Medication Recommendations after Various Bariatric Surgeries
Gastric Bypass
Gastric Banding
Sleeve Gastrectomy
Bilopancreatic Diversion DS
NSAIDs
No
No
No
No
Baby Aspirin (81 mg)
YES, but consider individually
YES
YES
YES, but consider individually
Acetaminophen
YES
YES
YES
YES
Opiates
YES
YES
YES
YES
Water Pills (Lasix)
NO, but consider individually
NO, but consider individually
NO, but consider individually
NO, but consider individually
Vitamins (B12, C, D)
YES
NO
NO
YES
Iron
YES
NO
NO
YES
Calcium
YES
NO
NO
YES
Protein Supplements
YES
NO
NO
YES
Antacid
YES
YES
YES
YES
Actigall (Anti- Gallstones)
YES
YES
YES
YES
Insulin and Diabetes Pills
YES, under strict blood glucose control
YES, under strict blood glucose control
YES, under strict blood glucose control
YES, under strict blood glucose control
Hypertension Pills
(other than Lasix)
YES, under strict blood glucose control
YES, under strict blood glucose control
YES, under strict blood glucose control
YES, under strict blood glucose control
Antidepressants
YES
YES
YES
YES
Extended-Release (XL, XR), Coated Medications
NO
YES
YES
NO

Tomasz Rogula, MD, PhD, a Staff Surgeon at the Bariatric and Metabolic Institute at Cleveland Clinic, has published frequently on the topics of bariatric and laparoscopic surgery.

Philip Schauer, MD, FACS, the Director of Advanced Laparoscopic and Bariatric Surgery at Cleveland Clinic, has served as president of the American Society for Metabolic and Bariatric Surgery.


89 Comment(s)
Comment by Rusky on May 03, 2010 at 01:29pm
Great article - I've printed it out for my primary care doctor. Thank you.
Comment by GlennTrubee on May 03, 2010 at 11:15pm
What about allergy medicines?
Comment by MissD1969 on May 08, 2010 at 01:32am
I've been told by many doctors that those with the DS can take NSAIDS. Thats one reason I chose the DS over the Gastric Bypass.
Comment by Losing2Live on May 12, 2010 at 02:57am
Very helpful article - thanks!
Comment by 1234567890 on May 13, 2010 at 05:49am
This article is very good, and very inportant information thanks
Comment by Yme on May 18, 2010 at 03:27am
Thanks for this info. I'm printing and giving it to my medical and pain control doctors.. Thank You!
Comment by JAMJACKS76 on May 21, 2010 at 03:34am
I dont understand why they reccomend you stop taking your water pill ? does anyone know ?
Comment by Go4th on May 28, 2010 at 11:12am
JAMJACKS76-They recommend that you stop taking your water pill because it can cause dehydration. Especially with the decreased area of the intestine to absorb water in Gastric Bypass and DS surgery. WLS patients are at increased risk for dehydration even without diuretics.
Comment by aksonflower on May 30, 2010 at 12:51pm
This is something I have scoured the internet to find, thank you immensely for putting this up! aksonflower
Comment by pigletom on Jun 01, 2010 at 06:49am
I have been trying to figure out how a.d.d. meds should be handled. My doctor is well versed in a.d.d. but not on ds. can anyone tell me the type that has worked best for them. I am on a generic adderall currently, but it doesn't seem to work very even at a relatively high dose. I seem to remember coming across a med that didn't have to be broken down in the stomach, but can't find it now to save my life. Thanks for this article!
Comment by patio on Jun 01, 2010 at 11:45pm
I have thought this for some time now. Is it suggested to crush meds prior or take more often
Comment by Kenwillmore on Jun 02, 2010 at 10:36pm
I was told NSAID were allow with the sleeve.
Comment by sharonaish on Jun 03, 2010 at 08:56am
I have severe arthritis and I'm about 7 yrs post op (gastric bypass). If I can't take NSIDS, then what can I take?!?
Comment by sharyn1961 on Jun 03, 2010 at 02:04pm
Very interesting article. This was very helpful to me. Thankyou
Comment by jukiejeans on Jun 03, 2010 at 09:31pm
If you can't take NSAIDs and Tylenol does not work, you can take Ultram (tramadol). The next step would be narcotic medication.
Comment by AlaskanSnowflower on Jun 12, 2010 at 02:00pm
Wow, very good article and the information is invaluable! I'm printing this out for my Primary Doctor.
Comment by Rosiebud on Jun 13, 2010 at 10:02pm
Thank you so much. To find this all in one place is very helpful for both prior to and post surgery patients. Another concern I have is other perscription medication. i.e. my doctor told me about a patient who had to take nuerontin. After surgury he was having a real problem with this medication. It no longer worked.This was because of the way it assimulation into the body. We need to know more about this for other medications. i.e. Where in the intestines does a specific medication get assorbed. It's really important and I can't find this information anywhere. Does anyone have a clue (other than reading the enclosed documentation given with the medication, because this is not understandable to me).Thank you.
Comment by LeemaBean on Jun 20, 2010 at 08:43am
Hi Rosiebud, I have found that If I am taking a gel pill or a pill with an enteric cover, I have to break open the gel pill to allow the contents to spill right out and then I quickly put it on my tongue and drink water. It sometimes tastes pretty nasty, but I have had the same problem with most of the pills I take. They just aren't as effective because it takes too long to digest them. This is gross, but I actually had pills coming out the other end, still intact. Especially gel pill, caplets and enteric coated ones. I take neurontin and I do have to break it open to use it. I found I had to quit taking the extended release ones because I was only getting the initial help with them, but then the long term help with them was exiting the body before I could digest it. For example, I take zolipedam instead of ambian, because once the patent was up on ambian, they came out with the extended release pill, which was way more expensive and didn't do a thing for me because of the extended release factor. The zolepidem worked as well as the regular ambian. I don't think I am spelling zolipedem correctly, but it is the generic form of ambian and any doctor that knows their pharmocology will know what to prescribe and if they don't, tell them you want generic ambian that isn't extended release. The pharmD at the pharmacy will know exactly what to give you.
Comment by WickedLovely on Jun 20, 2010 at 10:52am
Good to know.
Comment by thepielady4 on Jun 20, 2010 at 01:16pm
I take percocet 5/325 for 3 bulging discs, arthritis in my back, and degenerative disc disease. I take 2 pills at a time, but it only lasts 2 hrs. I end up taking more than I'm suppose to, but I'm in terrible pain if I have to wait for the next dose. Anyone else have this problem?? What do I tell My Dr. They refuse to give me more. Tylenol does nothing and Ultram gives me headaches. I'm suffering and don't know what else to do..any suggestions will be appreciated.
Comment by trvlnfem on Jun 22, 2010 at 08:03am
Very good article. I was really happy to see it as I am still pre-surgery and have been looking for some helpful information. I copied and saved in Word so I could refer to it at a later date. Thanks
Comment by vivianchilders.1 on Jun 23, 2010 at 11:00am
Hello, thepielady, Before my RNY surgery I used to take Percocet 10/325, 2 at a time, every 4 hours. I also took Oxycontin 120mg three times a day. Since my surgery (June 7, 2010)I have been swithced to oral Methadone and oral oxycodone and it is working great! I also take Lyrica for nerve pain. (I open it and dump it into sugar-free Jello to hide the taste. lol) I hope this helps. At least it gives you something to talk to you Dr. about. I wish you my best.
Comment by ZannaCanada on Jun 25, 2010 at 12:00am
There is a difference between medications or supplements that are required after WLS and those that are premitted, and it seems to me that this table doesn't seem to make that distinction. My understanding is that with RNY, for example, NSAIDs are prohibited and vitamins are required, hence the No and the Yes. But the "No" for both under sleeve gastrectomy suggests people with the sleeve should not take either NSAIDs or vitamins. If possible, I'd like to see the table divided in 2, so I could better identify which are required and which are allowed if/when needed.
Comment by Papoose79 on Jun 30, 2010 at 08:35am
I have seen doctors that don't recommend taking NSAIDs regardless of if you have had surgery or not. It has been said that long term use is not good.
Comment by Brendajrob on Jul 03, 2010 at 04:54am
I have lap band. I was taking a tiny red Wellbutrin pill (dont remember if it was xR or XL) but was told I could not take it after the band because it is time released....I am having a very difficult time with the regular wellbutrin because of the coating. They are large pills and if I cut them up they have pointed edges. If I crush them the coating turns into little skin-like pieces that get stuck. It looks from this article as if I might be ok to take the extended release Wellbutrin. Any comments?
Comment by robinbird666 on Jul 05, 2010 at 04:06am
Are there any researchers looking at appropriate NSAID use for post-surgery patients? I have intractable back pain (disc bulge, facet syndrome, arthritis) and really want to avoid opiates. Is there anyone who knows a safe(r) option?
Comment by bh4god on Jul 15, 2010 at 04:31am
I have gout and am most concerned about not taking Colchicine 0.6 Mg twice a day. When I have Gout attacks I have to increase it, sometimes up to 7 times a day until it has passed. Please advise.
Comment by Mari54 on Jul 15, 2010 at 01:54pm
Great article, I am printing. A month ago I had total knee replacement. I informed the oft surgeon of my RNY bypass. He acted aware but he was not at all. I had huge problem with pain medication after surgery at ion. PRt of my pain treatment included time release oxycontin and no one would listen to me about it's ineffectualness. It was a nightmare. I learned after the fact that I needed to confer with my RNY surgeon and Ortho surgeon prior to surgery.
Comment by bludogwa on Jul 27, 2010 at 01:13am
I needed this today. My GI prescribed the generic prilosec today. My band is fully open, but I get morning tightness. It is not that the medication is so huge that I don't think I could swallow it, but that i know without my morning coffee, it will not go down. Would love suggestions for things like that!
Comment by RainbowSapphyre on Jul 29, 2010 at 01:52pm
Thank you this article helped alot!
Comment by cpschulte on Jul 29, 2010 at 11:18pm
Thanks. The article was easy to read and informative. One of the posters mentioned that (s)he opened capsules. Is it necessary? I have bothCymbalta and Lyrica in cpsule form. The rest are tables or chewable. Thanks.
Comment by [Anonymous] on Aug 02, 2010 at 08:35am
OK, I have been warned about NSAIDs post banding. If I want to move, I take my Celebrex. My BS (bariatric surgeon) recommends opening it and mixing it with food. How do we convince the company we need an alternative food of this pill to take . . . like enteric coated?
Comment by REDKAT42025 on Aug 05, 2010 at 05:34pm
Very good article. My sister has severe bipolar disorder that was controlled by her medicines for the last 10 years. She had a roux -n-y and lost 220lb. but now is acting out full blown bipolar ...? Is it possible that her meds are not absorbing..I'm not sure what part of the intestine the psych meds aborb into?
Comment by gammie7 on Aug 30, 2010 at 11:34am
Thanks for the helpful information. I would like to know about hormone med's (prem)? Do you think it is being absorbed?
Comment by DS4dana on Sep 04, 2010 at 12:36pm
Who authored this? They REALY need to correct the NSAID facts. They are ok for VSG and DS, no pouch. This is also a reason some people may need their RNY turned into a DS. I must take NSAIDS a few times a month and that is why I am getting the DS, thank god I didn't read this misinformation when I was doing my research and talking to doctors.
Comment by krkmed on Sep 12, 2010 at 05:42am
As far as I was told by my doctors, NSAIDS are OK with the sleeve. That was one of the main reasons I picked the sleeve over RNY (I have endometriosis leading to pain was not going to disappear just by losing weight). I wouldnt suggest that anyone go against their personal doctors suggestions, but Im not convinced this article is completely accurate in regards to the sleeve. Plus, I think the fact that it does NOT recommend vitamins and calcium with the sleeve to be misleading as well. Yes, we do absorb what we eatbut we eat less. It makes sense to take reasonable vitamin and calcium supplements to ensure we are getting everything we need.
Comment by cbea25 on Sep 18, 2010 at 12:00pm
What about thyroid meds for pyhothyroidism? Will i be able to take them?
Comment by TheHelly on Sep 23, 2010 at 01:17pm
Flexeril isn't on that NSAID list... Flexeril is a NSAID... Anyone know why it's not listed?
Comment by [Anonymous] on Sep 23, 2010 at 09:32pm
Thank you for this information, printed a copy for my pc doctor to have. Thanks good information
Comment by jordiesmama on Oct 06, 2010 at 11:08pm
Flexeril is a muscle relaxant. In the 32 years I've been a nurse, I've never known it to be an Nsaid.
Comment by myroomisblue on Oct 12, 2010 at 05:10am
Ditto on the thyroid meds question. I'm trying to decide to do the full DS procedure or just the sleeve to start. Medication absorption may end up being the deciding factor for me.
Comment by VanityConfidential on Oct 14, 2010 at 07:31am
I'm having a VSG next week and, unfortunately, take quite a few meds for things ranging from seizure meds, psych meds to adult asprin for a clotting disorder. I don't think this list is up to date for VSG patients especially regarding NSAIDS and Vitamins. Think I'll stick with recommendations from my surgeon and primary care physician.
Comment by tbariatric on Nov 20, 2010 at 04:20am
What is the recommendation for people on Wellbutrin XL, if extended release isn't recommended post-RNY?
Comment by zoo_mom268 on Nov 20, 2010 at 06:07pm
My psych changed my 300 mg Wellbutrin XL to 3 smaller doses of 100 mg - not extended release - and I spread them out @ 8 AM, noon and 5 PM. She told me not to take the last one too late as it might cause sleeplessness. I have been crushing them (and they are pretty gross!!!) & taking them like a BC powder - I toss it to the back of my tongue, hold my breath and swallow it down with iced tea. I also am taking Mobic which is NSAID and have been for about 5 years now for tendonitis in both heels (until I have my stomach stapling taken down and replaced with Gastric BP). I had stapling done in 1990, lost 150lbs, kept off all but 15 lbs until 2005 when the staples started coming out. I have been told by my bariatric surgeon that he doesn't recommend the stapling anymore for that reason - it's a common problem from surgeries done 15-20 yrs ago. So will go in on 11-29 for the RNY. I hope the dr can do it lapro, but he's not sure. I have scar tissue build-up from the 1st stomach stapling and also from hernia repair. I also have been told to not take Mobic anymore. I don't know what I will do. I'm going to take the issue up with a pharmacist to see what I can do about putting the Mobic (very small pill) inside something to get it past the stomach pouch. I will get back as soon as I get any info.
Comment by 1happywoman on Nov 22, 2010 at 04:48am
Where is the research that went into compiling this list??? I've been waiting for that since I had gastric bypass 8 years ago. I take ibuprofen for headaches when needed and never had a problem. In fact, my surgeon told me years ago that moderation is the key with medications as well as anything else. And that certainly seems to be true. I don't think I want to be taking Tramadol or narcotics for headaches or other minor aches and pains. (Tylenol and such are a waste of time and money for me - don't work.)
Comment by janetrichardson on Dec 09, 2010 at 08:33am
I am having by pass surgery in 10 days and am concerned as i have three degenerative disks and bad sciatia so have been takign two celebrex a day to get by with .However i alm not allowd to take that after the surgery.I also am plagued with restless elgs at night and am hooked on reuip.Am not sure how i can sleep without that and it is a muscle relaxer.Any help please.
Comment by lacylacy421 on Mar 08, 2011 at 02:53am
I am also having trouble with my medications I am 3 yrs post op and have suffered from depression and Aniexty I keep complaining of having no relief one doc increased my med then another drug tested me and said my test came back negative of my meds and completely cut me off. I have been so sick. Can't get anyone listen to me..I wonder when they wil figure out this absorpion problem
Comment by rexysmamma on Mar 12, 2011 at 03:07am
This should be given to ALL doctors that one has after the surgery or even before to arrange the aftercare for meds. If this wasn't here we would all look like druggies as we need to take so much!
Comment by DiTheHuntress on Sep 16, 2011 at 01:51am
Thanks so much for a very informative article. Even after close to 8 years post bypass there is so much to learn! I will print this out and make copies to pass out to my doctors! Thanks again!
Comment by ilovmesla2 on Nov 27, 2011 at 04:29pm
This was a very helpful article. I will make certain to print it and have it with me at all times.
Comment by shotseyrudi on Jul 25, 2012 at 06:39pm
I have severe pain in most joints and also fibromyalgia. I have gotten help from Morphine patches and Versatis patches.
Comment by shotseyrudi on Jul 25, 2012 at 06:46pm
Rhodiola is a herb for depression and anxiety.
Comment by schoonergirl on Aug 06, 2012 at 11:35pm
I'm considering taking the supplement ashwagandha that appears to have many health benefits but could possibly be a stomach irritant. Anyone know if this is something that should be avoided after gastric bypass? Completely unrelated but, is Nyquil (Dayquil) safe after bypass?
Comment by caiguise on Oct 09, 2012 at 10:59am
Thanks for the post, but looking up absorption for my meds it looks as if the thyroxine/synthroid/levothyroxine and mitirzapine need as strongly acidic environment to become soluble. If RNY bypasses stomach acids int he stomach, are these medications absorbed.
Comment by ginapeach on Dec 02, 2012 at 02:32am
My doctor told me no coumadin after Ruen n y surgery. Is that hold true as he said it can cause heart problems and has been proven to.
Comment by irish_mysts on Jan 18, 2013 at 05:42pm
Edmonton Weight Wise clinic advises NO NSAIDS for VSG or RnY. Both are to take prenatal and calcium citrate. Ultimately I think everyone needs to have clear communication with their surgeon about what is considered appropriate.
Comment by celticfaery on Sep 12, 2013 at 12:00am
I think this is misleading. I am 6+ years out with my sleeve and developed severe vitamin deficiencies by being told that I didn't need to take vitamins because I had a fully functioning stomach. Have your primary care doctor run a FULL panel of labs including all vitamin levels. Take those results to a hematologist and have them review with you and adjust your supplementation accordingly! You have to be an advocate for your own health.
Comment by cicerogirl on Sep 29, 2013 at 08:58am
This article fails to mention that one of the primary reasons that NSAIDs are contraindicated for RNYers is because of the possibility of ulcers in the kind, remnant stomach (which is removed for sleeve and DS procedures),
Comment by [Anonymous] on Jun 23, 2014 at 01:07am
I just stumbled upon your blog and wanted to say that I have really enjoyed reading your blog posts. I had gastric bypass surgery before six months. After that i was suffering from fatigue and chronic pain. Thus doctor prescribed me to take gastric bypass supplement once in a day. I can feel the difference after having this.
Comment by Polynieces on Aug 16, 2014 at 03:21am
My GP gave me poly folate 150 capsules. I had RNGB 14 years ago. How should I take them?
Comment by [Anonymous] on Sep 10, 2014 at 01:23am
Good article, I was wondering if it takes an acidic medium to help absorb some drugs especially calcium. Why we need to give a proton pump inhibitor for so long? Also is their a specific brand of vitamins that is advised?
Comment by Dyann on Sep 16, 2014 at 11:11am
Can this list be updated? I have seen a pain management doctor for 8 years, and had my RNY 9 years ago. After Oxycontin changed their prescription to the plastic coating, I told him it was providing very little relief. He is supposed to be one of the best in the country and he told me I did not know what I was talking about. I begged him for months, and he finally said he could no longer help me and now I am left in bed 24/7 from pain and having trouble finding another PM doctor due to lapse in insurance from husband starting new job. This surgery was supposed to make my life better!
Comment by lisard on Mar 06, 2015 at 10:51pm
I went in for upper endoscopy 2.5 mos after roux- en-y because of previous condition (barretts). Had reflux my entire adult life and been on prilosec for years. Against my better judgement, Surgeon said i didn't need it any more. Gastroenterologist found ulcer and mild stenosis at gastrojejunostomy. I believe the term 'hot mess' was used. I'm back on the prilosec for life. Haven't had any reflux up into my throat since surgery but apparently excess acid can still cause stomach / pouch damage and who knows whats going on in the remnant stomach.
Comment by dwilliamson on Apr 28, 2015 at 01:15am
Can anyone tell me about morphine?? I was ordered morphine and indomethacin suppository after my hysterectomy which was just last week for pain. I found after a couple days on the morphine that I would get pains in the middle..under my breast bone above belly button. Feel really full after only eating a few mouthfuls. I would hear gurgling sounds in my tummy. I stopped pain meds cause I didn't like the feeling but tylenol extra strength is not cutting the pain from surgery. I put in a call to my surgeon that did my gastric bypass at barix 7 years ago but no answer yet.
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Comment by jlogsdon on Sep 27, 2015 at 03:48am
GI transit time is shortened after bariatric surgery, esp DS and RNY. Extended- or timed-released meds (XL, SR, ER, etc) may not be in the GI tract long enough to be absorbed, but if the med is only for symptoms (depression, anxiety), and the extended-release is controlling symptoms, that med should be fine. Coumadin is absorbed in the stomach and duodenum (the first part of the small intestine), so may not be absorbed; however, vitamin K absorption is also reduced, leading to less active clotting factors. Continuation of Coumadin is recommended, but only with frequent monitoring until INR is stabilized and then regular (once every 4 wks as long as INR remains at goal) monitoring. Some psychiatric meds are mainly absorbed in the stomach (Zyprexa) or stomach and duodenum (Seroquel). Many other meds are also absorbed in stomach and/or duodenum. If you were stabilized on a med and it stops working, it is reasonable to try another med in the same class (for example, if Lopressor was controlling blood pressure before but not after surgery, switching to Tenormin may work), and it is very reasonable to ask your doctor to switch. Some meds are effected not due to absorption, but due to other factors. For example, Zocor (for cholesterol) is inactive and must be activated in the stomach and does not work well after bariatric surgery; changing to Lipitor, Crestor, Pravachol, or any other med in the class would be expected to work. NSAIDs are acidic meds and due to reduction in acid in the stomach after surgery, they release even more med while still in the stomach resulting in even more acid. They also reduce production of mucus which lines and protects the GI tract. Ulceration and erosion are likely with NSAIDs. With capsules, the risk of obstruction after surgery is high; think about how capsules stick to your fingers if your hands are damp. To take capsules that can be opened (check with your pharmacist), put a small amount (1-2 teaspoons) of semi-solid food or thick liquid in a medicine cup; open capsules and sprinkle on top; and then swallow contents without chewing. Follow with small amount of food or water to wash down remaining med. I hope this helps! J
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شركة تنظيف بالرياض شركة تنظيف فلل بالرياض شركة تنظيف شقق بالرياض شركة تنظيف موكيت بالرياض شركة تنظيف مجالس بالرياض شركة تنظيف خزانات بالرياض شركة عزل اسطح بالرياض شركة كشف تسربات المياه بالرياض شركة تسليك مجارى بالرياض شركة تنظيف بيارات بالرياض شركة رش مبيدات بالرياض شركة نقل اثاث بالرياض شركة تخزين اثاث بالرياض شركة تنظيف منازل بالرياض شركة مكافحة حشرات بالرياض شركة تنظيف بالمدينة المنورة شركة تنظيف فلل بالمدينة المنورة شركة تنظيف شقق بالمدينة المنورة شركة تنظيف موكيت بالمدينة المنورة شركة تنظيف مجالس بالمدينة المنورة شركة تنظيف خزانات بالمدينة المنورة شركة عزل اسطح بالمدينة المنورة شركة كشف تسربات المياه بالمدينة المنورة شركة تسليك مجارى بالمدينة المنورة شركة تنظيف بيارات بالمدينة المنورة شركة مكافحة حشرات بالمدينة المنورة شركة نقل اثاث بالمدينة المنورة شركة تخزين اثاث بالمدينة المنورة شركة تنظيف منازل بالمدينة المنورة شركة رش مبيدات بالمدينة المنورة شركة تنظيف بجدة شركة تنظيف فلل بجدة شركة تنظيف شقق بجدة شركة تنظيف مجالس بجدة شركة تنظيف موكيت بجدة شركة تنظيف خزانات بجدة شركة عزل اسطح بجدة شركة كشف تسربات المياه بجدة شركة تسليك مجارى بجدة شركة تنظيف بيارات بجدة شركة رش مبيدات بجدة شركة نقل اثاث بجدة شركة تخزين اثاث بجدة شركة تنظيف منازل بجدة شركة مكافحة حشرات بجدة شركة تنظيف بمكة شركة تنظيف فلل بمكة شركة تنظيف شقق بمكة شركة تنظيف موكيت بمكة شركة تنظيف مجالس بمكة شركة تنظيف خزانات بمكة شركة عزل اسطح بمكة شركة كشف تسربات المياه بمكة شركة تسليك مجارى بمكة شركة تنظيف بيارات بمكة شركة رش مبيدات بمكة شركة نقل اثاث بمكة شركة تخزين اثاث بمكة شركة تنظيف منازل بمكة شركة مكافحة حشرات بمكة شركة تنظيف بالطائف شركة تنظيف فلل بالطائف شركة تنظيف شقق بالطائف شركة تنظيف موكيت بالطائف شركة تنظيف مجالس بالطائف شركة تنظيف خزانات بالطائف شركة عزل اسطح بالطائف شركة كشف تسربات المياه بالطائف شركة تسليك مجارى بالطائف شركة تنظيف بيارات بالطائف شركة رش مبيدات بالطائف شركة نقل اثاث بالطائف شركة تخزين اثاث بالطائف شركة تنظيف منازل بالطائف شركة مكافحة حشرات بالطائف شركة تنظيف بابها شركة تنظيف فلل بابها شركة تنظيف شقق بابها شركة تنظيف موكيت بابها شركة تنظيف مجالس بابها شركة تنظيف خزانات بابها شركة عزل اسطح بابها شركة كشف تسربات المياه بابها شركة تسليك مجارى بابها شركة تنظيف بيارات بابها شركة رش مبيدات بابها شركة نقل اثاث بابها شركة تخزين اثاث بابها شركة تنظيف منازل بابها شركة مكافحة حشرات بابها شركة تنظيف بخميس مشيط شركة تنظيف فلل بخميس مشيط شركة تنظيف شقق بخميس مشيط شركة تنظيف موكيت بخميس مشيط شركة تنظيف مجالس بخميس مشيط شركة تنظيف خزانات بخميس مشيط شركة عزل اسطح بخميس مشيط شركة كشف تسربات المياه بخميس مشيط شركة تسليك مجارى بخميس مشيط شركة تنظيف بيارات بخميس مشيط شركة رش مبيدات بخميس مشيط شركة نقل اثاث بخميس مشيط شركة تخزين اثاث بخميس مشيط شركة تنظيف منازل بخميس مشيط شركة مكافحة حشرات بخميس مشيط
Comment by alrayyanclean on Feb 06, 2016 at 08:53am
شركة تنظيف بالرياض شركة نظافة بالرياض شركات تنظيف بالرياض شركات نظافة بالرياض شركة تنظيف منازل بالرياض شركة نظافة منازل بالرياض شركات تنظيف منازل بالرياض شركة تنظيف شقق بالرياض شركة نظافة شقق بالرياض شركات تنظيف شقق بالرياض شركة تنظيف فلل بالرياض شركة نظافة فلل بالرياض شركات تنظيف فلل بالرياض شركات نظافة فلل بالرياض شركة تنظيف خزانات بالرياض شركات تنظيف خزانات بالرياض شركة نظافة خزانات بالرياض شركات نظافة خزانات بالرياض شركة رش مبيدات بالرياض شركات رش مبيدات بالرياض شركة مكافحة حشرات بالرياض شركات مكافحة الحشرات بالرياض شركة نقل اثاث بالرياض شركات نقل اثاث بالرياض شركة نقل عفش بالرياض شركات نقل عفش بالرياض شركة عزل اسطح بالرياض شركات عزل اسطح بالرياض شركة كشف تسربات المياه بالرياض شركات كشف تسربات المياه بالرياض شركة كشف تسربات بالرياض شركات كشف تسربات بالرياض شركة تنظيف مجالس بالرياض شركات تنظيف مجالس بالرياض شركة تنظيف كنب بالرياض شركة تنظيف موكيت بالرياض شركة جلى بلاط بالرياض شركة تلميع رخام بالرياض شركة تنسيق حدائق بالرياض شركة تنظيف مزارع النخيل بالرياض شركة تنظيف واجهات بالرياض شركة تنظيف واجهات زجاج بالرياض شركات تنظيف واجهات زجاج بالرياض شركة تنظيف واجهات حجر بالرياض شركات تنظيف واجهات حجر بالرياض تشطيب فلل بالرياض شركة دهانات بالرياض شركة تنظيف بالرياض شركة جلى بلاط بالرياض
Comment by MS94 on Feb 08, 2016 at 11:29pm
شركة تنظيف بالرياض شركة تنظيف شقق بالرياض شركة تنظيف فلل بالرياض شركة تنظيف بيارات بالرياض شركة تنظيف منازل بالرياض شركة نقل أثاث بالرياض شركة تسليك مجاري بالرياض شركة عزل أسطح بالرياض شركة كشف تسربات المياه بالرياض شركة تخزين أثاث بالرياض شركة تنظيف خزانات بالرياض شركة تنظيف مجالس بالرياض شركة تنظيف موكيت بالرياض شركة رش مبيدات بالرياض شركة مكافحة حشرات بالرياض شركة تخزين أثاث بخميس مشيط شركة تسليك مجاري بخميس مشيط شركة تنظيف بخميس مشيط شركة تنظيف بيارات بخميس مشيط شركة تنظيف خزانات بخميس مشيط شركة تنظيف شقق بخميس مشيط شركة تنظيف فلل بخميس مشيط شركة تنظيف مجالس بخميس مشيط شركة تنظيف منازل بخميس مشيط شركة تنظيف موكيت بخميس مشيط شركة رش مبيدات بخميس مشيط شركة عزل أسطح بخميس مشيط شركة كشف تسربات المياه بخميس مشيط شركة مكافحة حشرات بخميس مشيط شركة نقل أثاث بخميس مشيط شركة تنظيف بيارات بالمدينة المنورة شركة مكافحة حشرات بالمدينة المنورة شركة نقل اثاث بالمدينة المنورة شركة تخزين اثاث بالمدينة المنورة شركة تنظيف منازل بالمدينة المنورة شركة رش مبيدات بالمدينة المنورة شركة تنظيف بالمدينه المنورة شركة تنظيف فلل بالمدينة المنورة شركة تنظيف شقق بالمدينة المنورة شركة تنظيف موكيت بالمدينة المنورة شركة تنظيف مجالس بالمدينة المنورة شركة تنظيف خزانات بالمدينة المنورة شركة عزل اسطح بالمدينة المنورة شركة كشف تسربات المياه بالمدينة المنورة شركة تسليك مجارى بالمدينة المنورة شركة تنظيف بجدة شركة تنظيف فلل بجدة شركة تنظيف شقق بجدة شركة تنظيف مجالس بجدة شركة تنظيف موكيت بجدة شركة تنظيف خزانات بجدة شركة عزل اسطح بجدة شركة كشف تسربات المياه بجدة شركة تسليك مجارى بجدة شركة تنظيف بيارات بجدة شركة رش مبيدات بجدة شركة نقل اثاث بجدة شركة تخزين اثاث بجدة شركة تنظيف منازل بجدة شركة مكافحة حشرات بجدة شركة تنظيف بمكة شركة تنظيف فلل بمكة شركة تنظيف شقق بمكة شركة تنظيف موكيت بمكة شركة تنظيف بيارات بمكة شركة رش مبيدات بمكة شركة نقل اثاث بمكة شركة تخزين اثاث بمكة شركة تنظيف منازل بمكة شركة مكافحة حشرات بمكة شركة عزل اسطح بمكة شركة تسليك مجاري بمكة شركة كشف تسربات بمكة شركة تنظيف خزانات بمكة شركة تنظيف مجالس بمكة شركة عزل اسطح بالطائف شركة كشف تسربات المياه بالطائف شركة تسليك مجارى بالطائف شركة تنظيف بيارات بالطائف شركة رش مبيدات بالطائف شركة نقل اثاث بالطائف شركة تخزين اثاث بالطائف شركة تنظيف منازل بالطائف شركة مكافحة حشرات بالطائف شركة تنظيف بالطائف شركة تنظيف فلل بالطائف شركة تنظيف شقق بالطائف شركة تنظيف موكيت بالطائف شركة تنظيف مجالس بالطائف شركة تنظيف خزانات بالطائف شركة تنظيف منازل بابها شركة مكافحة حشرات بابها شركة رش مبيدات بابها شركة عزل اسطح بابها شركة كشف تسربات المياه بابها شركة تسليك مجارى بابها شركة تنظيف بيارات بابها شركة تنظيف بابها شركة تنظيف فلل بابها شركة تنظيف شقق بابها شركة تنظيف موكيت بابها شركة تنظيف مجالس بابها شركة تنظيف خزانات بابها شركة نقل اثاث بابها شركة تخزين اثاث بابها شركة نقل اثاث بالدمام شركة نقل اثاث بجدة شركة مكافحة حشرات بالدمام شركة مكافحة حشرات بجدة
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