Generally, we don't take anything that is SR, XR and so on.
With something simple like vicodin, it's rx every 6 hrs and I get precisely 4.try to get that every 4 hrs.
yes, we do malabsorb meds. the timed release type more so, of course.
Welbutrin comes in an IR, immediate release. So, I take the mg my doc wants, but *I* am the timed release. Try this:
Vol. No: 30:02 Posted: 2/22/05
The Skinny on Gastric Bypass
What Pharmacists Need to Know
Sarah A. Fussy, PharmD Candidate,
BS Pharm Sci, minor Nutrition Sci,
North Dakota State University
Status: post Lap Roux-En-Y 6/03/03
US Pharm. 2005;2:HS-3-HS-12.
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Ask the Experts about Pharmacotherapy
>From Medscape Pharmacists
How Does Bariatric Surgery Affect the Absorption of Medications?
I have a patient who underwent gastric bypass surgery recently. I know that the absorption of medications could be affected by many factors pertaining to the gastrointestinal system. How does bariatric surgery affect the absorption of medications?
Response from Brigette Nelson, MS, PharmD,BCNP Director, Clinical Pharmacy Services, MSC-Medical Services Company, Jacksonville, Florida
The number of bariatric surgical procedures performed in the United States has risen dramatically, from an estimated 16,000 procedures in the early 1990s to about 103,000 in 2003. The surgery may involve a restrictive procedure (ie, vertical-banded gastroplasty or adjustable gastric banding), or a combination of restrictive and malabsorptive procedures (ie, biliopancreatic diversion or Roux-en-Y gastric bypass). Roux-en-Y gastric bypass is the most frequently performed variety in the United States, and it involves forming a small stomach pouch to restrict food intake and then reconnecting the small intestine to the pouch.
Bypassing a large portion of the stomach and small intestine puts these patients at risk for malabsorption, and it also changes the absorption of some medications. Patients are prone to deficiencies in the fat-soluble vitamins (A, D, E, and K) and in calcium.[2,3] Thus, appropriate supplementation with iron, vitamin B12, calcium, and folate is an important consideration.[2,3] In some cases, parenteral iron infusion may be necessary to avoid anemia, particularly in menstruating women.
Due to changes in the acidic environment and the reduced surface area for drug absorption, changes in drug delivery route or dose may be necessary to assure adequate drug concentrations. Avoiding extended-release formulations is recommended, due to their long absorptive phase in the intestine.[2,4] Immediate-release formulations with a more frequent dosing schedule may be required. It may be useful to use a liquid formulation to eliminate the drug absorption phase where possible. Other routes, such as intramuscular, transdermal, subcutaneous, and inhalation, may be considered. However, it is also important to keep in mind the impact obesity may have on these routes of administration.
The salt form of medications may also require consideration.[2,4] For example, calcium citrate does not require stomach acid for absorption and would be a more reasonable choice than calcium carbonate, which requires a higher acid concentration.[2,4]
Nonsteroidal anti-inflammatory drugs (NSAIDs) and oral bisphosphonates should be avoided in this population, since these patients are at increased risk for ulceration due to the reduced stomach size. Consider using alternatives for pain relief, such as acetaminophen, tramadol, and/or opiates. Likewise, alternatives for osteoporosis prevention can be used.
For gastric bypass patients, it is thus appropriate to regard these factors:
route of drug administration, salt formation, monitoring of medication blood levels to assure therapeutic concentrations, and appropriate nutrient and vitamin supplementation. As indicated, the impact of obesity and changes in lean body mass may also be important considerations when choosing drug form and dose.[2,5]
1.. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004:292:1724-1737. Abstract
2.. Miller AD, Smith KM. Medication and nutrient administration considerations after bariatric surgery. Am J Health-Syst Pharm.
3.. Virji A, Murr MM. Caring for patients after bariatric surgery.
Am Fam Physician. 2006;73:1403-1408. Abstract
4.. Fussy SA. The skinny on gastric bypass: what pharmacists need to know. US Pharm. 2005;2:HS-3-HS-12.
5.. Malone M. Altered drug disposition in obesity and after bariatric surgery. Nutr Clin Pract. 2003;18:131-135. Abstract
Medication and nutrient administration considerations after bariatric surgery
April D. Miller and Kelly M. Smith
American Journal of Health-System Pharmacy, Vol. 63, Issue 19,
Copyright © 2006 by American Society of Health-System Pharmacists
Great article for all to read about pill absorption -
FROM ABOVE LINK How does the gastric bypass affect the absorption of medications?
Most medications absorb normally. The exceptions to this are birth control pills, hormone replacement medication, and certain sustained release (slow release) medications.
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.