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03-01-2024 | Bariatric Surgery | REVIEW

Bioavailability of Orally Administered Drugs After Bariatric Surgery

Authors: Eliška Dvořáčková, Alena Pilková, Martin Matoulek, Ondřej Slanař, Jan Miroslav Hartinger

Published in: Current Obesity Reports | Issue 1/2024

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Abstract

Purpose of Review

Oral drug absorption after bariatric surgery is likely to be altered, but the impact of different bariatric surgery procedures on individual drugs is not uniform. The aim of this article is to describe factors influencing the bioavailability of orally administered drugs after bariatric surgery and to provide readers with practical recommendations for drug dosing. We also discuss the medications that may be harmful after bariatric surgery.

Recent Findings

The fundamental factors for enteral drug absorption are the production of gastric acid; the preserved length of the intestine, i.e., the size of the absorption surface and/or the preserved enterohepatic circulation; and the length of common loop where food and drugs are mixed with digestive enzymes and bile acids. Bypassing of metabolizing enzymes or efflux pumps and changes in intestinal motility can also play an important role. Significant changes of drug absorption early after the anatomic alteration may also be gradually ameliorated due to gradual intestinal adaptation. The most affected drugs are those with low or variable bioavailability and those undergoing enterohepatic circulation. Attention should also be paid to oral drug formulations, especially in the early postoperative period, when immediate-release and liquid formulations are preferred.

Summary

The changes in oral bioavailability are especially clinically meaningful in patients treated with drugs possessing narrow therapeutic index (e.g., oral anticoagulants, levothyroxine, and anticonvulsants) or in acute conditions (e.g., anti-infectives); nevertheless, it may also influence the therapeutic value of chronic therapy (e.g., antidepressants. antihypertensives, antiplatelets, statins, PPIs, contraceptives, and analgesics); therapeutic effect of chronic therapy is further influenced by pharmacokinetic alterations resulting from weight loss. Therapeutic drug monitoring, periodical clinical evaluation, and adequate dose adjustments are necessary. Due to safety reasons, patients should avoid oral bisphosphonates, regular use of non-steroidal anti-inflammatory drugs, and, if possible, corticosteroids after bariatric surgery.
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Metadata
Title
Bioavailability of Orally Administered Drugs After Bariatric Surgery
Authors
Eliška Dvořáčková
Alena Pilková
Martin Matoulek
Ondřej Slanař
Jan Miroslav Hartinger
Publication date
03-01-2024
Publisher
Springer US
Published in
Current Obesity Reports / Issue 1/2024
Electronic ISSN: 2162-4968
DOI
https://doi.org/10.1007/s13679-023-00548-7

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