Bioavailability of Vortioxetine After a Roux-en-Y Gastric Bypass

Excerpt

The impact of bariatric surgery on depression appears to be positive during the early months (the so-called honeymoon period), but depressive symptoms tend to increase 36 months post-intervention [1]. Despite the high prevalence of depression and obesity, little is known about pharmacokinetic modification of psychotropic drugs in patients undergoing bariatric surgery. Briefly, the reduction of gastric volume leads to a decrease in gastric mixing, an increase in gastric pH, and an increase in gastric emptying, affecting disintegration and dissolution of the oral medication. The reduction in intestine length after Roux-en-Y gastric bypass (RYGB) leads to a reduction in the absorptive surface area and modification of presystemic drug metabolism [2]. Limited clinical data are available for psychotropic drugs and concern mostly antidepressants. Two single-dose cross-sectional pharmacokinetic studies with 100 mg of sertraline and 60 mg of duloxetine found a significant decrease in the area under the plasma concentration time curve compared to the placebo group [3, 4]. A case series of four patients found a 33% (4–71%) decrease of serum escitalopram concentrations compared to preoperative values 2 weeks after RYGB surgery [5]. Another case series of 12 subjects treated with selective serotonin reuptake inhibitors (SSRI) and serotonin-noradrenaline reuptake inhibitors (SNRI) showed a decreased area under the curve (AUC) between 36 to 80% in eight patients 1 month after RYGB intervention [6]. …