Bioavailability of Orally Administered Drugs After Bariatric Surgery

Miedziaszczyk M, Ciabach P, Szałek E. The effects of bariatric surgery and gastrectomy on the absorption of drugs, vitamins, and mineral elements. Pharmaceutics. 2021;13:2111.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Porat D, Dahan A. Active intestinal drug absorption and the solubility-permeability interplay. Int J Pharm. 2018;537:84–93.

Article  CAS  PubMed  Google Scholar 

•• Kingma JS, Burgers DMT, Monpellier VM, Wiezer MJ, Blussé van Oud‐Alblas HJ, Vaughns JD, et al. Oral drug dosing following bariatric surgery: general concepts and specific dosing advice. Br J Clin Pharmacol. 2021;87:4560–76. List of important aspects influencing drug absorption after bariatric surgery.

Bettini S, Belligoli A, Fabris R, Busetto L. Diet approach before and after bariatric surgery. Rev Endocr Metab Disord. 2020;21:297–306.

Article  PubMed  PubMed Central  Google Scholar 

Santamaría MM, Villafranca JJA, Abilés J, López AF, Rodas LV, Goitia BT, et al. Systematic review of drug bioavailability following gastrointestinal surgery. Eur J Clin Pharmacol. 2018;74:1531–45.

Article  PubMed  Google Scholar 

Kwon Y. Handbook of essential pharmacokinetics, pharmacodynamics, and drug metabolism for industrial scientists. New York: Kluwer Academic/Plenum Publishers; 2001.

Google Scholar 

Montana L, Colas P-A, Valverde A, Carandina S. Alterations of digestive motility after bariatric surgery. J Visc Surg. 2022;159:S28-34.

Article  CAS  PubMed  Google Scholar 

•• Lorico S, Colton B. Medication management and pharmacokinetic changes after bariatric surgery. Can Fam Physician Med Fam Can. 2020;66:409–16. Absorption of drugs with low and variable BAV or enterohepatic circulation is most affected. SG influences drug absorption less than gastric bypass.

Darwich AS, Henderson K, Burgin A, Ward N, Whittam J, Ammori BJ, et al. Trends in oral drug bioavailability following bariatric surgery: examining the variable extent of impact on exposure of different drug classes: trends in oral drug bioavailability following bariatric surgery. Br J Clin Pharmacol. 2012;74:774–87.

Article  CAS  PubMed  PubMed Central  Google Scholar 

• Yska JP, Wanders JTM, Odigie B, Apers JA, Emous M, Totté ERE, et al. Effect of Roux-en-Y gastric bypass on the bioavailability of metoprolol from immediate and controlled release tablets: a single oral dose study before and after surgery. Eur J Hosp Pharm. 2020;27:e19–24. Example of decreased absorption from extended-release tablets.

Hua S. Advances in oral drug delivery for regional targeting in the gastrointestinal tract - influence of physiological, pathophysiological and pharmaceutical factors. Front Pharmacol. 2020;11:524.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Padwal R, Brocks D, Sharma AM. A systematic review of drug absorption following bariatric surgery and its theoretical implications. Obes Rev. 2010;11:41–50.

Article  CAS  PubMed  Google Scholar 

Wu C-Y, Benet LZ. Predicting drug disposition via application of BCS: transport/absorption/ elimination interplay and development of a biopharmaceutics drug disposition classification system. Pharm Res. 2005;22:11–23.

Article  CAS  PubMed  Google Scholar 

Stenberg E, dos Reis Falcão LF, O’Kane M, Liem R, Pournaras DJ, Salminen P, et al. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations: a 2021 update. World J Surg. 2022;46:729–51.

Article  PubMed  PubMed Central  Google Scholar 

• Porat D, Vaynshtein J, Gibori R, Avramoff O, Shaked G, Dukhno O, et al. Stomach pH before vs. after different bariatric surgery procedures: clinical implications for drug delivery. Eur J Pharm Biopharm. 2021;160:152–7. So far the only study investigating stomach pH after BS, even though with some limitations.

Sista F, Abruzzese V, Clementi M, Carandina S, Cecilia M, Amicucci G. The effect of sleeve gastrectomy on GLP-1 secretion and gastric emptying: a prospective study. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2017;13:7–14.

Article  Google Scholar 

Sioka E, Tzovaras G, Perivoliotis K, Bakalis V, Zachari E, Magouliotis D, et al. Impact of laparoscopic sleeve gastrectomy on gastrointestinal motility. Gastroenterol Res Pract. 2018;2018:1–17.

Article  Google Scholar 

Pellegrini CA, Deveney CW, Patti MG, Lewin M, Way LW. Intestinal transit of food after total gastrectomy and Roux-Y esophagojejunostomy. Am J Surg. 1986;151:117–25.

Article  CAS  PubMed  Google Scholar 

Dirksen C, Damgaard M, Bojsen-Møller KN, Jørgensen NB, Kielgast U, Jacobsen SH, et al. Fast pouch emptying, delayed small intestinal transit, and exaggerated gut hormone responses after Roux-en-Y gastric bypass. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2013;25:346-e255.

Article  CAS  Google Scholar 

Rogers CC, Alloway RR, Alexander JW, Cardi M, Trofe J, Vinks AA. Pharmacokinetics of mycophenolic acid, tacrolimus and sirolimus after gastric bypass surgery in end-stage renal disease and transplant patients: a pilot study: pharmacokinetics of immunosuppressants in gastric bypass patients. Clin Transplant. 2007;22:281–91.

Article  Google Scholar 

Shugarts S, Benet LZ. The role of transporters in the pharmacokinetics of orally administered drugs. Pharm Res. 2009;26:2039–54.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Zhang Y, Benet LZ. The gut as a barrier to drug absorption: combined role of cytochrome P450 3A and P-glycoprotein. Clin Pharmacokinet. 2001;40:159–68.

Article  CAS  PubMed  Google Scholar 

Mouly S, Paine MF. P-Glycoprotein increases from proximal to distal regions of human small intestine. Pharm Res. 2003;20:1595–9.

Article  CAS  PubMed  Google Scholar 

Porat D, Dahan A. Medication management after bariatric surgery: providing optimal patient care. J Clin Med. 2020;9:1511.

Article  PubMed  PubMed Central  Google Scholar 

Hakeam HA, Al-Sanea N. Effect of major gastrointestinal tract surgery on the absorption and efficacy of direct acting oral anticoagulants (DOACs). J Thromb Thrombolysis. 2017;43:343–51.

Article  CAS  PubMed  Google Scholar 

Skottheim IB, Jakobsen GS, Stormark K, Christensen H, Hjelmesæth J, Jenssen T, et al. Significant increase in systemic exposure of atorvastatin after biliopancreatic diversion with duodenal switch. Clin Pharmacol Ther. 2010;87:699–705.

Article  CAS  PubMed  Google Scholar 

Skottheim IB, Stormark K, Christensen H, Jakobsen GS, Hjelmesæth J, Jenssen T, et al. Significantly altered systemic exposure to atorvastatin acid following gastric bypass surgery in morbidly obese patients. Clin Pharmacol Ther. 2009;86:311–8.

Article  CAS  PubMed  Google Scholar 

Ziegler O, Sirveaux MA, Brunaud L, Reibel N, Quilliot D. Medical follow up after bariatric surgery: nutritional and drug issues general recommendations for the prevention and treatment of nutritional deficiencies. Diabetes Metab. 2009;35:544–57.

Article  CAS  PubMed  Google Scholar 

Jakobsen GS, Skottheim IB, Sandbu R, Christensen H, Røislien J, Åsberg A, et al. Long-term effects of gastric bypass and duodenal switch on systemic exposure of atorvastatin. Surg Endosc. 2013;27:2094–101.

Article  PubMed  Google Scholar 

Eriksson BI, Quinlan DJ, Weitz JI. Comparative pharmacodynamics and pharmacokinetics of oral direct thrombin and factor Xa inhibitors in development: Clin Pharmacokinet. 2009;48:1–22.

CAS  PubMed  Google Scholar 

•• Steele KE, Prokopowicz GP, Canner JP, Harris C, Jurao RA, Kickler TS, et al. The APB study: apixaban pharmacokinetics in bariatric patients before to 1 year after vertical sleeve gastrectomy or Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2022;18:594–603. Important information on non-vitamin K anticoagulant. Area where sparse data are available.

Kröll D, Stirnimann G, Vogt A, Lai DLL, Borbély YM, Altmeier J, et al. Pharmacokinetics and pharmacodynamics of single doses of rivaroxaban in obese patients prior to and after bariatric surgery: rivaroxaban in bariatric surgery. Br J Clin Pharmacol. 2017;83:1466–75.

Article  PubMed  PubMed Central  Google Scholar 

Mani H, Kasper A, Lindhoff-Last E. Measuring the anticoagulant effects of target specific oral anticoagulants—reasons, methods and current limitations. J Thromb Thrombolysis. 2013;36:187–94.

Article  CAS  PubMed  Google Scholar 

Mahlmann A, Gehrisch S, Beyer-Westendorf J. Pharmacokinetics of rivaroxaban after bariatric surgery: a case report. J Thromb Thrombolysis. 2013;36:533–5.

Article  PubMed  Google Scholar 

Rottenstreich A, Barkai A, Arad A, Raccah BH, Kalish Y. The effect of bariatric surgery on direct-acting oral anticoagulant drug levels. Thromb Res. 2018;163:190–5.

Article  CAS  PubMed  Google Scholar 

Parasrampuria DA, Kanamaru T, Connor A, Wilding I, Ogata K, Shimoto Y, et al. Evaluation of regional gastrointestinal absorption of edoxaban using the enterion capsule. J Clin Pharmacol. 2015;55:1286–92.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Martin KA, Lee CR, Farrell TM, Moll S. Oral anticoagulant use after bariatric surgery: a literature review and clinical guidance. Am J Med. 2017;130:517–24.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Stangier J. Clinical pharmacokinetics and pharmacodynamics of the oral direct thrombin??Inhibitor Dabigatran Etexilate: Clin Pharmacokinet. 2008;47:285–95.

Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, et al. 2021 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. EP Eur. 2021;23:1612–76.

Google Scholar 

Lee D, DeFilipp Z, Judson K, Kennedy M. Subtherapeutic anticoagulation with dabigatran following Roux-en-Y gastric bypass surgery. J Cardiol Cases. 2013;8:e49-50.

Article  PubMed  PubMed Central  Google Scholar 

•• Grainger B, Holloway R, Merriman E, Booth M, Royle G, Babor R, et al. Evidence of impaired dabigatran absorption following laparoscopic Roux‐en‐Y gastric bypass surgery: the Auckland regional experience (2011–2018). Br J Haematol [Internet]. 2020 [cited 2023 Mar 3];191. https://doi.org/10.1111/bjh.17004. Clinically important warning.

Douros A, Schlemm L, Bolbrinker J, Ebinger M, Kreutz R. Insufficient anticoagulation with dabigatran in a patient with short bowel syndrome. Thromb Haemost. 2014;112:419–20.

Article  CAS  PubMed  Google Scholar 

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