Absorption of Oral Penicillin before and after Gastroplasty for Morbid Obesity

Miskowiak, J; Andersen, Bjørn; Nielsen, Vance G.

doi:10.1159/000138106

Cited by 6 publications

(11 citation statements)

References 4 publications

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“…The latter may particularly be of relevance for drugs for which altered pharmacokinetics in obese patients compared to non-obese patients have been reported, or when the pharmacodynamics are different in obese individuals as is the case for VKAs or platelet inhibitors. We note that even for similar drugs, different results may be observed, as shown for phenoxymethylpenicilin 54,55 . Also for controlled release formulations, conflicting results were obtained in different studies 41,42 .…”

Section: Discussionmentioning

confidence: 64%

“…Terry et al and Miskowiak et al, describe the pharmacokinetics of oral phenoxymethylpenicillin after gastroplasty and jejunoileal bypass, procedures that are to date not often applied any more 54,55 . Miskowiak et al reported no significant changes of gastroplasty on the absorption and concentrations of phenoxymethylpenicillin when given as a non-coated tablet or as an aqueous solution (one-week washout) in eight female bariatric surgery patients before and three months after gastroplasty surgery 54 . There were also no significant differences in AUC between tablet and aqueous solution.…”

Section: Beta-lactam Antibiotics (Amoxicillin Penicillin and Ampicillin)mentioning

confidence: 99%

“…No specific dose alteration seems required, consider dosages in the higher range of the normal dosage. There is evidence for lower concentrations compared to normal weight subjects, however these concentrations are judged high enough to treat common pathogens [52][53][54][55][56] .…”

Section: B-lactam (Amoxicillin Ampicillin and (Phenoxymethyl-)penicillin)mentioning

confidence: 99%

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Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Kingma

Burgers

Monpellier

et al. 2021

Brit J Clinical Pharma

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Bariatric or weight-loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism, and/or elimination of drugs may be altered.The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide guidance for dosing of commonly used drugs in this special population. Upon oral drug administration, the time to maximum concentration is often earlier and this concentration may be higher with less consistent effects on trough concentrations and exposure. Additionally, prescription of liquid formulations to bariatric patients is supported by some reports, even though the high sugar load of these suspensions may be of concern. Studies on extended release medications result in an unaltered exposure for a substantial number of drugs. Also, studies evaluating the influence of timing after surgery show dynamic absorption profiles. Although for this group a specific advice can be proposed for many drugs, we conclude that there is insufficient evidence for general advices for oral drug therapy after bariatric surgery implying that a risk assessment on a case-by-case basis is required for each drug.

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Section: Discussionmentioning

confidence: 64%

Section: Beta-lactam Antibiotics (Amoxicillin Penicillin and Ampicillin)mentioning

confidence: 99%

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Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Kingma

Burgers

Monpellier

et al. 2021

Brit J Clinical Pharma

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“…Two studies, i.e. Terry et al and Miskowiak et al, describe the pharmacokinetics of oral phenoxymethylpenicillin after gastroplasty and jejunoileal bypass, procedures that are to date not often applied any more 44,45 . Miskowiak et al evaluated the effect of gastroplasty on the absorption of phenoxymethylpenicillin when given as a non-coated tablet or as an aqueous solution (one-week washout) in eight female bariatric surgery patients before and three months after gastroplasty surgery.…”

Section: Beta-lactam Antibiotics (Amoxicillin Penicillin and Ampicillin)mentioning

confidence: 99%

“…In this study, no significant changes in plasma concentrations, Cmax, T1/2, Tmax and AUC were found before versus after surgery. 44 . There were also no significant differences in AUC between tablet and aqueous solution.…”

Section: Beta-lactam Antibiotics (Amoxicillin Penicillin and Ampicillin)mentioning

confidence: 99%

Oral drug dosing following bariatric surgery - General concepts and specific dosing advices

Kingma

Burgers

Monpellier³

et al. 2020

Preprint

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Bariatric or weight-loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism, and/or elimination of drugs may be altered. The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide guidance for dosing of commonly used or high-risk drugs in this special population. Upon oral drug administration, the time to maximum concentration is often earlier and this concentration may be higher with less consistent effects on trough concentrations and exposure. Additionally, prescription of liquid formulations to bariatric patients is supported by some reports, even though the high sugar load of these suspensions may be of concern. Studies on extended release medications result in an unaltered exposure for a substantial number of drugs. Also, studies evaluating the influence of timing after surgery show dynamic absorption profiles. Although for this group a specific advice can be proposed for many drugs, we conclude that there is insufficient evidence for general advices for oral drug therapy after bariatric surgery implying that a risk assessment on a case-by-case basis is required for each drug.

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Influence of Obesity on Drug Disposition and Effect

Boullata¹

2004

Handbook of Drug-Nutrient Interactions

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Absorption of Oral Penicillin before and after Gastroplasty for Morbid Obesity

Cited by 6 publications

References 4 publications

Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Oral drug dosing following bariatric surgery - General concepts and specific dosing advices

Influence of Obesity on Drug Disposition and Effect

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