Carbamazepine Therapy After Bariatric Surgery: Eight Sleeve Gastrectomy Cases and Review of the Literature

Porat, Daniel; Margolin, Nadia; Lavon, Ophir; Dahan, Arik

doi:10.1007/s11695-022-06247-x

Cited by 7 publications

(7 citation statements)

References 35 publications

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“…15,87 These theoretical concepts are in line with our findings, which generally showed no significant changes in C max or AUC levels following SG for most medications included, except for carbamazepine, which had a post-operative decreased C max in a case series of eight participants. 59 In most bariatric or metabolic surgical procedures, the gastric surface area is reduced, as well as the total amount of fluids acting as a solvent in the stomach, which can lead to less dissolution, disintegration, and absorption of certain oral medications. 86,88 Medication disintegration in the stomach is the first and one of the most important steps for the absorption of solid-form medications.…”

Section: Discussionmentioning

confidence: 99%

Section: Changes In Vitamin and Trace Element Concentrationsmentioning

confidence: 99%

“…A total of 8 studies 41,57,59,66,75,77,81,85 on 8 different medications and including 110 participants who underwent SG were included (Table 1). Absorption (estimated using AUC and/or C max ) remained unchanged following bariatric surgery for most medications, except for 1) carbamazepine, whereby levels decreased following SG, 59 2) tacrolimus, where C 0 increased from 9 to 12 months post-operatively (n = 12, patients in chronic renal failure), 75 3) rivaroxaban, where C max increased when assessed shortly after SG (n = 6, measured between 1-and 3-days post-op), 77 but only in one study. 85 We included 30 studies 30,32,37,39,40,[56][57][58][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][76][77][78][79][80]82,83 reporting on PK outcomes of oral bioavailability following metabolic surgery (RYGB or BPD) with a total of 33 medications and 430 participants (Table 3).…”

Section: Changes In Vitamin and Trace Element Concentrationsmentioning

confidence: 99%

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Medication and supplement pharmacokinetic changes following bariatric surgery: A systematic review and meta‐analysis

Lajeunesse‐Trempe,

Okroj,

Ostarijas

et al. 2024

Obesity Reviews

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SummaryObjectivesTo evaluate the impact of bariatric surgery on the pharmacokinetic (PK) parameters of orally administered medications and supplements.MethodsSystematic searches of bibliographic databases were conducted to identify studies. Pooled effect estimates from different surgical procedures were calculated using a random‐effects model.ResultsQuantitative data were synthesized from 58 studies including a total of 1985 participants. Whilst 40 medications and 6 supplements were evaluated across these studies, heterogeneity and missing information reduced the scope of the meta‐analysis to the following medications and supplements: atorvastatin, paracetamol, omeprazole, midazolam, vitamin D, calcium, zinc, and iron supplements. There were no significant differences in PK parameters post‐surgery for the drugs atorvastatin and omeprazole, and supplements calcium, ferritin, and zinc supplements. Paracetamol showed reduced clearance (mean difference [MD] = −15.56 L/hr, p = 0.0002, I2 = 67%), increased maximal concentration (MD = 6.90 μg/ml, p = 0.006, I2 = 92%) and increased terminal elimination half‐life (MD = 0.49 hr, p < 0.0001, I2 = 3%) post‐surgery. The remaining 36 medications and 2 supplements were included in a systematic review. Overall, 18 of the 53 drugs and supplements showed post‐operative changes in PK parameters.ConclusionThis study demonstrates heterogeneity in practice and could not reach conclusive findings for most PK parameters. Prospective studies are needed to inform best practice and enhance patient healthcare and safety following bariatric surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Changes In Vitamin and Trace Element Concentrationsmentioning

confidence: 99%

Section: Changes In Vitamin and Trace Element Concentrationsmentioning

confidence: 99%

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Medication and supplement pharmacokinetic changes following bariatric surgery: A systematic review and meta‐analysis

Lajeunesse‐Trempe,

Okroj,

Ostarijas

et al. 2024

Obesity Reviews

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“…Other mechanisms involved in the pharmacokinetics of these drugs may also be affected by bariatric surgery [ 64 , 65 , 66 , 67 , 68 ]. For example, the activity of CYP3A enzymes is increased with weight loss [ 69 , 70 , 71 ], and since sildenafil is mainly metabolized by CYP3A4, its postbariatric plasma levels may be further decreased.…”

Section: Discussionmentioning

confidence: 99%

The Complexity of Bariatric Patient’s Pharmacotherapy: Sildenafil Biopharmaceutics and Pharmacokinetics before vs. after Gastric Sleeve/Bypass

Porat,

Dukhno,

Cvijić

et al. 2023

Pharmaceutics

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Postbariatric altered gastrointestinal (GI) anatomy/physiology may significantly harm oral drug absorption and overall bioavailability. In this work, sildenafil, the first phosphodiesterase-5 (PDE5) inhibitor, was investigated for impaired postbariatric solubility/dissolution and absorption; this research question is of particular relevance since erectile dysfunction (ED) is associated with higher body mass index (BMI). Sildenafil solubility was determined both in vitro and ex vivo, using pre- vs. postsurgery gastric contents aspirated from patients. Dissolution tests were done in conditions mimicking the stomach before surgery, after sleeve gastrectomy (post-SG, pH 5), and after one anastomosis gastric bypass (post-OAGB, pH 7). Finally, these data were included in physiologically based pharmacokinetic (PBPK) modelling (GastroPlus®) to simulate sildenafil PK before vs. after surgery. pH-dependent solubility was demonstrated with low solubility (0.3 mg/mL) at pH 7 vs. high solubility at pH 1–5, which was also confirmed ex vivo with much lower solubility values in postbariatric gastric samples. Hampered dissolution of all sildenafil doses was obtained under post-OAGB conditions compared with complete (100%) dissolution under both presurgery and post-SG conditions. PBPK simulations revealed delayed sildenafil absorption in postbariatric patients (increased tmax) and reduced Cmax, especially in post-OAGB patients, relative to a presurgery state. Hence, the effect of bariatric surgery on sildenafil PK is unpredictable and may depend on the specific bariatric procedure. This mechanistically based analysis suggests a potentially undesirable delayed onset of action of sildenafil following gastric bypass surgery.

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“…In addition, bariatric surgery is accompanied by anatomical changes that may affect the pharmacokinetic profile and the pharmacodynamics of many drugs. These changes include, among others, a decrease in stomach acidity [14], a decrease in the stomach volume, and bypass of the proximal part of the intestine and thus a decrease in surface area for absorption, and various enzymes and transporters that take part in drug metabolism and distribution [15][16][17]. Also, many changes may be required in the patient's chronic medication dosing due to an improvement in chronic diseases such as diabetes, hypertension, and hyperlipidemia.…”

Section: Introductionmentioning

confidence: 99%

Can Consultation by a Clinical Pharmacist Prevent Morbidity and Mortality in Patients Undergoing Bariatric Surgery?

Azran,

Dahan,

Shimoni

et al. 2024

JCM

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The purpose of this work was to investigate the effect of clinical pharmacist consultation on the long-term morbidity and mortality outcomes among patients undergoing bariatric surgery. In this retrospective cohort study, 165 bariatric patients at Herzliya Medical Center who were identified as complex cases and were consulted by a clinical pharmacist (2013–2019) were compared with a wider group of bariatric patients with chronic diseases who were recorded in the Israeli General Bariatric Registry during the same years. The primary outcomes were rates of surgical complications, re-hospitalizations, and death up to one year after surgery. The secondary outcome was the rate of re-hospitalizations in different time periods. The twelve (12)-month rate of re-hospitalization in the intervention group was 10.9% vs. 19.5% in the comparison group (p = 0.005); the rate of documented postoperative complications was 2.7% vs. 3.9% (p = 0.462), and mortality was null vs. 0.16%, respectively. As for the secondary outcomes, the rates of re-hospitalizations in the periods of 0–30, 31–90, 91–180, and 181–365 days after surgery were 1.8% vs. 5.3% (p = 0.046), 2.4% vs. 4.1% (p = 0.278), 3.6% vs. 4.8% (p = 0.476), and 7.3% vs. 9.9% (p = 0.256) in the intervention vs. comparison cohorts, respectively. In conclusion, this study demonstrates the importance and benefit of referring to a specialized clinical pharmacist around bariatric surgery for improving patient safety, especially in complex patients. This is the first study to look at the long-term effects of clinical pharmacist consultation on re-hospitalization and mortality among bariatric patients, and our encouraging outcomes should hopefully stimulate more studies to show the invaluable role of specialized clinical pharmacists.

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Carbamazepine Therapy After Bariatric Surgery: Eight Sleeve Gastrectomy Cases and Review of the Literature

Cited by 7 publications

References 35 publications

Medication and supplement pharmacokinetic changes following bariatric surgery: A systematic review and meta‐analysis

Medication and supplement pharmacokinetic changes following bariatric surgery: A systematic review and meta‐analysis

The Complexity of Bariatric Patient’s Pharmacotherapy: Sildenafil Biopharmaceutics and Pharmacokinetics before vs. after Gastric Sleeve/Bypass

Can Consultation by a Clinical Pharmacist Prevent Morbidity and Mortality in Patients Undergoing Bariatric Surgery?

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