Comparison of Bioavailability of Single‐Dose Extended‐Release Venlafaxine Capsules in Obese Patients Before and After Gastric Bypass Surgery

Krieger, Carrie A.; Cunningham, Julie L.; Reid, Joel M.; Langman, Loralie J.; Grothe, Karen; Clark, Matthew M.; Dierkhising, Ross A.

doi:10.1002/phar.2022

Cited by 32 publications

(26 citation statements)

References 19 publications

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“…Venlafaxine, a serotonin‐norepinephrine reuptake inhibitor (SNRI), is also predominantly metabolized by CYP2D6 into its major active metabolite, O ‐desmethylvenlafaxine . The effect of RYGBP on venlafaxine exposure was investigated in a prospective, single‐dose study presurgery and 3 to 4 months after surgery . There were no significant differences in venlafaxine exposure, C max and T max , neither prior to or after RYGBP, substantiating the metoprolol findings above of an unaltered CYP2D6 activity.…”

Section: Resultsmentioning

confidence: 64%

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The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review

et al. 2019

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Summary Anatomical changes in the gastrointestinal tract and subsequent weight loss may influence drug disposition and thus drug dosing following bariatric surgery. This review systematically examines the effects of bariatric surgery on drug pharmacokinetics, focusing especially on the mechanisms involved in restricting oral bioavailability. Studies with a longitudinal before‐after design investigating the pharmacokinetics of at least one drug were reviewed. The need for dose adjustment following bariatric surgery was examined, as well as the potential for extrapolation to other drugs subjected to coinciding pharmacokinetic mechanisms. A total of 22 original articles and 32 different drugs were assessed. The majority of available data is based on Roux‐en‐Y gastric bypass (RYGBP) (18 of 22 studies), and hence, the overall interpretation is more or less limited to RYGBP. In the case of the majority of studied drugs, an increased absorption rate was observed early after RYGBP. The effect on systemic exposure allows for a low degree of extrapolation, including between drugs subjected to the same major metabolic and transporter pathways. On the basis of current understanding, predicting the pharmacokinetic change for a specific drug following RYGBP is challenging. Close monitoring of each individual drug is therefore recommended in the early postsurgical phase. Future studies should focus on the long‐term effects of bariatric surgery on drug disposition, and they should also aim to disentangle the effects of the surgery itself and the subsequent weight loss.

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Section: Resultsmentioning

confidence: 64%

“…RYGBP was the predominant surgical procedure (n = 18) . In one study, BPD was investigated as the surgical procedure, while two studies investigated BPD‐DS, six studied SG, and one included jejunoileostomy …”

Section: Resultsmentioning

confidence: 99%

The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review

et al. 2019

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“…In studies of caffeine, tolbutamide, omeprazole, and venlafaxine, pharmacokinetic parameters were not changed after RYGB, apart from a significantly shorter time to peak serum concentration ( T max ) . Increased morphine exposure after RYGB has been reported, however …”

Section: Introductionmentioning

confidence: 98%

Plasma concentrations of etonogestrel in women using oral desogestrel before and after Roux‐en‐Y gastric bypass surgery: a pharmacokinetic study

Ginstman

Frisk

Carlsson

et al. 2018

BJOG

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Objective To investigate whether Roux‐en‐Y gastric bypass (RYGB) affects oral desogestrel (etonogestrel) pharmacokinetics. Design Single centre, open label, phase‐2 pharmacokinetic study. Setting University hospital of Linköping, Sweden. Population Fourteen women with planned RYGB surgery were included; nine women aged 18–45 years using 75 micrograms desogestrel completed the study. Methods Steady‐state etonogestrel pharmacokinetic (PK) parameters were measured on three occasions for each individual (at 8 ± 6 weeks before surgery, and at 12 ± 2 and 52 ± 2 weeks after surgery). Each patient served as her own control. On each occasion, serum samples were collected during a 24‐hour period and etonogestrel concentrations were determined with ultra‐performance liquid chromatography/tandem mass spectrometry. Main outcome measures Area under the plasma concentration time curve of etonogestrel (AUC0–24 hours). Results All women had significant postoperative weight loss. There were no significant differences in AUC0–24 hours, terminal half‐lives (t½), time to peak serum concentrations (Tmax), or apparent oral clearances of etonogestrel (CLoral) before and after gastric bypass surgery on any occasion. Peak serum concentrations (Cmax) increased after 52 ± 2 weeks compared with preoperative values (0.817 ng/ml versus 0.590 ng/ml, P = 0.024). Conclusion To our knowledge, this is the first study to investigate the effects on desogestrel pharmacokinetics after RYGB. This study did not reveal any clinically significant changes in etonogestrel pharmacokinetics, suggesting that oral desogestrel may be used by women after RYGB surgery. The sample size was limited, however, and therefore the results should be interpreted cautiously. Tweetable abstract The pharmacokinetics of oral desogestrel does not appear to change after gastric bypass surgery.

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“…Of the total 21 studies, some conducted more than one procedure: 19 studies investigated RYGB, five investigated SG, two investigated BPD‐DS, and one study investigated mini‐GB . The number of participants in these studies ranged from five patients in a single study to a maximum of 34 patients.…”

Section: Resultsmentioning

confidence: 99%

“…In the included articles, 11 studies reported a statistically significant change in pharmacokinetics before and after a bariatric procedure, measured as a change in either C max , T max , or AUC with statistical significance determined with a P value lower than .05. In six studies, the results were either reported as nonsignificant or the P values presented were above the threshold for statistical significance ( P < .05). In a further five studies, there was a reported pharmacokinetic change but neither P value nor statistical significance for a change in the reported parameters was reported.…”

Section: Resultsmentioning

confidence: 99%

Pharmacokinetic changes post–bariatric surgery: A scoping review

McLachlan

Chaar

2020

Obesity Reviews

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Summary Bariatric surgeries induce structural changes that can alter the absorption of drugs in patients already at risk of polypharmacy. This scoping review aimed to explore pharmacokinetic changes of orally administered drugs in patients post‐bariatric surgery, and assess the quality and level of bias. Electronic databases were searched for articles relating to bariatric surgery and pharmacokinetics published between 1998 and 2019. Pre‐post studies reporting on pharmacokinetic parameters were included, and the Newcastle‐Ottawa Scale was used to assess risk‐of‐bias. A total of 21 studies were included in this review, and changes in absorption were reported in all included studies across 29 drugs. In 11 studies, this change was reported as statistically significant (p<.05), while six reported a nonsignificant change. More drugs exhibited a shorter Tmax and higher Cmax after surgery than otherwise, however changes in AUC were variable. Four studies were assessed as having fair quality while the remainder of the included studies were of good quality and low risk‐of‐bias. Bariatric surgery alters the absorption of drugs and several mechanisms are implicated to be responsible. Short and long‐term monitoring is recommended in patients post‐surgery for clinical changes in response to medications. Future research with a higher number of participants and greater control of variables, such as concurrent medications, malabsorptive disorders, and body composition should be considered.

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Comparison of Bioavailability of Single‐Dose Extended‐Release Venlafaxine Capsules in Obese Patients Before and After Gastric Bypass Surgery

Abstract: This study suggests that RYGB does not significantly alter the amount of venlafaxine or its active metabolite, ODV, absorbed from a venlafaxine ER capsule or the time over which it is absorbed.

Cited by 32 publications

References 19 publications

The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review

The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review

Plasma concentrations of etonogestrel in women using oral desogestrel before and after Roux‐en‐Y gastric bypass surgery: a pharmacokinetic study

Pharmacokinetic changes post–bariatric surgery: A scoping review

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