Dissolution of Common Psychiatric Medications in a Roux-en-Y Gastric Bypass Model

Seaman, Jeff S.; Bowers, Steven P.; Dixon, Patricia; Schindler, Libby

doi:10.1176/appi.psy.46.3.250

Cited by 70 publications

(53 citation statements)

References 4 publications

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“…Often, all SR, ER, LA, and EC dosage forms are contraindicated after malabsorptive procedures by nature of the lack of absorptive surface and gastric acid, but again, studies are lacking [10]. Seaman et al [18] compared the dissolution of 22 instant-release psychiatric medications versus controls in Roux-en-Y in vitro models. He concluded that almost half of the medications had significantly less dissolution and two had significantly greater dissolution in the Roux-en-Y model than in the control.…”

Section: Discussionmentioning

confidence: 99%

“…He concluded that almost half of the medications had significantly less dissolution and two had significantly greater dissolution in the Roux-en-Y model than in the control. He also concluded that although dissolution data do not predict therapeutic efficacy, they do provide qualitative information about the availability of the medication since absorption is limited by dissolution rate [18].…”

Section: Discussionmentioning

confidence: 99%

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Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient

Lizer

Papageorgeon

Glembot³

2010

OBES SURG

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The purpose of this study was to describe vitamin and nutrient supplement practices and assess medication dosage formulations utilized in patients hospitalized with a history of bariatric surgery. Retrospective pilot study was conducted from January 1, 2006 through December 31, 2007 in patients with a past history of bariatric surgery. Demographic data, vitamin and nutrient supplements, and medication dosage formulations were evaluated upon admission. This was compared to published guidelines. Compliance with the following supplementation was categorized: daily multivitamin, calcium, iron, vitamin B-12, and folic acid. The frequency of non-immediate-release and enteric-coated medication dosage forms was also examined. Discrepancies were identified as lack of one of the supplements or if an inappropriate dosage formulation was ordered. Of 133 admissions, 117 (88%) had a history of a malabsorptive procedure and at least one discrepancy was found. Only 33.3% of admissions were ordered a multivitamin, 5.1% were ordered supplemental vitamin B-12, and 7.7% received a calcium supplement. Additional folic acid was ordered in 11.1% and iron ordered in 12.0%. Inappropriate medication formulations were ordered in 61.5% of patients; 34.7% included non-immediate-release formulations, 25.0% enteric-coated formulations, and 40.3% both non-immediate-release and enteric-coated. Upon discharge from the institution, 50% had inappropriate formulations continued. Patients with a history of bariatric surgery may not have their vitamin and nutrient needs met upon hospitalization. Prior bariatric surgery is not consistently taken into consideration when ordering medications. Healthcare providers need to be cognizant of vitamin regimens to recommend as well as medication dosage formulations to avoid.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient

Lizer

Papageorgeon

Glembot³

2010

OBES SURG

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“…Due to its ionized state, sertraline likely requires active transport for absorption, although no active transporters have been identified. Secondly, in a simulated environment, sertraline undergoes significantly greater dissolution in a normal environment versus a RYGB environment (16% dissolved vs. 10% dissolved, p<0.04) [25]. As the Log P value increases, solubility of medications decrease.…”

Section: Literature Reviewmentioning

confidence: 96%

Pharmacokinetic Changes Secondary to Roux en Y Gastric Bypass

Giuliano¹

2012

Adv Pharmacoepidem Drug Safety

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Objective: To review the influence of Roux-en-Y gastric bypass (RYGB) on pharmacokinetic parameters of medications.Data sources: PubMed was searched from inception to September 2012 to identify studies. Search terms included bariatric surgery, gastric bypass, Roux-en-Y, pharmacokinetic, and absorption. Studies included for this review were limited to English language studies published in full.Data synthesis: Obesity is a major health care concern and is on the rise. This has led to an increasing number of bariatric surgeries. Such procedures may have profound effects on pharmacokinetic parameters of many medications depending on the extent of surgical changes that are made. Surgical procedures such as RYGB are most likely to affect medication absorption. Factors that may affect medication absorption in RYGB patients include changes in intestinal or gastric pH, surface area, intestinal metabolism and transport mechanisms. Published studies have been primarily conducted in RYGB patients and have shown varied effect on overall absorption of medications.Conclusions: RYGB may have profound effects on medication absorption. Predicting absorption is difficult due to interplay of several factors including, changes in intestinal surface area, intestinal metabolism, efflux pumps, active transporters and gastrointestinal pH. Future studies are needed, particularly studies evaluating medications that have a low bioavailability and are commonly used in the bariatric surgery population.

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“…Midazolam is a CYP3A4 substrate with a high extraction rate which was further increased after RYGB. Seaman et al [57] developed an in vitro drug dissolution model to approximate the gastrointestinal environment of the preoperative and post RYGB states. Psychiatric medication tablets were placed in the two environments, and the weights of the dissolved portions were compared.…”

Section: Bioavailability Of Drugs After Bypassmentioning

confidence: 99%

Oral Contraceptives after Bariatric Surgery

Schlatter

2017

Obes Facts

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Objective: Bariatric surgery offers a highly effective mode of treatment for obese patients. Some procedures such as bypass cause an alteration in normal gastrointestinal tract with possible consequences for the uptake of orally administered drugs. Methods: We assessed the literature to ascertain whether the use of oral drugs and especially oral contraceptives is effective and adequate after bariatric surgery. Results: The bioavailability of drugs could be affected by the solubility and pH of the modified medium after bariatric surgery and by the loss of gastrointestinal transporters. Bariatric surgery could potentially result in a transient change in the absorption of drugs such as analgesics, antibiotics, antiarrhythmics, anticoagulants, psychotropic, and oral contraceptive drugs. Effective contraception is especially critical in the postoperative period, and implants might be representing a safe contraceptive method in women undergoing bariatric surgery. Conclusion: Each drug will have to be evaluated with respect to its site of absorption and its mechanism of absorption, with special attention on parameters influencing the effectiveness of the absorption processes.

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Dissolution of Common Psychiatric Medications in a Roux-en-Y Gastric Bypass Model

Cited by 70 publications

References 4 publications

Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient

Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient

Pharmacokinetic Changes Secondary to Roux en Y Gastric Bypass

Oral Contraceptives after Bariatric Surgery

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