Effect of Sleeve Gastrectomy on Buprenorphine Pharmacokinetics: A Planned Case Observation

Abstract

Purpose: Bariatric surgery may affect the absorption and metabolism of drugs by various mechanisms. We present a planned case observation of a patient treated with sublingual buprenorphine in an opioid maintenance treatment program, and the observed changes in buprenorphine pharmacokinetics following gastric sleeve surgery. Methods: Serial blood samples during a dose interval of 24 hours were obtained approximately 1 year preoperatively as well as 1 week, 1 month and 12 months postoperatively and key pharmacokinetic variables were calculated. Findings: The systemic exposure of buprenorphine (AUC) was relatively stable from the preoperative sampling to 1 week postoperatively (−6.3%), but declined markedly at 1 month (−43%) and 12 months (−42%) postoperatively. The maximum concentration of buprenorphine almost doubled at 1 week postoperatively before returning to baseline values 1 month and 12 months postoperatively. Implications: This case observation indicates that after sleeve gastrectomy, the systemic exposure of sublingual buprenorphine can decrease. Clinicians should be aware of the possibility of loss of effect and emerging abstinence symptoms following sleeve gastrectomy. We recommend monitoring the patient closely for abstinence symptoms postoperatively and considering measuring serum concentrations of buprenorphine pre-and postoperatively.

Opioid Analgesics after Bariatric Surgery: A Scoping Review to Evaluate Physiological Risk Factors for Opioid-Related Harm

“…Contrarily, a PK study on non-obese cancer patients also studied an oral oxycodone prolonged release preparation after total gastrectomy and did not find differences in the PK parameters [ 61 ]. Two case reports of patients on opioid replacement therapy with buprenorphine [ 62 ] and methadone [ 63 ] were identified, reporting increased T max and C max in the month following surgery. For buprenorphine, a decreased AUC (up to 43% at 1 year post-surgery) was determined [ 62 ].…”

“…Two case reports of patients on opioid replacement therapy with buprenorphine [ 62 ] and methadone [ 63 ] were identified, reporting increased T max and C max in the month following surgery. For buprenorphine, a decreased AUC (up to 43% at 1 year post-surgery) was determined [ 62 ]. In the methadone case, the AUC increased significantly (up to 213% at seven months post-surgery) [ 63 ].…”

New important data concerning problems with substance abuse disorder after bariatric surgery

“…As also reviewed, the alcohol use problem to some extent may reflect pharmacokinetic changes, as well as central changes that are not yet understood. Relative to SUDs, the report mentions that pharmacokinetic problems may also occur over time with morphine [5], although other reports concerning opioids have not adequately clarified this issue [6,7]. However, psychosocial problems after bariatric surgery must also be considered [8], including persistence of medical comorbidities after surgery and lack of adequate improvement in quality of life or physical mobility, previously discussed in depth in a paper addressing suicide risk [9].…”