Medication Use Following Bariatric Surgery: Factors Associated with Early Discontinuation

Kennedy, Ann C.; Nelson, Tracy L.; Pettine, Stefan; Miller, Benjamin F.; Hamilton, Karyn L.

doi:10.1007/s11695-013-1131-8

Cited by 19 publications

(12 citation statements)

References 21 publications

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“…The ongoing need for medications for T2D depends on the specific bariatric surgical procedure and needs to be monitored postoperatively. In a retrospective review of 400 patients in the Bariatric Outcomes Longitudinal Database, the use of oral hypoglycemic agents or insulin decreased after bariatric surgery by 18.8% and 4.2%, respectively . In a prospective, single‐center cohort study of 65 patients having SG, there was a 50% reduction in diabetes medications .…”

Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

339

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

339

464

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“…Pharmacological therapy is commonly needed, often including polypharmacy . Weight loss is associated with improvement of obesity‐related comorbidities and reduces the need for pharmacological intervention . Bariatric surgery is the treatment modality that gives the best results for long‐lasting weight loss and associated improvement in comorbidities .…”

Section: Introductionmentioning

confidence: 99%

“…3 Weight loss is associated with improvement of obesity-related comorbidities and reduces the need for pharmacological intervention. [4][5][6][7] Bariatric surgery is the treatment modality that gives the best results for long-lasting weight loss and associated improvement in comorbidities. 8,9 There are several techniques in use, including sleeve gastrectomy (SG), adjustable gastric band, biliopancreatic diversion (BPD), biliopancreatic diversion with duodenal switch (BPD-DS), and Roux-en-Y gastric bypass (RYGBP).…”

Section: Introductionmentioning

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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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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“…Die folgende Frage "Wenn ja, welche Medikamentenverordnungen haben sich verändert?" wurde von 48 Pa- 32 (13,3) 66 (26,7) 30 (12,4) 43 (17,6) 59 (24,3) 37 15,36 2,54 1,74 1,78 3,316 6,749 (20,4) 28 (11,6) 11 4,718 7,5) 7 (2,94 1,722 (9,1) 25 (10,4) 62 (25,6) 20 (8,2) 18 (7,4) 25 (10,4) 15 ( Der statistische Vergleich der prä-und postoperativen Verordnungshäufigkeiten wurde mittels des exakten Fischer-Tests durchgeführt. ▶ Tabelle 4 zeigt eine Auswahl, Arzneimittel mit unveränderten Verordnungszahlen werden hier überwiegend nicht gezeigt.…”

Section: Discussionunclassified

“…13 (14,8) 12 (13,6) 3 (3,4) 18 (20,5) 18 (20,5) Verordnungen. Ein Jahr postoperativ war die doppelte Standarddosis nur noch bei 18% der Verordnungen zu finden.…”

Section: Der Spezialfall: Protonenpumpen-hemmerunclassified

Änderungen der Pharmakotherapie nach Adipositas-Chirurgie - eine monozentrische Erhebung

Hansen¹,

Mall²,

Engeli³

2018

Adipositas - Ursachen, Folgeerkrankungen, Therapie

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ZusammenfassungDie Arzneimitteltherapie des adipösen Patienten wird durch vielfältige ungeklärte Fragen erschwert und die Situation wird noch komplizierter, wenn sich ein Patient einer gewichtsreduzierenden Operation unterzieht. Postoperative Änderungen der Medikation hängen nicht nur mit der veränderten Pharmakokinetik einzelner Arzneimittel zusammen, sondern auch mit der Änderung von Begleiterkrankungen. Unsere Akten- und Fragebogenauswertung ergab für 88 Patienten eines zertifizierten Adipositas-Chirurgie-Zentrums eine Reduktion des BMI um 18,4 kg/m2 ein Jahr nach Operation bei 71% Schlauchmagenoperationen. Wie erwartet, ging die Gewichtsreduktion mit einem signifikant reduzierten Bedarf an blutzucker- (-76%) und blutdrucksenkenden (-60%) Arzneimitteln einher, der Bedarf an Eisensubstitution stieg an. Entgegen unserer Erwartung blieb die antidepressive Therapie unverändert und die Verordnungen analgetischer Arzneimittel nahmen an. Die Verordnungsraten von Protonenpumpen-Hemmern veränderten sich dynamisch von 50% präoperativ zu annähernd 100% direct postoperativ zu 50% ein Jahr postoperativ, was auch durch die Prophylaxe zur Sicherung der gastrointestinalen Wundheilung zu erklären ist.

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Medication Use Following Bariatric Surgery: Factors Associated with Early Discontinuation

Cited by 19 publications

References 21 publications

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

Änderungen der Pharmakotherapie nach Adipositas-Chirurgie - eine monozentrische Erhebung

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