Morphine and metabolites plasma levels after administration of sustained release morphine in Roux-en-Y gastric bypass subjects versus matched control subjects

Hachon, Lorry; Reis, Rafael; Labat, Laurence; Poitou, Christine; Jacob, Aude; Declèves, Xavier; Lloret‐Linares, Célia

doi:10.1016/j.soard.2017.07.030

Cited by 12 publications

(15 citation statements)

References 21 publications

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“…In another study the pharmacokinetics of a morphine controlled release formulation was investigated in subjects undergoing RYGB surgery and weight-matched controls. No significant difference in any of the studied pharmacokinetic parameters was demonstrated [63]. Thus, the hypothetic pathophysiological changes might not have any significant impact on the pharmacokinetics of morphine for subjects who underwent RYGB surgery.…”

Section: Pharmacokinetics Of Opioids After Bariatric Surgerymentioning

confidence: 75%

“…Thus, subjects who underwent bariatric surgery are theoretically at higher risk for adverse events if opioid doses are not adjusted. A higher degree of drowsiness have been reported among subjects who underwent RYGB surgery compared to controls following a controlled release formulation of morphine [63]. Elevating opioid doses could also change pharmacokinetic parameters more drastically in subjects who underwent RYGB surgery depending on the formulation, thus enhancing risks of adverse events [62,63].…”

Section: Adverse Events and Addictionmentioning

confidence: 99%

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Chronic abdominal pain and persistent opioid use after bariatric surgery

Simoni

Ladebo

Christrup

et al. 2019

Scandinavian Journal of Pain

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Background and aimsBariatric surgery remains a mainstay for treatment of morbid obesity. However, long-term adverse outcomes include chronic abdominal pain and persistent opioid use. The aim of this review was to assess the existing data on prevalence, possible mechanisms, risk factors, and outcomes regarding chronic abdominal pain and persistent opioid use after bariatric surgery.MethodsPubMed was screened for relevant literature focusing on chronic abdominal pain, persistent opioid use and pharmacokinetic alterations of opioids after bariatric surgery. Relevant papers were cross-referenced to identify publications possibly not located during the ordinary screening.ResultsEvidence regarding general chronic pain status after bariatric surgery is sparse. However, our literature review revealed that abdominal pain was the most prevalent complication to bariatric surgery, presented in 3–61% of subjects with health care contacts or readmissions 1–5 years after surgery. This could be explained by behavioral, anatomical, and/or functional disorders. Persistent opioid use and doses increased after bariatric surgery, and 4–14% initiated a persistent opioid use 1–7 years after the surgery. Persistent opioid use was associated with severe pain symptoms and was most prevalent among subjects with a lower socioeconomic status. Alteration of absorption and distribution after bariatric surgery may impact opioid effects and increase the risk of adverse events and development of addiction. Changes in absorption have been briefly investigated, but the identified alterations could not be separated from alterations caused solely by excessive weight loss, and medication formulation could influence the findings. Subjects with persistent opioid use after bariatric surgery achieved lower weight loss and less metabolic benefits from the surgery. Thus, remission from comorbidities and cost effectiveness following bariatric surgery may be limited in these subjects.ConclusionsPain, especially chronic abdominal, and persistent opioid use were found to be prevalent after bariatric surgery. Physiological, anatomical, and pharmacokinetic changes are likely to play a role. However, the risk factors for occurrence of chronic abdominal pain and persistent opioid use have only been scarcely examined as have the possible impact of pain and persistent opioid use on clinical outcomes, and health-care costs. This makes it difficult to design targeted preventive interventions, which can identify subjects at risk and prevent persistent opioid use after bariatric surgery. Future studies could imply pharmacokinetic-, pharmacodynamics-, and physiological-based modelling of pain treatment. More attention to social, physiologic, and psychological factors may be warranted in order to identify specific risk profiles of subjects considered for bariatric surgery in order to tailor and optimize current treatment recommendations for this population.

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Section: Pharmacokinetics Of Opioids After Bariatric Surgerymentioning

confidence: 75%

Section: Adverse Events and Addictionmentioning

confidence: 99%

Chronic abdominal pain and persistent opioid use after bariatric surgery

Simoni

Ladebo

Christrup

et al. 2019

Scandinavian Journal of Pain

View full text Add to dashboard Cite

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“…investigated the effect of RYGB surgery on the pharmacokinetics of morphine CR tablets in RYGB patients (two years after surgery) and healthy controls. They found no significant changes in the AUC or other PK parameters between studied groups 44 .…”

Section: Gastro-intestinal Transit Timementioning

confidence: 87%

“…In general, the pharmacokinetic profile of orally administered drugs seems to change after bariatric surgery; the Tmax can be earlier and Cmax higher, with less consistent results on the AUC, which can be similar 43,44,56,74,75 , lower 36,56,60,62,133,135 or higher 33,55,57 after surgery.…”

Section: Discussionmentioning

confidence: 99%

Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Kingma

Burgers

Monpellier

et al. 2021

Brit J Clinical Pharma

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Bariatric or weight-loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism, and/or elimination of drugs may be altered.The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide guidance for dosing of commonly used drugs in this special population. Upon oral drug administration, the time to maximum concentration is often earlier and this concentration may be higher with less consistent effects on trough concentrations and exposure. Additionally, prescription of liquid formulations to bariatric patients is supported by some reports, even though the high sugar load of these suspensions may be of concern. Studies on extended release medications result in an unaltered exposure for a substantial number of drugs. Also, studies evaluating the influence of timing after surgery show dynamic absorption profiles. Although for this group a specific advice can be proposed for many drugs, we conclude that there is insufficient evidence for general advices for oral drug therapy after bariatric surgery implying that a risk assessment on a case-by-case basis is required for each drug.

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“…20 A later study by this research group examined the pharmacokinetics of extended release oral morphine in patients who underwent RYGB versus BMI matched nonsurgical controls and found no differences between groups in AUC, maximum concentration, or the time it took to reach it. 21 Currently, pharmacokinetic data concerning opioids following LSG are limited to one case report that found that methadone serum concentrations increased early (5 days) following LSG and further increased by 7 months post-operatively, suggesting the need for careful monitoring of methadone pharmacotherapy in post-bariatric surgery patients. 22 A rapid and exaggerated peak concentration may be important since prior studies in the drug abuse literature have demonstrated a relationship between the rate at which a substance enters the central nervous system and the risk for abuse/dependence.…”

Section: Pharmacological and Biological Mechanisms Of Riskmentioning

confidence: 99%

Opioids and bariatric surgery: A review and suggested recommendations for assessment and risk reduction

Heinberg

Pudalov

Alameddin

et al. 2019

Surgery for Obesity and Related Diseases

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Prescription opioid use has increased significantly over the past 25 years due to a number of factors including efforts to help patients struggling to cope with pain, overprescribing by providers and marketing by pharmaceutical companies. However, opioids provide euphoria as well as analgesia. 1 This euphoria coupled with iatrogenic physical dependence and addictive qualities has contributed to an epidemic of opioid abuse, addiction and overdose. 2 The increased use of opioids for treating non-cancer chronic pain and the increased use of higher-dose and higher bioavailability formulations has added to what the Centers for Disease Control and the Department of Health and Human Services have referred to as an'epidemic'. 1 Clinicians struggle to weigh the potential benefits of long-term opioids therapy (i.e., use of legitimately obtained prescribed opioids at least five days per week for 90 days) with the risk of misuse or addiction. 3 Recently, the Centers for Disease Control (CDC) has issued prescribing guidelines to address the issue of opioid over-use. 4 Obesity and Chronic Pain Co-Morbidity Patients with severe obesity are more likely to experience chronic pain and related increased functional and psychosocial complications related to chronic pain conditions. 5 Chronic pain also has quality of life implications in patients with severe obesity and has been the subject of a prior review A large-scale survey of over 1 million US residents demonstrated a linear relationship between Body Mass Index (BMI) and chronic pain prevalence. 6 Compared to individuals with normal BMIs, individuals who were overweight reported 20% greater rates of chronic pain, people with Class I obesity reported 68% greater, those with Class II reported 136% greater, and those with clinically severe Class III obesity reported 254% greater rates of chronic pain. 7 Recent research has indicated that although pain ratings and overall medication use is significantly reduced following bariatric surgeries, opioid use not only continues but

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Morphine and metabolites plasma levels after administration of sustained release morphine in Roux-en-Y gastric bypass subjects versus matched control subjects

Cited by 12 publications

References 21 publications

Chronic abdominal pain and persistent opioid use after bariatric surgery

Chronic abdominal pain and persistent opioid use after bariatric surgery

Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Opioids and bariatric surgery: A review and suggested recommendations for assessment and risk reduction

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