Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient

Abstract

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.

Nutritional Deficiencies in Patients after Roux-en-Y Gastric Bypass and Sleeve Gastrectomy during 12-Month Follow-Up

“…In a clinical report on nutritional and pharmacologic challenges after bariatric surgeries, Lizer et al recommended that all these patients should receive lifelong vitamin and mineral supplementation postoperatively. However, there are also opinions that only RYGB cohort should receive this form of prevention [34]. There are multiple strategies regarding type and complexity of postoperative supplementation.…”

Nuggets of Knowledge: Bariatric surgery – what happens to medicines absorption?

“…Restrictive bariatric surgery reduces gastric acidity and so potentially reduces the absorption of some medicines. [2][3][4] Most medicines are absorbed from the small intestine, either through active transport systems or through passive absorption over the extensive surface area of the small intestine. The area over which medicines may be absorbed, and specific transport systems may be bypassed through surgery.…”

“…The area over which medicines may be absorbed, and specific transport systems may be bypassed through surgery. 3,4 Gastric bypass surgery (restrictive + malabsorptive surgery)…”

“…People with a gastric bypass require supplementation with calcium, iron, Vitamin B 12 , folic acid, Vitamin D and a multivitamin. 3 Prescribers should note that the funded multivitamin tablet has minimal vitamins other than thiamine (B 1 ), riboflavin (B 2 ), nicotinamide (B 3 ), Vitamin A, Vitamin C and Vitamin D 3 .…”

Effect of Roux-en-Y gastric bypass on the bioavailability of metoprolol from immediate and controlled release tablets: a single oral dose study before and after surgery

“…[2][3][4] After RYGB the performance of oral formulation types such as slow release or delayed release may suffer from critical changes affecting adequate drug absorption and thereby their efficacy. 5 Generally after restrictive-malabsorptive procedures, such as RYGB, it is recommended to substitute controlled release (CR) drug formulations into immediate release (IR) dosage forms. 6 This is reflected in the European guidelines on metabolic and bariatric surgery, stating that in the follow-up after bariatric surgery, patients should be advised to preferably use crushed and/or rapid release medication.…”