Background
RouxâenâY gastric bypass (RYGBS), a surgery that creates a smaller stomach pouch and reduces the length of small intestine, is one of the most common medical interventions for the treatment of obesity.
Aim
The aim of this study was to determine how RYGBS affects the absorption and metabolism of acetaminophen.
Materials and Methods
Ten morbidly obese patients received 1.5Â g of liquid acetaminophen (APAP) orally on three separate pharmacokinetic study days (i.e., preâRYGBS baseline and 3 and 12Â months postâRYGBS). Plasma was collected at preâspecified timepoints over 24Â hours, and the samples were analyzed using liquid chromatographyâmass spectrometry for APAP, APAPglucuronide (APAPâgluc), APAPâsulfate (APAPâsulf), APAPâcysteine (APAPâcys), and APAPâNacetylcysteine (APAPânac).
Result
Following RYGBS, peak APAP concentrations at the 3âmonth and 12âmonth visits increased by 2.0âfold compared to baseline (p=0.0039 and p=0.0078, respectively) and the median time to peak concentration decreased from 35 to 10 minutes. In contrast, peak concentrations of APAPâgluc, APAPâsulf, APAPâcys, and APAPânac were unchanged following RYGBS. The apparent oral clearance of APAP and the ratios of metabolite area under the curve (AUC)âtoâAPAP AUC for all four metabolites decreased at 3 and 12Â months postâRYGBS compared to the presurgical baseline. In a simulation of expected steadyâstate plasma concentrations following multiple dosing of 650Â mg APAP every 4 hours, postâRYGBS patients had higher steadyâstate peak APAP concentrations compared to healthy individuals and obese preâRYGBS patients, though APAP exposure was unchanged compared to healthy individuals.
Conclusion
Following RYGBS, the rate and extent of APAP absorption increased and decreased formation of APAP metabolites was observed, possibly due to downregulation of Phase II and cytochrome P450 2E1 enzymes.