Abstract
Bariatric surgery may alter the absorption and overall bioavailability of oral drugs. Lamotrigine is a major antiepileptic and mood stabilizer, that its use after bariatric surgery has not yet been studied. In this article, we provide a thorough mechanistic analysis of the effects of bariatric surgery on multiple mechanisms important for the absorption, bioavailability and overall pharmacokinetics of lamotrigine. Attributable to its pharmacokinetic properties and drug characteristics, the use of lamotrigine after bariatric surgery may be challenging. The complex situation in which some mechanisms may lead to increased drug exposure (e.g., decreased metabolism, weight loss) while others to its decrease (e.g., hampered dissolution/solubility, decreased gastric volume), may result in lowered, unchanged, or enhanced lamotrigine plasma levels after the surgery. We conclude with a set of clinical recommendations for lamotrigine treatment after bariatric surgery, aiming to allow better patient care, and emphasizing the extra caution that needs to be taken with these patients.
Highlights
Bariatric surgery is an effective long-term treatment for severe obesity and comorbidities [1]
A few bariatric procedures are commonly available worldwide, including sleeve gastrectomy, some variations of gastric bypass surgeries, notably Roux-en-Y gastric bypass (RYGB) and the newer one-anastomosis gastric bypass (OAGB), and more; and while each procedure is unique in the gastrointestinal anatomic changes that it brings and despite the fact that literature data is mainly available on RYGB, all of these procedures may affect oral drug pharmacokinetics [5,6,7,8,9], with clinically significant ramifications
We provide a clinically relevant analysis of the important mechanisms related to lamotrigine absorption and bioavailability after bariatric surgery
Summary
Bariatric surgery is an effective long-term treatment for severe obesity and comorbidities [1]. Epilepsy is a serious neurological condition requiring appropriately dosed, chronic medication treatment to allow controlled and seizure-free disease. Due to this reason, therapeutic drug monitoring is a common practice with some anticonvulsants [11]. Various drug characteristics make lamotrigine use challenging after these operations In this communication, we provide a clinically relevant analysis of the important mechanisms related to lamotrigine absorption and bioavailability after bariatric surgery. We provide a clinically relevant analysis of the important mechanisms related to lamotrigine absorption and bioavailability after bariatric surgery This analysis should expose clinicians and pharmacologists to the many variables involved in the complex issue of pharmacokinetics and pharmacotherapy of patients after bariatric surgery, aiming for better patient-centered care. The drug is lipophilic, with logP of around 2 [17]
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