Abstract
Substantially altered gastrointestinal anatomy/physiology after bariatric surgery presents new challenges for the proper medication management of these patients; drug absorption and bioavailability may increase, decrease, or remain unchanged post surgery, depending on the specific drug in question and the type of bariatric procedure. In this article, we offer a concise overview of the various aspects of this clinically significant issue, aiming to provide readers with a clear understanding as well as practical tools to handle drug management post bariatric surgery. Realizing the potentially altered pharmacokinetics of various drugs after bariatric surgery is essential for providing optimal pharmacological therapy and overall patient care.
Highlights
The global rise of the obesity epidemic is amongst the toughest challenges we face
The many comorbidities associated with severe obesity have turned this disease into the second most common factor contributing to preventable death [1]
The complex process of drug absorption involves multiple stages, and many of them may be affected by bariatric surgery, due to physiological factors, drug-related physicochemical factors, and factors associated with the dosage form
Summary
The global rise of the obesity epidemic is amongst the toughest challenges we face. The many comorbidities associated with severe obesity (type 2 diabetes, hyperlipidemia, hypertension, heart disease, stroke, cancer, depression, and many others) have turned this disease into the second most common factor contributing to preventable death (second only to tobacco) [1]. Bariatric surgery, which aims to limit caloric intake, decrease nutrient absorption, or both, is the most effective solution for severe obesity with comorbidities, and the number of patients undergoing bariatric surgery is rapidly and constantly growing worldwide [2] This rapidly growing population of bariatric patients presents new challenges to the field of oral drug therapy (Figure 1). Drug molecules pass through the liver before reaching the systemic circulation and may undergo presystemic hepatic metabolism This process may be affected by bariatric surgery; the reduced liver size attributable to the rapid weight loss may cause decreased hepatic metabolism and increased bioavailability. Renal function is altered in patients with obesity, and after substantial weight changes; the limited fluid intake after bariatric surgery can further impair renal function, with potentially reduced excretion and increased overall exposure of relevant drugs. It should be noted that GI adaptation processes take place over time [24], making the first 1–2 years post surgery a timeframe more prone to PK changes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
