Influence of Bariatric Surgery on the Use and Pharmacokinetics of Some Major Drug Classes
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REVIEW
Influence of Bariatric Surgery on the Use and Pharmacokinetics of Some Major Drug Classes Jan Peter Yska & Susanne van der Linde & Véronique V. Tapper & Jan A. Apers & Marloes Emous & Erik R. Totté & Bob Wilffert & Eric N. van Roon
Published online: 22 February 2013 # Springer Science+Business Media New York 2013
Abstract The purpose of this review is to evaluate the influence of bariatric surgery on the use and pharmacokinetics of some frequently used drugs. A PubMed literature search was conducted. Literature was included on influence of bariatric surgery on pharmacoepidemiology and pharmacokinetics. Drug classes to be searched for were antidepressants, antidiabetics, statins, antihypertensive agents, corticosteroids, oral contraceptives, and thyroid drugs. A reduction in the use of medication by patients after bariatric surgery has been reported for various drug classes. Very few studies have been published on the influence of bariatric surgery on the pharmacokinetics of drugs. After bariatric surgery, theoretically, reduced drug absorption may occur. Correct dosing and choosing the right dosage form for drugs used by patients after bariatric surgery are necessary for optimal pharmacotherapy. Therefore, more clinical studies are needed on the influence of bariatric surgery on the pharmacokinetics of major drugs. Keywords Bariatric surgery . Pharmacoepidemiology . Pharmacokinetics . Drug class J. P. Yska (*) : S. van der Linde : V. V. Tapper : E. N. van Roon Department of Clinical Pharmacy and Clinical Pharmacology, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR, Leeuwarden, The Netherlands e-mail: [email protected] J. A. Apers : M. Emous : E. R. Totté Department of Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands B. Wilffert Unit of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen, Groningen, The Netherlands B. Wilffert Department of Hospital and Clinical Pharmacy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Introduction Worldwide obesity is a growing problem. In 2008, an estimated 205 million men and 297 million women had a body mass index (BMI) of 30 kg/m2 or higher [1]. Bariatric surgery is the only treatment for morbid obesity (BMI>40) that has been shown to produce long-term weight loss [2]. Several metabolic surgical techniques are available, including purely restrictive (gastric banding) and restrictive/malabsorptive (gastric bypass) procedures. Of these techniques, the Roux-en-Y gastric bypass is the most commonly performed procedure [3]. Morbid obesity is associated with many comorbidities and reduced life expectancy [2]. Patients undergoing bariatric surgery have excess weight accompanied by multidrug use for multiple medical comorbidities. Bariatric surgery can influence the prevalence and incidence of comorbidities as well as the pharmacokinetics of drugs. For accomplishing optimal effects in patients, this might lead to changes in pharmacotherapy. After bariatric surgery, the use of a drug ma
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