I am writing this because to this day I have found very little
information regarding the absorption of medication and health issues
in regards to unknown absorption. I had weight loss surgery in 2003
and have had several complications along the way. I researched the
surgery for about two years prior to choosing to undergo it. I had
high blood pressure, high cholesterol, severe back problems, etc and
wanted to be able to eliminate those health issues. Unfortunately,
the weight loss surgery wasn't enough to beat my poor "genes" that
were my fate to inherit, in spite of being successful in my weight
loss. I went from a high of 238 lbs. to a low of 116 lbs. and have
settled at about 125-130 lbs. I recently underwent another surgery
for complications of a marginal ulcer and bowel adhesions and am
recuperating at this moment.
I have constantly researched whether anyone has
done or is doing research regarding medication absorption, especially
prescription meds. This issue was the one that I never realized would
have such a profound affect on how successful I would feel with this
surgery. Prior to the surgery, I had been a long term NSAID user for
arthritis. But, in spite of not ever touching one since surgery, I
have developed problems with ulcers including bleeding ulcers. My
doctors and I are in a continual game of trying to determine how much
of each of my meds is absorbed, if any, the benefits I am receiving
and how to adjust them. In addition, we are constantly studying which
drugs can't be taken within so many hours of other drugs and the
effects each has based on how much I am getting. It is well known
that long acting or sustained release meds don't work for us because
they are not completely absorbed before leaving the system but what
else isn't absorbed well and what kinds of medications am I also
possibly getting too little of.
I was truly hoping that there would have been
some studies done on this issue with the weight loss surgery medical
community and especially with pharmacists and pharmaceutical
companies. Who better to study the absorption of various medications
than pharmacists who understand the make-up of medications, how and
where they are broken down within the digestive tract, etc?
I can't believe there aren't more of us who are
truly suffering to have medications that work, in the amount that we
need in order to be as healthy and comfortable as we can. Are you
aware of any studies or information that has been found on this
issue? I stay in touch with many bariatric post-op communities and
try to keep updated on the latest information, but information has
been sporadic at best and very little when some is obtained. So far,
I haven't found anyone with any updated insight so I thought I would
give you a try.
Thank you so much for your newsletter and website
that provides information for weight loss surgery patients. We really
need to be very proactive in our own health care and having people
like you to share information is invaluable to all of us who have had,
or are thinking about having this surgery. I truly appreciate any
information you can share with me regarding this issue.
You are correct. There is very little written about the absorption of
medication following gastric bypass surgery. There are many articles
titles that sound promising; however they deal with the absorption of
nutrients rather than medications. In general what the articles state
is what we already know and what I have stated in my book,
Weight Loss Surgery; Finding the Thin Person Hiding Inside You.
Those statements include:
- NSAIDS such as aspirin products are to be
avoided because they cause bleeding which can lead to ulcers. Since
the surface of the pouch is so small, NSAIDS tend to fall on the
same area of the pouch all the time resulting in more chance of bleeding.
- Avoid sustained or timed release medications.
Because intestines are shorter, the medication is not in the
intestines as long and some is lost.
- If at all possible, take medication as shots
(intramuscular), injected under the skin (subcutaneous), rubbed on
the skin (transdermal), or inhaled through the nose.
I did find one article that was very useful.
Seaman, Jeff S. et al. Dissolution of Common
Psychiatric Medications in a Roux-en-Y Gastric Bypass Model.
Psychosomatics. 46: 250-253, Je 2005.
In the article the authors compare the absorption
of many psychiatric medications in pre-op patients and post-op
patients. While each medication shows less absorption in post-ops than
pre-ops, what is especially interesting is that each medication shows
a different level of absorption. So some medications are absorbed better
than others. Therefore there can be no general rule as to how much of
any one medication is absorbed.
Further, we are all different. Our surgeries are
the same type, but our anatomies are all slightly different. Your
pouch and the exact amount of intestines bypassed vary greatly
depending upon your surgeon, your own anatomy, and even when your
surgery was performed because surgeons have been making pouches
smaller and smaller over the years. Because the variances are so
great, doctors or pharmacists cannot say that for every bypass patient
taking every medication, there will be a certain amount less
medication absorbed. The percentages can be all over the place.
that what you are doing with your doctor is the best practice. The
medication is to control a condition. Dosage should be adjusted for
the best result with the least amount of dosage. It is all very