Medication management and pharmacokinetic changes after bariatric surgery.

OBJECTIVE: To identify expected pharmacokinetic changes and provide practical recommendations for the medication management of chronic disease states after bariatric surgery. SOURCES OF INFORMATION: MEDLINE, EMBASE, PubMed, Scopus, and the Cochrane Library were searched. The search was limited to studies in human adults. Search terms included obesity, obese, bariatric surgery, gastric bypass, gastrectomy, gastric band, RYGB, roux-en-y, gastrointestinal absorption, medication absorption, drug absorption, bioavailability, dose adjust, drug monitoring, medication adjust, drug change, medication change, medication management, and medication dosing. Reference lists of original studies and reviews were also hand searched. Included studies were entered into PubMed and articles under the "Similar articles" heading were also reviewed. Only studies relevant to bariatric surgery types currently available in Canada (ie, Roux-en-Y gastric bypass, sleeve gastrectomy, or gastric banding) were included. MAIN MESSAGE: Pharmacokinetic changes anticipated after bariatric surgery vary by surgery type. There are several guiding principles that might be applied to medication management regimens after bariatric surgery. Practice tips are also presented for medication management of specific chronic disease states.
CONCLUSION: Changes to long-term medication regimens after bariatric surgery should be anticipated and managed in an appropriate and timely manner. The provided clinical practice recommendations might be used in conjunction with a patient's clinical picture to adjust chronic medication regimens in an appropriate and evidence-based manner after bariatric surgery. Copyright© the College of Family Physicians of Canada.