Decreased Escitalopram Concentrations Post–Roux-en-Y Gastric Bypass Surgery

Marzinke, Mark A.; Petrides, Athena K.; Steele, Kimberley E.; Schweitzer, Michael; Magnuson, Thomas; Reinblatt, Shauna P.; Coughlin, Janelle W.; Clarke, William

doi:10.1097/ftd.0000000000000146

Cited by 30 publications

(40 citation statements)

References 31 publications

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“…RYGBP was the predominant surgical procedure (n = 18) . In one study, BPD was investigated as the surgical procedure, while two studies investigated BPD‐DS, six studied SG, and one included jejunoileostomy …”

Section: Resultsmentioning

confidence: 99%

“…Among the 22 studies, 16 utilized a single‐dose design, administering a given dose of the studied drug on the day of the pharmacokinetic study intervention. In the remaining six studies, patients were investigated in steady state . Several drugs were studied because of their status as probe drugs/substrates for different CYP enzymes and drug transporters, eg, midazolam for CYP3A as well as digoxin for P‐gp .…”

Section: Resultsmentioning

confidence: 99%

“…There was an indication of lower drug exposure following RYGBP. However, both the small number of patients and the pharmacokinetic investigations limit the conclusions drawn from these two studies.…”

Section: Resultsmentioning

confidence: 99%

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The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review

et al. 2019

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Summary Anatomical changes in the gastrointestinal tract and subsequent weight loss may influence drug disposition and thus drug dosing following bariatric surgery. This review systematically examines the effects of bariatric surgery on drug pharmacokinetics, focusing especially on the mechanisms involved in restricting oral bioavailability. Studies with a longitudinal before‐after design investigating the pharmacokinetics of at least one drug were reviewed. The need for dose adjustment following bariatric surgery was examined, as well as the potential for extrapolation to other drugs subjected to coinciding pharmacokinetic mechanisms. A total of 22 original articles and 32 different drugs were assessed. The majority of available data is based on Roux‐en‐Y gastric bypass (RYGBP) (18 of 22 studies), and hence, the overall interpretation is more or less limited to RYGBP. In the case of the majority of studied drugs, an increased absorption rate was observed early after RYGBP. The effect on systemic exposure allows for a low degree of extrapolation, including between drugs subjected to the same major metabolic and transporter pathways. On the basis of current understanding, predicting the pharmacokinetic change for a specific drug following RYGBP is challenging. Close monitoring of each individual drug is therefore recommended in the early postsurgical phase. Future studies should focus on the long‐term effects of bariatric surgery on drug disposition, and they should also aim to disentangle the effects of the surgery itself and the subsequent weight loss.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review

et al. 2019

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“…Of the total 21 studies, some conducted more than one procedure: 19 studies investigated RYGB, five investigated SG, two investigated BPD‐DS, and one study investigated mini‐GB . The number of participants in these studies ranged from five patients in a single study to a maximum of 34 patients.…”

Section: Resultsmentioning

confidence: 99%

Pharmacokinetic changes post–bariatric surgery: A scoping review

McLachlan

Chaar

2020

Obesity Reviews

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Summary Bariatric surgeries induce structural changes that can alter the absorption of drugs in patients already at risk of polypharmacy. This scoping review aimed to explore pharmacokinetic changes of orally administered drugs in patients post‐bariatric surgery, and assess the quality and level of bias. Electronic databases were searched for articles relating to bariatric surgery and pharmacokinetics published between 1998 and 2019. Pre‐post studies reporting on pharmacokinetic parameters were included, and the Newcastle‐Ottawa Scale was used to assess risk‐of‐bias. A total of 21 studies were included in this review, and changes in absorption were reported in all included studies across 29 drugs. In 11 studies, this change was reported as statistically significant (p<.05), while six reported a nonsignificant change. More drugs exhibited a shorter Tmax and higher Cmax after surgery than otherwise, however changes in AUC were variable. Four studies were assessed as having fair quality while the remainder of the included studies were of good quality and low risk‐of‐bias. Bariatric surgery alters the absorption of drugs and several mechanisms are implicated to be responsible. Short and long‐term monitoring is recommended in patients post‐surgery for clinical changes in response to medications. Future research with a higher number of participants and greater control of variables, such as concurrent medications, malabsorptive disorders, and body composition should be considered.

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“…Marzinke et al () prospectively evaluated escitalopram kinetics in four patients who underwent RYGB. Dose‐normalized plasma levels where drawn presurgery and at 2 and 6 weeks postsurgery.…”

Section: Methodsmentioning

confidence: 99%

Psychopharmacology and Bariatric Surgery

Roerig

Steffen

2015

Euro Eating Disorders Rev

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Currently, it has been demonstrated that psychotropic drugs, particularly antidepressants, are frequently prescribed for patients who seek bariatric surgery. Many bariatric surgery patients have a history of a mood disorder. Unlike medications for diabetes, hypertension or hyperlipidemia, which are generally reduced and at times discontinued, postsurgery antidepressants use is only slightly reduced. The Roux-en-Y procedure is most frequently associated with alteration in drug exposure. Medication disintegration, dissolution, absorption, metabolism and excretion have been found to be altered in postbariatric patients, although data are sparse at this time. This paper will review the current evidence regarding the effect of bariatric surgery on drug treatment including mechanism of interference as well as the extent of changes identified to date. Data will be presented as controlled trials followed by case series and reports.

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Decreased Escitalopram Concentrations Post–Roux-en-Y Gastric Bypass Surgery

Abstract: RYGB significantly alters the gastrointestinal tract and impacts escitalopram drug concentrations, even shortly after surgery.

Cited by 30 publications

References 31 publications

The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review

The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review

Pharmacokinetic changes post–bariatric surgery: A scoping review

Psychopharmacology and Bariatric Surgery

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