Effect of Roux-en-Y gastric bypass on the bioavailability of metoprolol from immediate and controlled release tablets: a single oral dose study before and after surgery

Yska, Jan Peter; Wanders, Jacquelien T M; Odigie, Blessing; Apers, Jan A.; Emous, Marloes; Totté, E.; Boerma, E. Christiaan; Ubels, F.L.; Woerdenbag, Herman J.; Frijlink, Henderik W.; Wilffert, Bob; Roon, E.N. Van

doi:10.1136/ejhpharm-2018-001804

Cited by 7 publications

(14 citation statements)

References 32 publications

(29 reference statements)

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“…We note that even for similar drugs, different results may be observed, as shown for phenoxymethylpenicilin 54,55 . Also for controlled release formulations, conflicting results were obtained in different studies 41,42 . While these differences may result from large inter and intra-individual variability known in oral drug dosing, they may also result from different surgical techniques and formulations.…”

Section: Discussionmentioning

confidence: 99%

“…Information on changes in the gastro-intestinal transit time as a result of bariatric surgery may also be deduced from results on studies evaluating the effect of bariatric surgery on the exposure of slow-release vs. immediate-release tablets. Yska et al studied the effect of RYGB surgery on the exposure of metoprolol from immediate-release (IR) and controlledrelease (CR) tablets in female patient volunteers one month before and six months after RYGB surgery 41 . The endpoint was the ratio of the metoprolol AUCafter/AUCbefore surgery.…”

Section: Gastro-intestinal Transit Timementioning

confidence: 99%

“…For the CR tablets, a significantly lower AUC was observed after surgery (range ratio AUC0-24 hours after/AUC0-24 hours before: 0.43-0.77). Based on these highly variable results, the authors conclude that RYGB surgery may influence the bioavailability of metoprolol from an IR tablet and that after surgery, the dose of metoprolol CR tablets should be increased according to clinical response 41 . In contrast with these results, another study showed no significant effect on the AUC of metoprolol measured at 6 -8 months after RYGB surgery in patients receiving oral metoprolol CR tablets 42 .…”

Section: Gastro-intestinal Transit Timementioning

confidence: 99%

“…Monitor for reduced absorption and therapy failure. When this occurs, switch to alternative therapy or prescribe immediate-release tablets but beware of early and higher peaks [39][40][41][42] .…”

Section: Controlled Release Tabletsmentioning

confidence: 99%

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Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Kingma

Burgers

Monpellier

et al. 2021

Brit J Clinical Pharma

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Bariatric or weight-loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism, and/or elimination of drugs may be altered.The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide guidance for dosing of commonly used drugs in this special population. Upon oral drug administration, the time to maximum concentration is often earlier and this concentration may be higher with less consistent effects on trough concentrations and exposure. Additionally, prescription of liquid formulations to bariatric patients is supported by some reports, even though the high sugar load of these suspensions may be of concern. Studies on extended release medications result in an unaltered exposure for a substantial number of drugs. Also, studies evaluating the influence of timing after surgery show dynamic absorption profiles. Although for this group a specific advice can be proposed for many drugs, we conclude that there is insufficient evidence for general advices for oral drug therapy after bariatric surgery implying that a risk assessment on a case-by-case basis is required for each drug.

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Section: Discussionmentioning

confidence: 99%

Section: Gastro-intestinal Transit Timementioning

confidence: 99%

Section: Gastro-intestinal Transit Timementioning

confidence: 99%

Section: Controlled Release Tabletsmentioning

confidence: 99%

See 2 more Smart Citations

Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Kingma

Burgers

Monpellier

et al. 2021

Brit J Clinical Pharma

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“…Information on changes in the gastro-intestinal transit time as a result of bariatric surgery may also be deduced from results on studies evaluating the effect of bariatric surgery on the exposure of slow-release vs. immediate-release tablets. Yska et al studied the effect of RYGB surgery on the exposure of metoprolol from immediate-release (IR) and controlled-release (CR) tablets in female patient volunteers one month before and six months after RYGB surgery 35 . The endpoint was the ratio of the metoprolol AUC after /AUC before surgery.…”

Section: Gastro-intestinal Transit Timementioning

confidence: 99%

Oral drug dosing following bariatric surgery - General concepts and specific dosing advices

Kingma

Burgers

Monpellier³

et al. 2020

Preprint

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Bariatric or weight-loss surgery is a popular option for weight reduction. Depending on the surgical procedure, gastric changes like decreased transit time and volume and increased pH, decreased absorption surface in the small intestine, decreased exposure to bile acids and enterohepatic circulation, and decreased gastrointestinal transit time may be expected. In the years after bariatric surgery, patients will also substantially lose weight. As a result of these changes, the absorption, distribution, metabolism, and/or elimination of drugs may be altered. The purpose of this article is to report the general influence of bariatric surgery on oral drug absorption, and to provide guidance for dosing of commonly used or high-risk drugs in this special population. Upon oral drug administration, the time to maximum concentration is often earlier and this concentration may be higher with less consistent effects on trough concentrations and exposure. Additionally, prescription of liquid formulations to bariatric patients is supported by some reports, even though the high sugar load of these suspensions may be of concern. Studies on extended release medications result in an unaltered exposure for a substantial number of drugs. Also, studies evaluating the influence of timing after surgery show dynamic absorption profiles. Although for this group a specific advice can be proposed for many drugs, we conclude that there is insufficient evidence for general advices for oral drug therapy after bariatric surgery implying that a risk assessment on a case-by-case basis is required for each drug.

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The Effects of Bariatric Surgery on Pharmacokinetics of Drugs: a Review of Current Evidence

Konstantinidou,

Argyrakopoulou,

Dalamaga

et al. 2023

Curr Nutr Rep

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Purpose of Review Obesity constitutes a major public health concern and has been recognized as an epidemic. To date, bariatric surgery remains the most effective way for substantial long-lasting weight loss in severe obesity. The purpose of this review is to summarize how the pharmacokinetics of drugs are affected by the most common types of bariatric surgery, i.e., Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Recent Findings Limited data are available regarding the changes in pharmacokinetics of drugs after bariatric surgery. The lack of existing guidelines may lead patients to experience drug toxicity or therapeutic undertreatment. Pharmacokinetic parameters that need to be taken into consideration postoperatively include gastric motility, gastric volume, pH, surface area, bile secretions, carrier proteins, and first-pass metabolism. For drugs with a narrow therapeutic index, other factors need to be monitored closely, including plasma drug levels, patients’ clinical outcomes, and laboratory markers. Patients should be followed up frequently and treated in accordance with their response to the drug therapy. Summary Bariatric surgery may affect the pharmacokinetics of various drugs, due to the resultant anatomical changes and the substantial weight loss. Therefore, there is a need to identify those potential changes and adjust patients’ medication doses in order to achieve higher efficacy and avoid toxicity.

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Effect of Roux-en-Y gastric bypass on the bioavailability of metoprolol from immediate and controlled release tablets: a single oral dose study before and after surgery

Cited by 7 publications

References 32 publications

Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Oral drug dosing following bariatric surgery: General concepts and specific dosing advice

Oral drug dosing following bariatric surgery - General concepts and specific dosing advices

The Effects of Bariatric Surgery on Pharmacokinetics of Drugs: a Review of Current Evidence

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