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. 2019 Sep;20(9):1299-1311.
doi: 10.1111/obr.12869. Epub 2019 Jun 24.

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

Philip Carlo Angeles  1   2   3 , Ida Robertsen  4 , Lars Thomas Seeberg  2 , Veronica Krogstad  4 , Julie Skattebu  5 , Rune Sandbu  1   2 , Anders Åsberg  4   6 , Jøran Hjelmesaeth  1   3
Affiliations

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

Philip Carlo Angeles et al. Obes Rev. 2019 Sep.

Abstract

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.

Keywords: bariatric surgery; pharmacokinetics.

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Conflict of interest statement

Philip Carlo Angeles received PhD‐project funding from AstraZeneca. He also received a tuition fee grant from Johnson & Johnson/Ethicon to attend the European Obesity Academy 3.

Figures

Figure 1
Figure 1
Flow chart of study selection
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