Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Oct;33(10):3266-3302.
doi: 10.1007/s11695-023-06770-5. Epub 2023 Aug 18.

Impact of Bariatric Surgery in the Short and Long Term: A Need for Time-Dependent Dosing of Drugs

Cedric Lau  1   2   3 , Charlotte van Kesteren  4 , Robert Smeenk  5 , Alwin Huitema  6   7   8 , Catherijne A J Knibbe  9   10
Affiliations
Review

Impact of Bariatric Surgery in the Short and Long Term: A Need for Time-Dependent Dosing of Drugs

Cedric Lau et al. Obes Surg. 2023 Oct.

Abstract

Sparse information is available on pharmacokinetic changes of drugs over time after bariatric surgery. By reviewing the literature on the short- and long-term pharmacokinetic changes of drugs, several patterns were identified for 39 drugs. No relevant pharmacokinetic changes were identified for roughly a third of the drugs. Of the remaining drugs, levels were variable and partly unpredictable shortly after the surgery. In the long term, most of the drug levels remain altered, but in some cases they returned to preoperative values. Based on the changes and the efficacy-safety balance of each drug, clinicians may need to perform additional clinical monitoring for specific drugs, including measuring drug levels. This review provides suggestions for clinicians and pharmacists for specific time-dependent drug dosing advice.

Keywords: Bariatric surgery; Pharmacokinetics; Roux-en-Y gastric bypass; Sleeve gastrectomy.

PubMed Disclaimer

Conflict of interest statement

All the authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of included articles. * For drugs whose pharmacokinetics are usually not measured, the used dosages and/or laboratory values were used (i.e., vitamin K antagonists and thyroid hormones). BPD = biliopancreatic diversion
Fig. 2
Fig. 2
Numbers of studied drugs of which the pharmacokinetics were assessed at multiple time points up to 1 year after bariatric surgery (A) and from 1 to 5 years after surgery (B). The Y-axis depicts the number of studied drugs. The size of the dots indicates the total number of patients that were studied
See this image and copyright information in PMC

References

    1. Bal BS, Finelli FC, Shope TR, et al. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8(9):544–556. doi: 10.1038/nrendo.2012.48. - DOI - PubMed
    1. Kingma JS, Burgers DMT, Monpellier VM, et al. Oral drug dosing following bariatric surgery: General concepts and specific dosing advice. Br J Clin Pharmacol. 2021;87(12):4560–4576. doi: 10.1111/bcp.14913. - DOI - PMC - PubMed
    1. Hamad GG, Helsel JC, Perel JM, et al. The effect of gastric bypass on the pharmacokinetics of serotonin reuptake inhibitors. Am J Psychiatry. 2012;169(3):256–263. doi: 10.1176/appi.ajp.2011.11050719. - DOI - PMC - PubMed
    1. Steele KE, Prokopowicz GP, Canner JP, et al. The APB study: apixaban pharmacokinetics in bariatric patients before to 1 year after vertical sleeve gastrectomy or Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2022;18(5):594–603. doi: 10.1016/j.soard.2021.12.023. - DOI - PubMed
    1. Busetto L, Dicker D, Azran C, et al. Obesity management task force of the European association for the study of obesity released “practical recommendations for the post-bariatric surgery medical management”. Obes Surg. 2018;28(7):2117–2121. doi: 10.1007/s11695-018-3283-z. - DOI - PubMed