The impact of intestinal failure on oral drug absorption: a review.
BACKGROUND
Intestinal failure is a complex gastroenterological condition that occurs as a result of reduced intestinal absorption of nutrients and/or water and electrolytes. Without treatment, nutritional depletion and/or dehydration will result. It can be acute or chronic and occurs secondary to a variety of causes, including massive bowel resection, inflammatory bowel diseases of the bowel, and small bowel dysfunction.


CONCLUSIONS
Resection of the small bowel results in a range of physiological changes that affect the absorption of nutrients, water, and electrolytes. In addition, these changes may also affect the absorption of orally administered medication. However, there is only minimal published literature regarding this, with the publications limited to case reports of failure or efficacy of certain medicines such as digoxin and warfarin in individual patients. Due to the highly heterogeneous nature of intestinal failure patients, there is little generalizability of the information within these articles to other patients. Only one article seeks to provide limited practical advice regarding prescribing in this complex patient group.


CONCLUSIONS
The input of specialist pharmacists is necessary in the management of these patients to ensure that appropriate drugs and formulations are prescribed in a timely manner to optimize absorption and resultant efficacy.
Ward
Nicola
N
Pharmacy Department, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UK. nicola.ward@uhl-tr.nhs.uk
D000284:Administration, Oral; D006801:Humans; D007408:Intestinal Absorption / Q000502:physiology*; D007410:Intestinal Diseases / Q000503:physiopathology*; D007421:Intestine, Small / Q000503:physiopathology*; D010599:Pharmacokinetics