title: Clinicians' prescribing practices for bariatric surgery patients: is there an issue?
abstract: OBJECTIVE
  Patients undergoing Roux-en-Y gastric bariatric (RYGB) surgery present a reduced absorption site, and special attention should therefore be taken when prescribing oral-dosage forms. This study was carried out to investigate the extent to which non-bariatric clinicians are aware of this issue when prescribing medicines for this population, and what type of information is available to aid them in their decision-making.
  
  
  METHODS
  Two questionnaires were created, one for non-bariatric clinicians and another for their patients who had undergone RYGB surgery, to gather information about the prescription practices for this population. Additionally, a literature search of pharmacokinetic studies on bariatric patients and recommended prescription practices was carried out.
  
  
  CONCLUSIONS
  Of the 62 non-bariatric clinicians surveyed, 50% believed RYGB surgery interferes with drug absorption; however, 68% still prescribed tablets as the first choice form of dosage. Young clinicians (35%) were less likely to believe that RYGB surgery could affect drug absorption than experienced clinicians (43%). The main reasons for changing dosage forms were patient complaints about efficacy or difficulty in swallowing tablets. Of the 73 patients, 43 were taking drugs in tablet form after the surgery, 24 of whom had health issues unrelated to the surgery. None of the journals read by the clinicians contained pharmacokinetics (PK) studies involving bariatric surgery patients or presented recommendations for the prescription of oral-dosage forms for this population. The literature search revealed a total of 22 drugs that had undergone PK studies in RYGB patients. Fifteen of them were reported to have decreased effects, 12 of which were administered as tablets.
  
  
  CONCLUSIONS
  There is still a relative lack of clinical evidence to guide clinicians when prescribing medicines for bariatric patients. It is therefore recommended that pharmacists should have greater participation in the prescription process to advise non-bariatric clinicians and educate RYGB surgery patients to help avoid therapeutic failure.
authors.affiliation: Post-Graduate Program in Bioscience and Physiopathology, State University of Maringa, Paraná, Brazil.
authors.forename: B L da S
authors.initials: BL
authors.lastname: Guedes
authors.forename: M C
authors.initials: MC
authors.lastname: Montanha
authors.forename: J J V
authors.initials: JJ
authors.lastname: Teixeira
authors.forename: A
authors.initials: A
authors.lastname: Diniz
authors.forename: S R B
authors.initials: SR
authors.lastname: Silva
authors.forename: I
authors.initials: I
authors.lastname: Previdelli
authors.forename: D
authors.initials: D
authors.lastname: Nasser
authors.forename: S S
authors.initials: SS
authors.lastname: Yamada
authors.forename: E
authors.initials: E
authors.lastname: Kimura
mesh_terms: D000284:Administration, Oral; D000328:Adult; D050110:Bariatric Surgery; D003376:Counseling; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D065568:Oral Mucosal Absorption; D010819:Physician's Role; D011182:Postoperative Care / Q000379:methods*; D011184:Postoperative Period; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: bariatric surgery; patient counselling; pharmacokinetics; pharmacotherapy; prescription practice