title: [Bariatric surgery, stomas and other digestive tract reductions: Insufficient data and recommendations to adapt medicines regimens in therapeutic practice].
abstract: Surgery modifying digestive tract may alter drugs pharmacokinetics. To maintain concentrations of active substance in their therapeutic ranges, a dosage adjustment or change of drug may be necessary. This is particularly important when no pharmacological or pharmacodynamic parameter reflecting the medication effectiveness is easily measurable. Our objective was to gather the information and documentary tools that can guide prescription in these patients with rearranged digestive tract. We searched information on the documentary portals of French agencies, on gray literature, on MEDLINE and in the summaries product characteristics. No information was found on the website of French agencies, sparse data were identified in gray literature. Some document are discordant, most are imprecise. One hundred and ten studies or case reports referenced on MEDLINE describe 79 medications pharmacokinetics after gastrointestinal surgery. Four are not available in France. Six literature reviews were found. Four summaries of product characteristics provided information related to drug absorption. No documentary tool adapted to clinical routine exists. This unsatisfactory situation is a barrier to optimal patients care. Information is available. It is however necessary to gather under an ergonomic shape adapted to clinical routine, bringing the surgery type, pharmacokinetic changes induced and what to do about the dose adjustment.
authors.affiliation: Hôpital de la Croix-Rousse, pharmacie, 103 grande rue de la Croix-Rousse, 69004 Lyon, France. Electronic address: bernard.elodie@hotmail.fr.
authors.forename: Élodie
authors.initials: É
authors.lastname: Bernard
authors.affiliation: Hôpital de la Croix-Rousse, pharmacie, 103 grande rue de la Croix-Rousse, 69004 Lyon, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Charpiat
authors.affiliation: Hôpital de la Croix-Rousse, service de chirurgie et transplantation, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mabrut
authors.affiliation: Centre national hospitalier d'information sur le médicament, 96, rue Didot, 75014 Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Dode
authors.affiliation: Hospices civils de Lyon, centre de documentation et d'information pharmaceutiques, pharmacie centrale, 57, rue Francisque-Darcieux, 69561 Saint-Genis-Laval cedex, France.
authors.forename: Stephan
authors.initials: S
authors.lastname: Garcia
authors.affiliation: Coordonnateur groupe de travail information sur les produits de santé, conseil d'administration de la Société française de pharmacie clinique, 35000 Rennes France.
authors.forename: Michel
authors.initials: M
authors.lastname: Le Duff
authors.affiliation: EPSM-Morbihan, pharmacie, 22, rue de l'Hôpital, 56896 Saint-Avé, France.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Rose
authors.affiliation: Hôpital de la Croix-Rousse, service de chirurgie et transplantation, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Ducerf
mesh_terms: D000284:Administration, Oral; D050110:Bariatric Surgery / Q000009:adverse effects; D002626:Chemistry, Pharmaceutical; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000601:surgery; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010599:Pharmacokinetics; D012778:Short Bowel Syndrome / Q000378:metabolism; D054047:Surgical Stomas
chemical_list: D004364:Pharmaceutical Preparations