title: Oral drug therapy following bariatric surgery: an overview of fundamentals, literature and clinical recommendations.
abstract: Bariatric surgery is the most effective solution for severe obesity and obesity with comorbidities, and the number of patients going through bariatric surgery is rapidly and constantly growing. The modified gastrointestinal anatomy of the patient may lead to significant pharmacokinetic alterations in the oral absorption of drugs after the surgery; however, because of insufficient available literature and inadequate awareness of the medical team, bariatric surgery patients may be discharged from the hospital with insufficient instructions regarding their medication therapy. In this article, we aim to present the various mechanisms by which bariatric surgery may influence oral drug absorption, to provide an overview of the currently available literature on the subject, and to draw guidelines for the recommendations bariatric surgery patients should be instructed before leaving the hospital. To date, and until more robust data are published, it is essential to follow and monitor patients closely for safety and efficacy of their medication therapies, both in the immediate and distant time post-surgery.
authors.affiliation: Clinical Pharmacy, Herzliya Medical Center, Herzliya, Israel.
authors.forename: Carmil
authors.initials: C
authors.lastname: Azran
authors.affiliation: Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Omri
authors.initials: O
authors.lastname: Wolk
authors.affiliation: Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Zur
authors.affiliation: Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Noa
authors.initials: N
authors.lastname: Fine-Shamir
authors.affiliation: Department of Surgery B, Soroka University Medical Center, Beer Sheva, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Shaked
authors.affiliation: Department of Surgery B, Soroka University Medical Center, Beer Sheva, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Czeiger
authors.affiliation: Department of Surgery B, Soroka University Medical Center, Beer Sheva, Israel.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Sebbag
authors.affiliation: Institute of Pharmacy, Biopharmaceutics and Pharmaceutical Technology, Johannes Gutenberg-University, Mainz, Germany.
authors.forename: Olga
authors.initials: O
authors.lastname: Kister
authors.affiliation: Institute of Pharmacy, Biopharmaceutics and Pharmaceutical Technology, Johannes Gutenberg-University, Mainz, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Langguth
authors.affiliation: Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. arikd@bgu.ac.il.
authors.forename: Arik
authors.initials: A
authors.lastname: Dahan
mesh_terms: D000284:Administration, Oral; D000928:Antidepressive Agents / Q000493:pharmacokinetics*; D000959:Antihypertensive Agents / Q000493:pharmacokinetics*; D013956:Antithyroid Agents / Q000493:pharmacokinetics*; D050110:Bariatric Surgery / Q000009:adverse effects*; D001682:Biological Availability; D015897:Comorbidity; D004334:Drug Administration Schedule; D041981:Gastrointestinal Tract / Q000378:metabolism / Q000601:surgery; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000493:pharmacokinetics*; D007004:Hypoglycemic Agents / Q000493:pharmacokinetics*; D009767:Obesity, Morbid / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery*; D017410:Practice Guidelines as Topic
chemical_list: D000928:Antidepressive Agents; D000959:Antihypertensive Agents; D013956:Antithyroid Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents
keywords: Bariatric surgery; bioavailability; drug solubility; intestinal permeability