title: RYGB and Drug Disposition: How to Do Better? Analysis of Pharmacokinetic Studies and Recommendations for Clinical Practice.
abstract: An important issue in the follow-up of patients with bariatric surgery remains to determine whether their therapeutic management should be different after surgery. In this article, we first reviewed all pharmacokinetic studies involving at least four subjects who underwent the Roux-en-Y gastric bypass (RYGB) bariatric surgery. Twenty-five publications were selected and, overall, 25 drugs were studied. Drug solubility and permeability parameters for each drug were defined using different parameters or classifications. Increased rates of oral drug absorption were predominantly observed. Conversely, drug exposure differed from one drug to another. Considering the galenic formulation and the Biopharmaceutics Classification System (BCS) class may help the prediction of oral drug exposure outcome after RYGB. We propose a strategy aiming to guide prescription and drug monitoring in patients with RYGB. But further research is clearly needed due to the unique characteristics of the bariatric population. Priority should be given to drugs that do not have clinical or biological surrogates for dose adaptation.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Therapeutic Research Unit, Department of Internal Medicine, Paris, F-75010, France.|Inserm, UMR-S 1144 Université Paris Descartes-Paris Diderot, Variabilité de réponse aux psychotropes, Paris, France.
authors.forename: Lorry
authors.initials: L
authors.lastname: Hachon
authors.affiliation: Inserm, UMR-S 1144 Université Paris Descartes-Paris Diderot, Variabilité de réponse aux psychotropes, Paris, France.|Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Pharmacokinetics and Pharmacochemistry Unit, Paris, F-75014, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Declèves
authors.affiliation: Nutrition Department, Assistance Publique-Hôpitaux de Paris, Hôpital La Pitié Salpêtrière, Paris, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Faucher
authors.affiliation: Nutrition Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Carette
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Therapeutic Research Unit, Department of Internal Medicine, Paris, F-75010, France. celialloret@yahoo.fr.|Inserm, UMR-S 1144 Université Paris Descartes-Paris Diderot, Variabilité de réponse aux psychotropes, Paris, France. celialloret@yahoo.fr.
authors.forename: Célia
authors.initials: C
authors.lastname: Lloret-Linares
mesh_terms: D000284:Administration, Oral; D016903:Drug Monitoring / Q000379:methods; D015390:Gastric Bypass; D006801:Humans; D007408:Intestinal Absorption; D009767:Obesity, Morbid / Q000378:metabolism / Q000601:surgery*; D010539:Permeability; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D010599:Pharmacokinetics; D011182:Postoperative Care / Q000379:methods; D011184:Postoperative Period
chemical_list: D004364:Pharmaceutical Preparations
keywords: Bariatric surgery; Drug disposition; Oral absorption; Pharmacokinetics; Roux-en-Y gastric bypass; Therapeutic drug monitoring