Optimizing Medication Management After Bariatric Surgery: A Guide for Pharmacists

Bariatric surgery has become increasingly common as an effective solution for weight loss, diabetes control, and cardiovascular risk reduction. Recognize that gastric banding (Lap-Band) and Roux-en-Y gastric bypass are the most frequently performed surgeries.

• Gastric banding involves using an inflatable ring to squeeze the neck of the stomach, reducing its volume and restricting intake.
• Gastric bypass involves surgically reducing stomach size and bypassing part of the small intestine to limit nutrient absorption.

Use liquid, crushable, or non-oral medications post-surgery to facilitate healing. Recommend sugar-free liquids to prevent cramps and diarrhea. Avoid extended-release and enteric-coated medications after gastric bypass due to unpredictable absorption. Avoid or split larger pills to prevent blocking the band or stomach outlet. Avoid gastrointestinal irritants such as NSAIDs, oral bisphosphonates, and corticosteroids. If an NSAID is necessary, suggest adding a proton pump inhibitor (PPI) to protect the small stomach pouch.

Monitor medication response to adjust or eliminate those no longer needed for diabetes and hypertension. Blood glucose levels often improve significantly shortly after surgery, even before substantial weight loss.

Monitor serum drug levels when possible to adjust critical medications such as immunosuppressives and anticonvulsants. Recommend essential vitamins and minerals, particularly vitamin B12, folate, thiamine, iron, calcium, and fat-soluble vitamins (A, D, E, and K). Suggest using calcium citrate (Cal-Mag) instead of calcium carbonate (Cal-Preg) for better absorption and separate calcium and iron supplements by at least 2 hours.

Understanding the complexities of medication management after bariatric surgery helps achieve optimal patient outcomes. Tailoring medication regimens to account for changes in absorption and gastrointestinal anatomy is crucial for patient safety and health.

Take-home points

Adjust medications for patients post-bariatric surgery for optimal outcomes...

1. Recognize gastric banding (Lap-Band) and Roux-en-Y gastric bypass for medication adjustments.
2. Use liquid or crushable medications post-surgery for better absorption.
3. Avoid extended-release and enteric-coated medications after bypass due to absorption issues.
4. Avoid NSAIDs, bisphosphonates, and corticosteroids to prevent GI complications.
5. Ensure patients take vitamins B12, folate, iron, and calcium citrate to avoid deficiencies.

References

Keywords: Bariatric surgery, Medication management, Gastric bypass, Lap-Band, Diabetes control, Cardiovascular risk, Medication absorption, Gastrointestinal irritants, Vitamin supplementation, Post-surgery care