Special considerations for bariatric surgery patients
Patients who have undergone bariatric surgery should take steps to be sure they are absorbing their medications and nutrients, according to University of Kentucky researchers writing in the Oct. 1, 2006, American Journal of Health-System Pharmacy. In the study, April Miller, PharmD, and Kelly Smith, PharmD, reviewed previously published literature to assess potential problems that bariatric surgery patients may have with absorption of medication and nutrients.
The authors focused on Roux-en-Y gastric bypass, the type of bariatric surgery most often performed in the United States. They said this form of gastric bypass surgery is associated with more absorption problems than other procedures because it combines techniques that restrict the amount of food passing through the stomach and impairs the ability of the small intestines to absorb nutrients.
"Both the smaller stomach size and the decreased absorption ability of the small intestines can mean that medications may not work as intended," Smith said. "It's important for physicians and pharmacists to be aware of these patients' special needs to make the best choices about appropriate medications."
Consider alternate formulations and delivery
Extended-release and delayed-release medications may not work properly because of the shortened small intestine, Smith said. Some of the necessary changes could be as simple as prescribing a liquid medication, which would be more easily absorbed than a tablet or capsule, and using immediate-release formulations, she added.
The study also found that patients could benefit from medications that are administered through patches worn on the skin, injection, suppositories, or nasal spray.
Nutrition deficiencies may also be a problem, Miller said, including deficiencies of calcium and fat-soluble vitamins (A, D, E, and K). Patients also are at higher risk for developing anemia because of deficiencies in iron, vitamin B12, and folate.
"After bariatric surgery, all patients should take a daily multivitamin and calcium supplementation, preferably in a powder or liquid form to enhance absorption," Miller said. "Monthly B12 injections and early bone density testing should also be considered."
Patients who have undergone bariatric surgery should take steps to be sure they are absorbing their medications and nutrients, according to University of Kentucky researchers writing in the Oct. 1, 2006, American Journal of Health-System Pharmacy.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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