Medications After Weight Loss Surgery

There are several different types of weight loss surgery, including the gastric bypass, adjustable gastric banding (lap band), the vertical sleeve gastrectomy, and the duodenal switch. Different weight loss surgeries have different implications for patients in terms of medications they can or should take after surgery and in terms of how they will absorb different medications.

Liquid or Chewable Medications Versus Capsules or Tablets

Weight loss surgery patients are sometimes advised to use liquid or chewable medications and vitamins instead of capsules or tablets that are swallowed. Some doctors feel liquids or chewables will be better absorbed. In addition, gastric bypass patients are usually advised to use liquid or chewable medications and vitamins for the first few weeks after their surgery because the stoma (the narrow opening between the stomach and the small intestine) will be swollen for a while and tall pills or capsules could “get stuck.” Patients are sometimes advised to crush medications that do not approach in a liquid or chewable beget, but they should check with their pharmacist before crushing any medications because some drugs should not be crushed.

Non-Steroidal Anti-Inflammatory Drugs

Non-steroidal anti-inflammatory drugs (NSAIDS) are medications used to treat pain and inflammation. They include over-the-counter medications like ibuprofen, Motrin, Advil, and Aleve. They also include prescription drugs like naproxen and Toradol. Gastric bypass patients should not take NSAIDS in any form due to an increased risk of ulcers. NSAIDS are systemic drugs, meaning that they work by getting into the bloodstream. When NSAIDS get into the bloodstream, they cause the lining of the stomach to thin, which can cause ulcers to get. They do not cause ulcers by coming into contact with the lining of the stomach, so taking them by injection or IV does not reduce the risk.

If gastric bypass patients have a strong need to use NSAIDS, some bariatric surgeons absorb it is acceptable to do so for a short period of time provided they also win an acid-reducing medication at the same time. Other surgeons feel strongly that NSAIDS should never be used by gastric bypass patients for any reason.

There may be some increased risk of ulcers with NSAID expend in lap band patients, as well. Vertical sleeve gastrectomy patients and duodenal switch patients, on the other, are free to use NSAIDS as needed. Patients who regularly use NSAIDS to treat conditions like arthritis sometimes opt for the vertical sleeve gastrectomy or duodenal switch instead of gastric bypass or lap band so that they will be able to continue using the medication they need after surgery.

Time Released Medications

Time released medications, or extended release drugs, are medications that are released into the system over time and absorbed slowly. Many antidepressants are extended release drugs, for example. A patient takes one capsule in the morning and it delivers a uninteresting, steady stream of medication throughout the next 24 hours. Gastric bypass patients and duodenal switch patients have shorter intestinal tracts than “normal” people, so extended release capsules may pass through their systems before they can be fully absorbed. For that reason, these patients are usually advised to avoid extended release drugs. Most extended release drugs are also available in a standard release form, and just have to be taken more frequently.

Vitamins

Weight loss surgery affects the way some patients absorb certain vitamins, too. For instance, gastric bypass patients are unable to absorb vitamin B12 from food that they eat after surgery because they no longer produce something called intrinsic factor. They also cannot absorb vitamin B12 from vitamin supplements that they swallow. They need to use sublingual B12 supplements, or there is a nasal spray that they can use, or a patch, or they can get injections.

Lap band patients, vertical sleeve gastrectomy patients, and duodenal switch patients do level-headed produce intrinsic factor, so they will absorb B12 from supplements that they swallow. They will also believe B12 from food that they eat, though, and may not need to consume a B12 supplement at all.

Gastric bypass patients are also advised to take calcium citrate, not calcium carbonate, because calcium carbonate requires a fair amount of stomach acid for absorption and gastric bypass patients produce shrimp stomach acid.

Oral Contraceptives

Gastric bypass patients and duodenal switch patients are often advised not to rely on oral contraceptives because these medications may not be absorbed well due to the malabsorption caused by those surgeries. Alternative methods of contraception to mediate include the Depo Provera shot, and IUD, the Nuvaring, a diaphragm, or condoms. The birth control patch is another option, but it is not suitable for patients weighing more than 250 pounds.

Sources:

American Journal of Health-System Pharmacy. http://www.ajhp.org/cgi/reprint/63/19/1852. Medication and Nutrient Administration Considerations After Bariatric Surgery.

North Shore University Hospital. http://www.morbidobesity.com/meds_after_bypass.htm. Medications After Gastric Bypass.

American Society for Metabolic and Bariatric Surgery. http://www.asbs.org/Newsite07/resources/bgs_final.pdf. ASMBS Guidelines.

Dr. Dirk Rodriguez, Deaconess Surgical Weight Loss Center, Cincinnati, Ohio.

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