[Effect of gastric banding on pharmacotherapy: not much known]

Following placement of gastric banding, the time that medication remains in the proximal part of the stomach may increase variably. This can lead to problems with oral administration of enteric coated or controlled-release preparations. Problems can be avoided by changing over to another form ofa dministration or sometimes by changing to another active compound. The placement of a gastric band changes the size of the stomach opening and the volume of the functional part of the stomach. Other than oral tablets, alternative formulations of medication, such as liquid or rectal forms are not always available, sometimes the only solution for giving some medication is to ground the tablet finely into powder for oral administration. For tablets with enteric coating or controlled release changing to normal tablets is not always perceivable. Patients should receive adequate instructions for intake and information on their therapy so that they do not fail to comply with treatment if tablets have a nasty taste after being ground into powder. The fat and water balance of both obese patients and patients who are losing weight is not usually known. Patients who have gastric banding should have medication dosages especially for medication with a narrow therapeutic index followed under strict supervision and have regular blood tests so that any necessary dosage adjustments can be made. At present little data are available to provide a comprehensive overview of the effects of gastric banding on pharmacotherapy. The potential consequences ofgastric banding on pharmacotherapy, together with the increasing frequency of gastric banding surgery, emphasize the need for further research in this field.