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Obesity significantly alters the pharmacokinetic processes of drug absorption and distribution, presenting unique challenges in medical treatment. The increased fat tissue and decreased lean muscle in obese individuals can significantly affect how drugs are absorbed into the body and distributed across different tissues. This alteration can lead to variances in the effectiveness and safety of medications, necessitating adjustments in dosing or drug selection for obese patients.One notable...
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Drug metabolism, a critical process in the liver, involves two primary phases: Phase I reactions and Phase II conjugation. Obesity introduces significant alterations in this metabolic process, primarily due to fatty infiltration of the liver, leading to conditions such as nonalcoholic fatty liver disease (NAFLD). This condition can modify the activities of both Phase I and II enzymes, impacting how drugs are metabolized in obese patients.Phase I metabolism sees variable effects across...
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In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
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Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
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Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are...
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Pharmacokinetic changes post-bariatric surgery: A scoping review.

Liam A McLachlan1, Betty B Chaar1, Irene S Um1

  • 1The University of Sydney School of Pharmacy Faculty of Medicine and Health, Australia.

Obesity Reviews : an Official Journal of the International Association for the Study of Obesity
|February 27, 2020
PubMed
Summary

Bariatric surgery significantly alters oral drug absorption, affecting drug efficacy and safety. Post-surgery patients require careful medication monitoring due to these pharmacokinetic changes.

Keywords:
bariatric surgerypharmacokineticsquality assessment

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Area of Science:

  • Pharmacology
  • Gastroenterology
  • Surgical Science

Background:

  • Bariatric surgery causes anatomical and physiological changes impacting drug pharmacokinetics.
  • Patients undergoing bariatric procedures are often on multiple medications (polypharmacy), increasing risks.

Purpose of the Study:

  • To review pharmacokinetic alterations of oral drugs after bariatric surgery.
  • To evaluate the quality and bias of existing research on this topic.

Main Methods:

  • Scoping review of electronic databases (1998-2019) for studies on bariatric surgery and pharmacokinetics.
  • Inclusion of pre-post studies reporting pharmacokinetic parameters.
  • Risk-of-bias assessment using the Newcastle-Ottawa Scale.

Main Results:

  • Twenty-one studies analyzed, reporting absorption changes for 29 drugs post-surgery.
  • Significant absorption changes (p<.05) noted in 11 studies; six showed nonsignificant changes.
  • Increased Cmax and shorter Tmax observed for many drugs; AUC changes were variable. Most studies were of good quality.

Conclusions:

  • Bariatric surgery demonstrably alters oral drug absorption through various mechanisms.
  • Continuous monitoring of patients post-bariatric surgery is crucial for medication management.
  • Future research should involve larger cohorts and control for confounding variables.