Clinical Implications of Bariatric Surgery on Prescribing in Dermatology: A Systematic Review

Bariatric surgery (BS) can modulate drug pharmacokinetics. This review sought to provide an overview of the available literature and to establish practical recommendations pertaining to the use of drugs commonly used in dermatology in the post-BS setting. PubMed, EMBASE and Cochrane Library databases were systematically reviewed. This study utilised the PRISMA guidelines and was registered on PROSPERO (ID CRD42024505309). Data collection and risk of bias analysis were conducted in duplicate. This review identified 132 eligible studies. Key inclusion criteria included: primary clinical publication, contains information on the implications of BS on medications used in dermatology and full-text availability. Key exclusion criteria included secondary clinical publications, editorials, animal studies and conference abstracts, not providing information on the impact of BS on drugs commonly used in dermatology, articles written in languages other than English and unavailability of the full-text. Oral liquid formulations, crushed tablets, opened capsules or non-oral alternatives may be preferred over solid formulations. Avoidance of enteric-coated and extended-release formulations has been suggested. Dose escalation may be required for highly lipophilic drugs such as acitretin and isotretinoin. Switching to non-oral contraceptive options may be favoured due to reports of reduced efficacy with oral contraception. Avoidance of non-steroidal anti-inflammatory drugs and oral corticosteroids has been recommended due to the risk of gastrointestinal bleeding and marginal ulceration. The use of direct oral anticoagulants may also increase bleeding risk, post-BS. Dose modifications for mycophenolate mofetil may not be required post-laparoscopic sleeve gastrectomy. The bioavailability of oral tyrosine/Janus kinase inhibitors may be decreased; dose escalation may be required in cases of suboptimal treatment response. Consideration of the potential pharmacokinetic effects of BS on drugs used in dermatology is fundamental to ensure optimal patient care. Until more robust data are available, management should be individualised with frequent monitoring of clinical response, laboratory markers and plasma drug levels. Collaboration with a clinical pharmacist is strongly advised.