The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review
| Autor: | Philip Carlo Angeles, Lars Thomas Seeberg, Rune Sandbu, Anders Åsberg, Veronica Krogstad, Ida Robertsen, Jøran Hjelmesæth, Julie Skattebu |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Drug
medicine.medical_specialty Future studies Endocrinology Diabetes and Metabolism media_common.quotation_subject bariatric surgery 030209 endocrinology & metabolism 03 medical and health sciences 0302 clinical medicine Pharmacokinetics Weight loss medicine In patient 030212 general & internal medicine media_common business.industry Public Health Environmental and Occupational Health medicine.disease Obesity Obesity Surgery/Pharmacology Surgery Bioavailability medicine.symptom business pharmacokinetics Oral retinoid |
| Zdroj: | Obesity Reviews |
| ISSN: | 1467-789X 1467-7881 |
| Popis: | Summary Anatomical changes in the gastrointestinal tract and subsequent weight loss may influence drug disposition and thus drug dosing following bariatric surgery. This review systematically examines the effects of bariatric surgery on drug pharmacokinetics, focusing especially on the mechanisms involved in restricting oral bioavailability. Studies with a longitudinal before‐after design investigating the pharmacokinetics of at least one drug were reviewed. The need for dose adjustment following bariatric surgery was examined, as well as the potential for extrapolation to other drugs subjected to coinciding pharmacokinetic mechanisms. A total of 22 original articles and 32 different drugs were assessed. The majority of available data is based on Roux‐en‐Y gastric bypass (RYGBP) (18 of 22 studies), and hence, the overall interpretation is more or less limited to RYGBP. In the case of the majority of studied drugs, an increased absorption rate was observed early after RYGBP. The effect on systemic exposure allows for a low degree of extrapolation, including between drugs subjected to the same major metabolic and transporter pathways. On the basis of current understanding, predicting the pharmacokinetic change for a specific drug following RYGBP is challenging. Close monitoring of each individual drug is therefore recommended in the early postsurgical phase. Future studies should focus on the long‐term effects of bariatric surgery on drug disposition, and they should also aim to disentangle the effects of the surgery itself and the subsequent weight loss. |
| Databáze: | OpenAIRE |
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