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RYGB and Drug Disposition: How to Do Better? Analysis of Pharmacokinetic Studies and Recommendations for Clinical Practice

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Abstract

An important issue in the follow-up of patients with bariatric surgery remains to determine whether their therapeutic management should be different after surgery. In this article, we first reviewed all pharmacokinetic studies involving at least four subjects who underwent the Roux-en-Y gastric bypass (RYGB) bariatric surgery. Twenty-five publications were selected and, overall, 25 drugs were studied. Drug solubility and permeability parameters for each drug were defined using different parameters or classifications. Increased rates of oral drug absorption were predominantly observed. Conversely, drug exposure differed from one drug to another. Considering the galenic formulation and the Biopharmaceutics Classification System (BCS) class may help the prediction of oral drug exposure outcome after RYGB. We propose a strategy aiming to guide prescription and drug monitoring in patients with RYGB. But further research is clearly needed due to the unique characteristics of the bariatric population. Priority should be given to drugs that do not have clinical or biological surrogates for dose adaptation.

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Acknowledgments

We would like to thank Julie Lecas for English review.

Author information

Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Therapeutic Research Unit, Department of Internal Medicine, Paris, F-75010, France

    Lorry Hachon & Célia Lloret-Linares

  2. Inserm, UMR-S 1144 Université Paris Descartes-Paris Diderot, Variabilité de réponse aux psychotropes, Paris, France

    Lorry Hachon, Xavier Declèves & Célia Lloret-Linares

  3. Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Pharmacokinetics and Pharmacochemistry Unit, Paris, F-75014, France

    Xavier Declèves

  4. Nutrition Department, Assistance Publique-Hôpitaux de Paris, Hôpital La Pitié Salpêtrière, Paris, France

    Pauline Faucher

  5. Nutrition Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France

    Claire Carette

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  1. Lorry Hachon
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Correspondence to Célia Lloret-Linares.

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Conflict of Interest

Authors 1, 2, 3, and 4 declare that they have no conflict of interest. The last author (5) received 7500 euros from the APICIL study group for conducting a clinical study on morphine absorption following RYGB, OBEMO 2, that was conducted during the year 2016.

Ethical Approval

For this review, informed consent was not necessary. But in each article included in the review, informed consent was obtained from all individual participants for whom identifying information was included.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Hachon, L., Declèves, X., Faucher, P. et al. RYGB and Drug Disposition: How to Do Better? Analysis of Pharmacokinetic Studies and Recommendations for Clinical Practice. OBES SURG 27, 1076–1090 (2017). https://doi.org/10.1007/s11695-016-2535-z

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  • DOI: https://doi.org/10.1007/s11695-016-2535-z

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