Patients that choose an adjustable gastric band or a gastric sleeve operation should still be able to absorb any medications prescribed since there has not been any changes in the small intestine. With the gastric sleeve procedure the stomach has been reduced in size and anything that is ingested may leave the stomach faster that prior to surgery but I doubt that this will be a significant problem with medicines. Therefore I do not recommend any changes in medications for people that choose to have either of these two operations.
However, patients that have a gastric bypass are choosing an operation that essentially allows the medications that are taken by mouth to pass directly into the small intestine. The time it takes to pass through the mouth through the small gastric pouch, through the available length of small intestine and into the large intestine, (also called the colon), is about 45 minutes. That will be fine for medications that are in a regular form since the small intestine is so efficient in absorbing these medications. However medicines taken in some forms will be effected by this change.
There are many ways the drug companies have made taking medicines easier for us. For instance, medications are sometimes “wrapped” into a pill that releases medications in two stages hours apart or in other preparations the medicine is released very slowly over several hours so a person only has to take the medicine once a day and instead of several times a day.
Unfortunately, to get all the medication that is in these extended release pills a patient needs a stomach that stores at least some of the medicine for a few hours slowly sending the medication out of the stomach a little at a time. The combination of an intact stomach and a small intestine that is of full length results in several hours between swallowing the pill until it would reach the large intestine. This allows extended release medications to work so they can slowly release the medicine over a long time.
A gastric bypass shortens the time so much that the person only has time to have the first part of the medicine released. Anything that would be released after 45 minutes is no longer available for absorption because the pill is likely to already be in the colon by that time.
A gastric bypass patient may be paying more for a specially designed extended release medicine but only absorbing half of it. You are probably just wasting your money and not benefiting as much as you should from extended release medicines.
Therefore I recommend that my patients avoid extended release medicines and take the medicines in a non-extended release form.
For example, Toprol is an extended release form of Lopressor, (metoprolol). You may have taken Toprol XL 100 mg prior to your gastric bypass operation. If you continue to take Toprol XL 100 mg daily after your operation you are likely to only absorb the first half on the pill and since Lopressor is a 12 hour medicine you are likely not to have the appropriate amount of medicine for the second half of the day. Therefore I would suggest that you change from the extended release form to the regular form of metoprolol and have your doctor prescribe it as Lopressor 50 mg twice a day.
In fact, I would suggest that you always ask your doctor about each of your medicines and ask to have the non-extended release form. Primary care doctors and psychiatrists may or may not be aware of these issues and you as the patient must remember to inform them of your new changes and request that the medicines that are prescribed for you are in the correct form.
This goes for over the counter medicines as well.. Read the labels and make sure the medicines are not extended release or delayed release medications. Ask your pharmacist if you are not sure.
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