Table 1.

General approaches to medication management after bariatric surgery based on anticipated changes: Based on the anticipated medication and absorption changes after 3 specific procedures: 2 types of restrictive procedures (gastric banding and sleeve gastrectomy) and 1 type with both restrictive and malabsorptive properties (Roux-en-Y gastric bypass).

PARAMETERRECOMMENDATION
Suspicion that medications are not being absorbed appropriately
  • Switch solid-dose forms to liquid-dose forms, dissolvable or crushable tablets, or capsules that can be opened and sprinkled on food4,5

  • Consider using nonoral dose forms (eg, sublingual, intranasal, rectal, subcutaneous, transdermal)4

  • Switch extended-release formulations to immediate-release formulations4

  • Switch to medications that undergo less first-pass metabolism

  • Consider proactively adjusting medication regimens after malabsorptive procedures when treatment failure might result in a detrimental outcome

Medications that increase the risk of upper gastrointestinal irritation, ulceration, and impaired healing
  • Minimize use of nonsteroidal anti-inflammatory drugs,5,6 oral bisphosphonates,5 and corticosteroids6

Dumping syndrome
  • Avoid liquid formulations that have non-absorbable sugars (eg, mannitol, sorbitol)6