Malabsorption of psych meds? Or any meds?

[Briswife15 890]

I recently discovered, 4 months post RNY, that my antidepressant is no longer being absorbed. (I was having withdrawals).

Has anyone else experienced this? I have been crushing the meds and it seems to be helping, but I fear other meds are also not being absorbed!

Any tips or suggestions?

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[RickM 1,747]

Have you talked to your surgeon about this, as they would be the most familiar with the absorption quirks of the procedure (though a pharmacist should also be familiar with it as the RNY is pretty "mainstream". Generally, time release meds (and a lot of the psych meds are time release) can have problems depending upon their delayed release mechanism. My wife has a DS, which has a different malabsorption scheme than your bypass, but she still has to research how a new ER med works and whether that is compatible with her anatomy.

[Briswife15 890]

Have you talked to your surgeon about this, as they would be the most familiar with the absorption quirks of the procedure (though a pharmacist should also be familiar with it as the RNY is pretty "mainstream". Generally, time release meds (and a lot of the psych meds are time release) can have problems depending upon their delayed release mechanism. My wife has a DS, which has a different malabsorption scheme than your bypass, but she still has to research how a new ER med works and whether that is compatible with her anatomy.

Thanks, RickM. I didn't mention this to the surgeon yet. But will when I go next week. I did switch from ER to immediate release once I had the bypass, and for the first 4 months all was well. My strange anatomy!! I think you're right. And I should talk to a pharmacist. How does your wife determine if a new med is going to work for her? I don't take any ER meds now.

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[Darktowerdream 420]

Having chronic illness I’m trying to figure this out myself. I have basically no pain management. Especially since nsaids like Motrin are on the permanent cannot have list. Some pills should never be crushed. Some (if you are Lucky) might come in a liquid form. The crushed pills put too much into your system too fast. I did find a post on another forum with Information about medication after gastric bypass surgery. I don’t think the surgeons know anything, nor did mine ever mention medications after surgery. Seems that none of them do or know. Maybe they assume we won’t need medication afterwards.

i will look for the information and share it below.

[Darktowerdream 420]

21 Medication Rules after Gastric Bypass

There are certain pills that you should not be taking after surgery because they will either irritate your pouch, such as all pills in the NSAIDs catagory or pills that just won't be absorbed like they should. Any pills with enteric coating (kind of like a candy coating) or any extended release type med may not be absorbed like it is supposed to. If any of your meds do fall into those catagories you will want to get them changed. Those meds need the gastric juices to break them down and after RNY those juices just aren't there to do the job until well down your intestinal system which won't be enough time to break those meds down.

So basicly, you want to avoid any meds that are extended release, delayed, controlled, sustained or any medication that is an NSAIDs.

Over-the-counter NSAIDs are:

Aspirin, Motrin, Advil, Aleve, Orudis KT, Ibuprofen, Excederin

Prescribed NSAIDs are:

Motrin, Naprosyn, Anaprox, Toradol, Lodine, Feldene, Indocin, Daypro, Relafen, Voltaren and Celebrex.

There is the belief by some surgeons out there that even one NSAIDs can cause some kind of damage to your pouch and they strongly recommend staying away from them, if possible. If medically there is a reason to be taking them, such as the use of low dose asprin for heart conditions, it is okay to take them but you should also be placed on some kind of protectant such as Carafate or Cytotec.

If you are unsure if any of the meds you are on fall into any of these catagories talk to your Pharmacist, they will know. It isn't a bad idea to let your Pharmacist know that you are a Gastric Bypass patient. They can list it in your information almost like an allergy so that if you are ordered a med that you shouldn't be on an alert will be generated. There are ALOT of physicians out there that don't know this kind of information it is our respondsibility to make sure they are aware of it.

Here are 21 basic rules we should all follow in regards to our meds:

1. If side effects appear or increase, consult your doctor or your pharmacist about dosage or other medication options.

2. First-pass effect medications may not provide effective absorption at the currant dosages. Check dosage or check for alternative medications that do not have first pass effect. (your Pharmacist will know if any of your meds are "first-pass" meds)

3. Medications that are in a liquid or solution form will be absorbed faster than those that are solids. Check for liquid forms of medications.

4. No extended-release, sustained-release, controlled-release, timed-release or osmotic pump medications.

5. Many medications can also have gastrointestinal side-effects like gas, diarrhea, Constipation or intestinal cramping.

6. Read the pamphlet attached to the prescription bag for potential side-effects.

7. You should not take any NSAIDs without a protectant such as Cytotec or Carafate. EVER!!!!

8. Be able to recognize an NSAIDs when you see one.

9. Use a protectant if taking daily low-dose aspirin for heart health or to prevent stroke.

10. Check all PMS over the counter medications (OTC) for NSAID ingredients.

11. Read all OTC medication packaging to check for NSAIDs ingredients.

12. Inhaled steroids for asthma are okay.

13. Taking steroids of any kind, even by injection, requires taking a protectant as well.

14. Medications commonly used in the treatment and prevention of osteoporosis such as Fosamax, Actonel and Boniva have the potential to cause gastrointestinal ulceration. Talk to your doctor or pharmacist about alternatives.

15. Do not continue to take medications that have been discontinued.

16. If dosages have been changed, do not finish out a previous dosage just because it is there. CHange the dosage immediately unless instructed otherwise by your physician.

17. Ask your doctor or pharmacist if any of your medications are fat soluble. If so, stay in touch with the prescribing physician and report your currant weight every month for possible dosage changes. (as the amount of fat in your body changes your dosages may also need to be changed)

18. Tell all medical providers about your status as a weight loss surgery patient. (Lap-Banders too!)

19. Keep all your scripts at one pharmacy if possible.

20. Meet and get to know your local pharmacists. They truly can be invaluable friends.

21. Remember to have everyone work as a team for you! You're worth it!

One other word of warning when it comes to taking Tylenol. You MUST watch the amount of Tylenol you are taking. No more than 4,000mg in a 24 hour period. You can cause yourself liver damage with Tylenol overdose. You need to read your labels. Look to see if things have Tylenol or acetamenophin in them. Vicodan has Tylenol so if you are taking Vicodan or Lortab make sure you aren't adding a lot of Tylenol on top of it. That is why it is important to read the information on those pharmacy bags and on otc medications.

[GradyCat 3,695]

I asked my psychiatrist if any of my meds would fail to absorb and she explained the science to me of why they're not going to be affected by the WLS or not get absorbed properly.

[Briswife15 890]

21 Medication Rules after Gastric Bypass
There are certain pills that you should not be taking after surgery because they will either irritate your pouch, such as all pills in the NSAIDs catagory or pills that just won't be absorbed like they should. Any pills with enteric coating (kind of like a candy coating) or any extended release type med may not be absorbed like it is supposed to. If any of your meds do fall into those catagories you will want to get them changed. Those meds need the gastric juices to break them down and after RNY those juices just aren't there to do the job until well down your intestinal system which won't be enough time to break those meds down.

So basicly, you want to avoid any meds that are extended release, delayed, controlled, sustained or any medication that is an NSAIDs.

Over-the-counter NSAIDs are:

Aspirin, Motrin, Advil, Aleve, Orudis KT, Ibuprofen, Excederin

Prescribed NSAIDs are:

Motrin, Naprosyn, Anaprox, Toradol, Lodine, Feldene, Indocin, Daypro, Relafen, Voltaren and Celebrex.

There is the belief by some surgeons out there that even one NSAIDs can cause some kind of damage to your pouch and they strongly recommend staying away from them, if possible. If medically there is a reason to be taking them, such as the use of low dose asprin for heart conditions, it is okay to take them but you should also be placed on some kind of protectant such as Carafate or Cytotec.

If you are unsure if any of the meds you are on fall into any of these catagories talk to your Pharmacist, they will know. It isn't a bad idea to let your Pharmacist know that you are a Gastric Bypass patient. They can list it in your information almost like an allergy so that if you are ordered a med that you shouldn't be on an alert will be generated. There are ALOT of physicians out there that don't know this kind of information it is our respondsibility to make sure they are aware of it.

Here are 21 basic rules we should all follow in regards to our meds:

1. If side effects appear or increase, consult your doctor or your pharmacist about dosage or other medication options.

2. First-pass effect medications may not provide effective absorption at the currant dosages. Check dosage or check for alternative medications that do not have first pass effect. (your Pharmacist will know if any of your meds are "first-pass" meds)

3. Medications that are in a liquid or solution form will be absorbed faster than those that are solids. Check for liquid forms of medications.

4. No extended-release, sustained-release, controlled-release, timed-release or osmotic pump medications.

5. Many medications can also have gastrointestinal side-effects like gas, diarrhea, Constipation or intestinal cramping.

6. Read the pamphlet attached to the prescription bag for potential side-effects.

7. You should not take any NSAIDs without a protectant such as Cytotec or Carafate. EVER!!!!

8. Be able to recognize an NSAIDs when you see one.

9. Use a protectant if taking daily low-dose aspirin for heart health or to prevent stroke.

10. Check all PMS over the counter medications (OTC) for NSAID ingredients.

11. Read all OTC medication packaging to check for NSAIDs ingredients.

12. Inhaled steroids for asthma are okay.

13. Taking steroids of any kind, even by injection, requires taking a protectant as well.

14. Medications commonly used in the treatment and prevention of osteoporosis such as Fosamax, Actonel and Boniva have the potential to cause gastrointestinal ulceration. Talk to your doctor or pharmacist about alternatives.

15. Do not continue to take medications that have been discontinued.

16. If dosages have been changed, do not finish out a previous dosage just because it is there. CHange the dosage immediately unless instructed otherwise by your physician.

17. Ask your doctor or pharmacist if any of your medications are fat soluble. If so, stay in touch with the prescribing physician and report your currant weight every month for possible dosage changes. (as the amount of fat in your body changes your dosages may also need to be changed)

18. Tell all medical providers about your status as a weight loss surgery patient. (Lap-Banders too!)

19. Keep all your scripts at one pharmacy if possible.

20. Meet and get to know your local pharmacists. They truly can be invaluable friends.

21. Remember to have everyone work as a team for you! You're worth it!

One other word of warning when it comes to taking Tylenol. You MUST watch the amount of Tylenol you are taking. No more than 4,000mg in a 24 hour period. You can cause yourself liver damage with Tylenol overdose. You need to read your labels. Look to see if things have Tylenol or acetamenophin in them. Vicodan has Tylenol so if you are taking Vicodan or Lortab make sure you aren't adding a lot of Tylenol on top of it. That is why it is important to read the information on those pharmacy bags and on otc medications.

Wow, Darktowerdream! Thank you so much for that detailed and informative message!! Lots of good stuff in there! I appreciate it!

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[Briswife15 890]

I asked my psychiatrist if any of my meds would fail to absorb and she explained the science to me of why they're not going to be affected by the WLS or not get absorbed properly.

Thanks. GradyCat. My psychiatrist does not have any experience with weight loss surgery and was surprised that my antidepressant stopped working. She and I are learning together by trial and error.

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[froufrou 678]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583374/

"

“Ms. Z” is a 48-year-old white married woman who had failed multiple attempts at weight loss and presented for Roux-en-Y gastric bypass surgery. Her height was 1.57 m, and her weight was 114 kg (body mass index=46)

She had a history of obsessive-compulsive disorder and recurrent major depression and had been successfully treated with sertraline, 100 mg/day, with a 2-year period of remission prior to surgery. Ms. Z underwent a laparoscopic retrocolic, retrogastric Roux-en-Y gastric bypass under general anesthesia. She had an uncomplicated postoperative course. Three months after surgery, she reported a relapse during the previous month, with symptoms of marked anxiety. She had a recurrence of obsessions and compulsions involving keeping objects in an orderly and symmetrical fashion.

Ms. Z was the first subject to enter our formal pharmacokinetics study. We confirmed that the bioavailability of sertraline postoperatively was only 36% of the preoperative value. We offered Ms. Z liquid sertraline at the same dosage (100 mg/day) to improve absorption. One month later, she reported a return to baseline, with marked reduction in her anxiety and obsessive-compulsive symptoms."

Edited July 19, 2019 by froufrou

[froufrou 678]

This information is really making me think... is this why a lot of us struggle a few months after surgery? If the levels of the ssri were maintained, would we not have so much of the compulsive head stuff? I am definitely coming up against this right now and I am going to go and see my doctor about getting liquid sertraline! Thank you @Briswife15 for bringing this topic up. I would never have thought about it otherwise!

[toodlerue 452]

Wow! This could explain why I am So much more emotional!

[Macy6 356]

Yeah I was started on an SSRI a month before surgery, which is an ER. My surgeon gave his blessing and told me I might need to increase my dose post op. So far (6 weeks out) I am OK but I keep it in mind.

[Briswife15 890]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583374/
"

“Ms. Z” is a 48-year-old white married woman who had failed multiple attempts at weight loss and presented for Roux-en-Y gastric bypass surgery. Her height was 1.57 m, and her weight was 114 kg (body mass index=46)

She had a history of obsessive-compulsive disorder and recurrent major depression and had been successfully treated with sertraline, 100 mg/day, with a 2-year period of remission prior to surgery. Ms. Z underwent a laparoscopic retrocolic, retrogastric Roux-en-Y gastric bypass under general anesthesia. She had an uncomplicated postoperative course. Three months after surgery, she reported a relapse during the previous month, with symptoms of marked anxiety. She had a recurrence of obsessions and compulsions involving keeping objects in an orderly and symmetrical fashion.

Ms. Z was the first subject to enter our formal pharmacokinetics study. We confirmed that the bioavailability of sertraline postoperatively was only 36% of the preoperative value. We offered Ms. Z liquid sertraline at the same dosage (100 mg/day) to improve absorption. One month later, she reported a return to baseline, with marked reduction in her anxiety and obsessive-compulsive symptoms."

Thanks for that, froufrou! Im glad I'm not the only one! That was an interesting read. And my psychiatrist and I did discuss liquid antidepressants.

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[Briswife15 890]

This information is really making me think... is this why a lot of us struggle a few months after surgery? If the levels of the ssri were maintained, would we not have so much of the compulsive head stuff? I am definitely coming up against this right now and I am going to go and see my doctor about getting liquid sertraline! Thank you [mention=339061]Briswife15[/mention] for bringing this topic up. I would never have thought about it otherwise!

Your welcome,@froufrou! Let us know jow you make out with the liquid.

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[GradyCat 3,695]

15 hours ago, Briswife15 said:

Thanks. GradyCat. My psychiatrist does not have any experience with weight loss surgery and was surprised that my antidepressant stopped working. She and I are learning together by trial and error.

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You're welcome. My psychiatrist deals with bariatric patients in her routine practice at the hospital, so I think she should know what she's talking about. I'm 7 months post-op and haven't noticed any depressive episodes or extra anxiety as a result of drugs not working. I take Prozac and Rexulti.