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There               are               several               different               types               of               weight               loss               surgery,               including               the               gastric               bypass,               adjustable               gastric               banding               (lap               band),               the               vertical               sleeve               gastrectomy,               and               the               duodenal               switch.

Different               weight               loss               surgeries               have               different               implications               for               patients               in               terms               of               medications               they               can               or               should               take               after               surgery               and               in               terms               of               how               they               will               absorb               different               medications.

Liquid               or               Chewable               Medications               Versus               Capsules               or               Tablets
               Weight               loss               surgery               patients               are               sometimes               advised               to               use               liquid               or               chewable               medications               and               vitamins               instead               of               capsules               or               tablets               that               are               swallowed.

Some               doctors               feel               liquids               or               chewables               will               be               better               absorbed.

In               addition,               gastric               bypass               patients               are               usually               advised               to               use               liquid               or               chewable               medications               and               vitamins               for               the               first               few               weeks               after               their               surgery               because               the               stoma               (the               narrow               opening               between               the               stomach               and               the               small               intestine)               will               be               swollen               for               a               while               and               large               pills               or               capsules               could               "get               stuck."               Patients               are               sometimes               advised               to               crush               medications               that               do               not               come               in               a               liquid               or               chewable               form,               but               they               should               check               with               their               pharmacist               before               crushing               any               medications               because               some               drugs               should               not               be               crushed.
               Non-Steroidal               Anti-Inflammatory               Drugs
               Non-steroidal               anti-inflammatory               drugs               (NSAIDS)               are               medications               used               to               treat               pain               and               inflammation.

They               include               over-the-counter               medications               like               ibuprofen,               Motrin,               Advil,               and               Aleve.

They               also               include               prescription               drugs               like               naproxen               and               Toradol.

Gastric               bypass               patients               should               not               take               NSAIDS               in               any               form               due               to               an               increased               risk               of               ulcers.

NSAIDS               are               systemic               drugs,               meaning               that               they               work               by               getting               into               the               bloodstream.

When               NSAIDS               get               into               the               bloodstream,               they               cause               the               lining               of               the               stomach               to               thin,               which               can               cause               ulcers               to               develop.

They               do               not               cause               ulcers               by               coming               into               contact               with               the               lining               of               the               stomach,               so               taking               them               by               injection               or               IV               does               not               reduce               the               risk.
               If               gastric               bypass               patients               have               a               strong               need               to               use               NSAIDS,               some               bariatric               surgeons               believe               it               is               acceptable               to               do               so               for               a               short               period               of               time               provided               they               also               take               an               acid-reducing               medication               at               the               same               time.

Other               surgeons               feel               strongly               that               NSAIDS               should               never               be               used               by               gastric               bypass               patients               for               any               reason.
               There               may               be               some               increased               risk               of               ulcers               with               NSAID               use               in               lap               band               patients,               as               well.

Vertical               sleeve               gastrectomy               patients               and               duodenal               switch               patients,               on               the               other,               are               free               to               use               NSAIDS               as               needed.

Patients               who               regularly               use               NSAIDS               to               treat               conditions               like               arthritis               sometimes               opt               for               the               vertical               sleeve               gastrectomy               or               duodenal               switch               instead               of               gastric               bypass               or               lap               band               so               that               they               will               be               able               to               continue               using               the               medication               they               need               after               surgery.
               Time               Released               Medications
               Time               released               medications,               or               extended               release               drugs,               are               medications               that               are               released               into               the               system               over               time               and               absorbed               slowly.

Many               antidepressants               are               extended               release               drugs,               for               example.

A               patient               takes               one               capsule               in               the               morning               and               it               delivers               a               slow,               steady               stream               of               medication               throughout               the               next               24               hours.

Gastric               bypass               patients               and               duodenal               switch               patients               have               shorter               intestinal               tracts               than               "normal"               people,               so               extended               release               capsules               may               pass               through               their               systems               before               they               can               be               fully               absorbed.

For               that               reason,               these               patients               are               usually               advised               to               avoid               extended               release               drugs.

Most               extended               release               drugs               are               also               available               in               a               standard               release               form,               and               just               have               to               be               taken               more               frequently.
               Vitamins
               Weight               loss               surgery               affects               the               way               some               patients               absorb               certain               vitamins,               too.

For               instance,               gastric               bypass               patients               are               unable               to               absorb               vitamin               B12               from               food               that               they               eat               after               surgery               because               they               no               longer               produce               something               called               intrinsic               factor.

They               also               cannot               absorb               vitamin               B12               from               vitamin               supplements               that               they               swallow.

They               need               to               use               sublingual               B12               supplements,               or               there               is               a               nasal               spray               that               they               can               use,               or               a               patch,               or               they               can               get               injections.
               Lap               band               patients,               vertical               sleeve               gastrectomy               patients,               and               duodenal               switch               patients               do               still               produce               intrinsic               factor,               so               they               will               absorb               B12               from               supplements               that               they               swallow.

They               will               also               absorb               B12               from               food               that               they               eat,               though,               and               may               not               need               to               take               a               B12               supplement               at               all.
               Gastric               bypass               patients               are               also               advised               to               take               calcium               citrate,               not               calcium               carbonate,               because               calcium               carbonate               requires               a               fair               amount               of               stomach               acid               for               absorption               and               gastric               bypass               patients               produce               little               stomach               acid.
               Oral               Contraceptives
               Gastric               bypass               patients               and               duodenal               switch               patients               are               often               advised               not               to               rely               on               oral               contraceptives               because               these               medications               may               not               be               absorbed               well               due               to               the               malabsorption               caused               by               those               surgeries.

Alternative               methods               of               contraception               to               consider               include               the               Depo               Provera               shot,               and               IUD,               the               Nuvaring,               a               diaphragm,               or               condoms.

The               birth               control               patch               is               another               option,               but               it               is               not               suitable               for               patients               weighing               more               than               250               pounds.
               Sources:
               American               Journal               of               Health-System               Pharmacy.

http://www.ajhp.org/cgi/reprint/63/19/1852.

Medication               and               Nutrient               Administration               Considerations               After               Bariatric               Surgery.
               North               Shore               University               Hospital.

http://www.morbidobesity.com/meds_after_bypass.htm.

Medications               After               Gastric               Bypass.
               American               Society               for               Metabolic               and               Bariatric               Surgery.

http://www.asbs.org/Newsite07/resources/bgs_final.pdf.

ASMBS               Guidelines.
               Dr.

Dirk               Rodriguez,               Deaconess               Surgical               Weight               Loss               Center,               Cincinnati,               Ohio.






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