Effects of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Escitalopram Pharmacokinetics: A Cohort Study

Background: Changes in the gastrointestinal physiology after bariatric surgery may affect the pharmacokinetics of medications. Data on the impact of different surgical techniques on the pharmacokinetics of commonly prescribed antidepressants such as escitalopram are limited. Methods: This case-only prospective study investigated escitalopram-treated patients who underwent bariatric surgery at hospitals in Central Norway. Escitalopram concentrations were assessed using serial blood samples obtained during a dose interval of 24 hours preoperatively and at 1, 6, and 12 months, postoperatively. The primary outcomes were changes in the area under the time–concentration curve (AUC$_{0-24}$) with secondary outcomes, including full pharmacokinetic profiling. We performed repeated-measures analysis of variance for the AUC$_{0-24}$ and secondary outcomes. Results: Escitalopram-treated obese patients who underwent sleeve gastrectomy (n = 5) and Roux-en-Y gastric bypass (n = 4) were included. Compared with preoperative baseline, dose-adjusted AUC$_{0-24}$ values were within ±20% at all time points, postoperatively in the sleeve gastrectomy and oux-en-Y gastric bypass groups, with the largest changes occurring 1 month postoperatively (+14.5 and +17.2%, respectively). No statistically significant changes in any pharmacokinetic variables over time were reported; however, there was a trend toward increased maximum concentrations after surgery (P = 0.069). Conclusions: Our findings suggest that bariatric surgery has no systematic effect on the pharmacokinetics of escitalopram. However, because of the substantial interindividual variation, therapeutic drug monitoring can be considered to guide postoperative dose adjustments

Interpreting oral fluid drug results in prisoners: monitoring current drug intake and detection times for drugs self-administered prior to detention

Purpose: Although urine is the most common matrix for prisoner drug testing, oral fluid offers a possible alternative. Identifying new drug intake by a prisoner results in negative sanctions. Detection times in oral fluid after chronic drug intake may be extended. Within the prison, admission population is chronic drug users. Our aim was to investigate detection windows for drugs of abuse in oral fluid from prisoners. Methods: Nineteen frequent drug-abusing prisoners provided oral fluid and urine at admission and each morning thereafter for 9 consecutive days. Results: The most positive findings were for amphetamine/methamphetamine, cannabis and benzodiazepines. Maximum detection times in oral fluid were ≥ 9 days for diazepam, methadone and methamphetamine, with corresponding urinary detection times of ≥ 9, 7 and 6 days, respectively. Maximum oral fluid detection times were 9 days for clonazepam, 8 for oxazepam, 3 for amphetamine and nitrazepam, and 2 for tetrahydrocannabinol, with positive urinary detection times of 8, ≥ 9, 5, 7 and ≥ 9 days, respectively. Cocaine, morphine and 6-acetylmorphine were all positive only 1 day in oral fluid; cocaine and morphine were positive 1 and 2 days, respectively, in urine, while 6-acetylmorphine was not detected in urine. Conclusion: We confirmed oral fluid as a viable matrix for monitoring drugs of abuse in prisoners. Windows of detection for benzodiazepines and amphetamines were up to 1 week, which is an important consideration for evaluating oral fluid drug testing results. Some likely new drug exposures were observed based on urine and oral fluid drug results, but there were few data to guide these interpretations