Prescribing Challenges after Bariatric Surgery

Obesity is an increasing problem in the UK, with over half the population being overweight or obese. The use of gastric surgery is increasing, with a 5% increase in 2016/17 compared to 2015/16. However, little is known about ideal drug formulations after bariatric surgery. An exploratory literature search of research databases was carried out to address this. We found that there was a dearth of high-quality primary studies available, with many studies using low numbers of participants. The major finding was of the need for increased vigilance and monitoring of patients after surgery

Het gebruik van antidepressiva na een bariatrische operatie

Patiënten met een body-mass index (BMI) ≥ 40 kg/m² of > 35 kg/m² met een of meer comorbiditeiten kunnen in aanmerking komen voor bariatrische chirurgie. Een bariatrische operatie kan mogelijk de prevalentie, frequentie en de ernst van depressieve symptomen verminderen. Gegevens uit de literatuur over het gebruik en de farmacokinetiek van antidepressiva na bariatrische chirurgie zijn beperkt. Bariatrische chirurgie, vooral Roux-‘en Y’-gastric bypass (RYGB), kan de biologische beschikbaarheid van antidepressiva beïnvloeden. Een goede follow-up na de operatie met aandacht voor werkzaamheid en bijwerkingen van het antidepressivum en regelmatig uitvoeren van therapeutic drug monitoring (TDM) is daarom een vereiste voor een optimale behandeling van de patiënt

DRASTIC IMPROVEMENT IN THE RECTAL ABSORPTION PROFILE OF MORPHINE IN MAN

Rectal absorption of morphine HCl from aqueous vehicles at different pHs in man has been compared with an orally administered solution. Plasma concentrations of morphine were measured by electrochemical HPLC analysis after a single dose of 10 mg morphine HCl, in a cross-over study in 7 volunteers. Rectal absorption of morphine was dependent on pH, which could be explained as being due to pH partitioning. The absorption rate and bioavailability could be greatly improved, as compared to orally administered morphine, by adjusting the pH. It was concluded that a rectal solution adjusted to pH 7 to 8 provided an entirely adequate dosage form

A rapid and simple determination of A77 1726 in human serum by high-performance liquid chromatography and its application for optimization of leflunomide therapy

Leflunomide is a disease-modifying antirheumatic drug, which is bioactivated by fort-nation of A77 1726. In this study a rapid and simple quantitative assay using a reversed phase HPLC-UV method is validated for detection of A77 1726 in human serum. The HPLC-UV method uses a mobile phase consisting of methanol and a KH2PO4-buffer (45 mM, pH = 3) (50:50,v/v), at a flow rate of I mL/min. A77 1726 is detected by UV-absorption at 295 nm with a retention time of 8.9 min. Demoxepam is used as internal standard. Validation showed lower and upper limits of quantitation of 0.5 and 100 mg/L, respectively. The assay was linear over the concentration range of 0.5-100 mg/L (r(2) > 0.999). Intra- and inter-day precision showed coefficients of variation within 15% over the complete concentration range; accuracy was within 8%. Commonly prescribed drugs to treat rheumatoid arthritis like disease-modifying antirheumatic drugs, analgesics and corticosteroids, and their main metabolites, are separated from A77 1726 with a resolution >2. Serum levels of A77 1726 in 37 patients on leflunomide therapy were determined using this HPLC-UV method. Measured serum A77 1726 serum concentrations in patient samples showed large variability with a range of 3-176 mg/L. (C) 2004 Elsevier B.V. All rights reserved