Carbamazepine Therapy After Bariatric Surgery: Eight Sleeve Gastrectomy Cases and Review of the Literature

Daniel Porat, Nadia Margolin, Ophir Lavon, Arik Dahan

Research output: Contribution to journalArticlepeer-review

Abstract

Bariatric surgery modifies the anatomy and physiology of the gastrointestinal tract. Carbamazepine (CBZ) is an anticonvulsant with multiple neuropsychiatric indications. Given CBZ physicochemical properties and narrow therapeutic index, bariatric surgery may potentially introduce clinically significant changes in CBZ oral absorption and bioavailability. In this communication, we describe eight patients undergoing sleeve gastrectomy (SG) and treated with CBZ, including therapeutic drug monitoring (TDM) and dosage adjustments at different timeframes before vs. after the surgery (< 3, 4–6, and 7–12 months post-SG), as well as clinical outcomes. We then provide a review of the available literature on CBZ therapy among bariatric patients, concluding with a mechanistic analysis of the results. Four of the eight patients presented with decreased post-SG CBZ levels, and two of them also experienced significant worsening of their previously well-controlled disease. Overall, altered CBZ levels are likely for at least a year after SG. Clinical recommendations include consultation with a clinical pharmacist, careful clinical monitoring, and periodic TDM after (vs. before) the bariatric surgery.

Original languageEnglish
Pages (from-to)3481-3486
Number of pages6
JournalObesity Surgery
Volume32
Issue number10
DOIs
StatePublished - 22 Aug 2022

Keywords

  • Anticonvulsant agent
  • Bariatric surgery
  • Drug dissolution
  • Oral drug absorption
  • Sleeve gastrectomy
  • Therapeutic drug monitoring

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

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