Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
Expert Opin Drug Metab Toxicol. 2012 Dec;8(12):1505-19. doi: 10.1517/17425255.2012.722757. Epub 2012 Sep 24.
Being overweight is widespread in most societies and represents a major health threat. Gastric bypass surgery offers a highly effective mode of treatment for the morbidly obese patients. The procedures cause an alteration in normal gastrointestinal anatomy and physiology, with consequences not only on nutrient absorption, but also possibly on orally administered drugs. Bypass of the acidic environment of the stomach, partial impairment of bile salts-drug interactions and reduced absorptive surface, all create the potential for reduced absorption of drugs.
This article provides an overview of the effects of obesity and the most prevalent type of gastric bypass (Roux-en-Y) on pharmacokinetics. Articles for review were searched using Pubmed.
The absorption of those drugs with known bioavailability issues generally seem to be most affected by bypass surgery. It is important to consider the effect of obesity on pharmacokinetics independent of the bypass procedure, because it leads to a dramatic drop in body mass over a relatively short period of time. This may be associated with reversals in the influence of obesity on drug disposition to characteristics more in line with leaner patients. Drugs will differ in their pharmacokinetic response to surgery, limiting any general conclusions regarding the impact of the surgery on drug disposition.
超重在大多数社会中普遍存在，是一个主要的健康威胁。胃旁路手术为病态肥胖患者提供了一种非常有效的治疗方式。这些手术改变了正常的胃肠道解剖和生理学，不仅会影响营养物质的吸收，还可能会影响口服药物的吸收。胃酸性环境的旁路、胆汁盐-药物相互作用的部分受损以及吸收表面积的减少，都有可能导致药物吸收减少。
本文概述了肥胖症和最常见的胃旁路术（Roux-en-Y）对药代动力学的影响。使用 Pubmed 搜索了综述文章。
那些已知生物利用度问题的药物的吸收似乎通常受旁路手术影响最大。重要的是要独立于旁路手术考虑肥胖对药代动力学的影响，因为它会导致体重在相对较短的时间内急剧下降。这可能与肥胖对药物处置的影响逆转为更符合消瘦患者的特征有关。药物在手术中的药代动力学反应会有所不同，这限制了任何关于手术对药物处置影响的一般性结论。
