Schoretsanitis Georgios, Krabseth Hege-Merete, Strømmen Magnus, Helland Arne, Spigset Olav
The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, United States of America.
Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Northwell/Hofstra, Hempstead, New York, United States of America.
PLoS One. 2025 Mar 26;20(3):e0319912. doi: 10.1371/journal.pone.0319912. eCollection 2025.
Bariatric surgery may affect the pharmacokinetics of medications by altering the gastrointestinal physiology. Pharmacokinetic changes of first-line neuropathic pain medications such as gabapentin and pregabalin following bariatric treatment have barely been investigated.
In our prospective five-case study we included gabapentin- or pregabalin-treated patients undergoing bariatric surgery at hospitals in Central Norway. Concentrations of gabapentin and pregabalin were assessed using serial blood samples over a dose interval, preoperatively and one, six and twelve months postoperatively. The primary outcomes of the study included changes in area under the time-concentration curve (AUC) with secondary outcomes comprising full pharmacokinetic profiling. Formal statistical testing was not performed due to few cases.
Three pregabalin-treated obese patients undergoing Roux-en-Y gastric bypass (RYGB) and two gabapentin-treated patients undergoing RYGB (n = 1) and sleeve gastrectomy (SG) (n = 1) were included. Largest changes for dose-adjusted AUC values after surgery were seen in pregabalin-treated patients at one and six months (average increases of 53% one month and 28% 6 months postoperatively). In the patients on gabapentin, mean AUC changes were less than 10% from baseline throughout the study period. The inter-individual variation was high.
Postoperative pharmacokinetic changes for gabapentin were minimal, but for pregabalin we observed more pronounced changes, particularly in one patient. Due to few cases, the results should be interpreted with caution. Given the large inter-individual variation, therapeutic drug monitoring could be considered to capture pharmacokinetic changes and guide dose adjustments postoperatively.
减肥手术可能通过改变胃肠生理学来影响药物的药代动力学。减肥治疗后一线神经性疼痛药物（如加巴喷丁和普瑞巴林）的药代动力学变化几乎未被研究。
在我们的前瞻性五例研究中，纳入了挪威中部医院接受减肥手术且正在接受加巴喷丁或普瑞巴林治疗的患者。在术前术前期术前以及术后1个月、6个月和12个月，在一个给药间隔内使用系列血样评估加巴喷丁和普瑞巴林的浓度。该研究的主要结局包括时间 - 浓度曲线下面积（AUC）的变化，次要结局包括完整的药代动力学分析。由于病例数少，未进行正式的统计学检验。
纳入了3例接受普瑞巴林治疗的肥胖患者接受 Roux - Y胃旁路术（RYGB），以及2例接受加巴喷丁治疗的患者，其中1例接受RYGB，1例接受袖状胃切除术（SG）。术后1个月和6个月时，普瑞巴林治疗的患者剂量调整后的AUC值变化最大（术后1个月平均增加53%，6个月平均增加28%）。在接受加巴喷丁治疗的患者中，整个研究期间平均AUC变化与基线相比小于10%。个体间差异很大。
加巴喷丁术后药代动力学变化最小，但普瑞巴林的变化更明显，尤其是在1例患者中。由于病例数少，结果应谨慎解释。鉴于个体间差异大，可考虑进行治疗药物监测以捕捉药代动力学变化并指导术后剂量调整。
