Expert Review of Clinical Pharmacology,
Journal Year:
2025,
Volume and Issue:
unknown, P. 1 - 8
Published: Jan. 31, 2025
Introduction
Medication
management
after
bariatric
surgery
is
a
major
and
complex
challenge.
The
altered
gastrointestinal
anatomy/physiology
post-surgery
may
impact
oral
drug
absorption/pharmacokinetics,
with
potential
clinical
implications.
Along
multiple
studies/cases
of
impaired
leading
to
treatment
failure,
reports
increased
exposure,
post-bariatric
safety
issues
adverse
effects
risk,
are
also
available;
yet,
this
second
scenario
levels,
less
familiar
in
practice.
Current Nutrition Reports,
Journal Year:
2023,
Volume and Issue:
12(4), P. 695 - 708
Published: Oct. 20, 2023
Abstract
Purpose
of
Review
Obesity
constitutes
a
major
public
health
concern
and
has
been
recognized
as
an
epidemic.
To
date,
bariatric
surgery
remains
the
most
effective
way
for
substantial
long-lasting
weight
loss
in
severe
obesity.
The
purpose
this
review
is
to
summarize
how
pharmacokinetics
drugs
are
affected
by
common
types
surgery,
i.e.,
Roux-en-Y
gastric
bypass
(RYGB)
sleeve
gastrectomy
(SG).
Recent
Findings
Limited
data
available
regarding
changes
after
surgery.
lack
existing
guidelines
may
lead
patients
experience
drug
toxicity
or
therapeutic
undertreatment.
Pharmacokinetic
parameters
that
need
be
taken
into
consideration
postoperatively
include
motility,
volume,
pH,
surface
area,
bile
secretions,
carrier
proteins,
first-pass
metabolism.
For
with
narrow
index,
other
factors
monitored
closely,
including
plasma
levels,
patients’
clinical
outcomes,
laboratory
markers.
Patients
should
followed
up
frequently
treated
accordance
their
response
therapy.
Summary
Bariatric
affect
various
drugs,
due
resultant
anatomical
loss.
Therefore,
there
identify
those
potential
adjust
medication
doses
order
achieve
higher
efficacy
avoid
toxicity.
Expert Review of Clinical Pharmacology,
Journal Year:
2024,
Volume and Issue:
17(7), P. 579 - 587
Published: June 3, 2024
Introduction
The
treatment
of
HIV
infection
has
been
revolutionized
in
recent
years
thanks
to
the
advent
dual
antiretroviral
regimens,
administered
orally
or
as
long-acting
injectable
formulations.
Here,
we
provide
an
update
on
usefulness
therapeutic
drug
monitoring
(TDM)
drugs
optimize
management
people
with
(PWH)
current
scenario.
HIV Medicine,
Journal Year:
2025,
Volume and Issue:
unknown
Published: Jan. 15, 2025
To
measure
concentrations
of
tenofovir
diphosphate
(TFV-DP)
in
dried
blood
spots
(DBS)
among
individuals
taking
disoproxil
fumarate
plus
emtricitabine
(TDF/FTC)
or
alafenamide
(TAF/FTC)
who
were
scheduled
to
undergo
had
already
undergone
bariatric
surgery.
We
enrolled
pre-exposure
prophylaxis
(PrEP)
users
attending
clinics
Toronto
Ottawa
undergoing
After
participants
completed
a
minimum
7
days
consecutive
PrEP
dosing,
we
collected
DBS
samples
immediately
before
they
administered
their
next
daily
dose
PrEP.
Participants
surgery
enrolment
provided
single
sample
at
baseline
only.
One
participant
planned
preoperatively
and
on
postoperative
7,
28
84.
TFV-DP
was
measured
by
liquid
chromatography
tandem
mass
spectrometry.
compared
results
against
the
population
range
varying
degrees
adherence
stratified
chronology
surgery,
type
regimen.
Of
seven
eligible
participants,
all
gay,
cis-gender
men.
Median
age
48
years
(Q1-Q3:
44-51).
Six
underwent
enrolment:
four
Roux-en-Y
gastric
bypass
(RYGB)
two
sleeve
gastrectomy
(SG).
Four
TDF/FTC
TAF/FTC.
All
therapeutic
concentrations,
except
for
one
SG.
TAF/FTC
receiving
RYGB
displayed
slight
decrease
over
time,
although
remained
range.
Tenofovir
near
values
this
small
men
using
oral
HIV Medicine,
Journal Year:
2023,
Volume and Issue:
24(10), P. 1029 - 1034
Published: June 20, 2023
Abstract
Background
and
objectives
Obesity
trends
metabolic
dysregulation
are
rising
in
people
living
with
HIV
using
antiretrovirals
(ARVs).
Underlying
causes
preventive
strategies
being
investigated.
Two
glucagon
like‐peptide
1
(GLP‐1)
agonists,
liraglutide
semaglutide,
were
formerly
approved
as
glucose‐lowering
drugs
have
been
recently
for
long‐term
weight
loss
obesity.
Due
to
the
lack
of
therapeutic
guidelines
or
clinical
trials
HIV,
we
discuss
potential
benefits,
safety
aspects
pharmacological
considerations
prescribing
semaglutide
HIV.
Results
Clinical
experience
is
limited
two
cases
diabetic
after
which
a
successful
glycaemic
control
observed.
None
adverse
events
associated
usage
indicate
an
additional
risk
Extra
caution
showed
be
warranted
when
initiating
GLP‐1
agonist
therapy
taking
protease
inhibitors
who
pre‐existing
factors
heart
rate
variability
reduce
incidence
RP
interval
prolongation.
agonists
metabolized
by
endopeptidases,
thus
do
not
generate
major
drug–drug
interactions
most
drugs,
including
ARVs.
GLP‐s
known
inhibit
gastric
acid
secretion,
warrants
close
monitoring
combined
atazanavir
oral
rilpivirine,
ARVs
that
require
low
pH
optimal
absorption.
Conclusion
Theoretical
few
available
observations
support
prescription
with,
far,
no
indications
concern
regarding
efficacy,
Clinical Infectious Diseases,
Journal Year:
2023,
Volume and Issue:
77(11), P. 1561 - 1568
Published: June 30, 2023
Abstract
Background
The
implications
of
bariatric
surgery
(BS)
on
virologic
and
metabolic
outcomes
in
people
with
human
immunodeficiency
virus
(HIV;
PWH)
antiretroviral
therapy
(ART)
are
unknown.
Methods
Here,
we
report
a
retrospective
analysis
up
to
18
months
post-BS
PWH
from
the
AIDS
Therapy
evaluation
Netherlands
(ATHENA)
cohort
data
all
dutch
HIV
treating
Centers.
Primary
end
points
were
confirmed
failure
(2
consecutive
HIV-RNA
measurements
>200
copies/mL)
percentage
patients
who
achieved
>20%
total
body
weight
loss
post-BS.
Switches
baseline
ART
trough
plasma
concentrations
antiretrovirals
also
reported
Metabolic
parameters
medication
usage
compared
pre-
Results
Fifty-one
included.
One
case
3
cases
viral
blips
detected
this
Eighty-five
percent
at
post-BS,
mean
difference
(95%
confidence
interval)
−33.5%
(−37.7%
−29.3%).
Trough
measured
agents
above
minimum
effective
concentrations,
except
for
1
sample
darunavir.
Lipid
profiles,
but
not
serum
creatinine
blood
pressure,
improved
significantly
(P
<
.01)
Total
medications
obesity-related
comedications
declined
203
103
62
25,
respectively,
Conclusions
BS
was
an
intervention
lipid
control
using
no
clear
link
poor
outcomes.
Obesity Surgery,
Journal Year:
2024,
Volume and Issue:
34(10), P. 3594 - 3605
Published: Aug. 27, 2024
Individuals
with
human
immunodeficiency
virus
(HIV)
infection
now
have
life
expectancies
similar
to
non-infected
people
but
face
increased
obesity
prevalence.
The
long-term
effects
of
bariatric
surgery
(BS)
and
conservative
weight
therapy
(CWT)
in
patients
living
HIV
(PLWH)
remain
unexplored.