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VA Boston Healthcare System


Pharmacy and Medications after Surgery

After your Bariatric surgery there are several considerations regarding your medications.  You will meet with our Bariatric Pharmacist, either in person or over the phone, to review your current medications and to discuss changes to your medications after surgery.

The considerations regarding your medications after surgery are:

1.  Supplements and Medications that  MUST be taken after surgery
2. Medications that must be avoided after surgery
3. Changes to your medications for chronic conditions (such as diabetes, high blood pressure) may be reduced or stopped after surgery
4. After surgery, you may require different formulations of your medications

Supplements and Medications that MUST be taken after surgery:

After your surgery, especially after RYGB or “Gastric Bypass” surgery, you are no longer able to absorb the following vitamins and minerals correctly from your diet.  You can become very sick if you stop your supplements.  When you follow up with the Bariatric Surgery team, the blood levels of these vitamins and minerals with be monitored.  These medications will be prescribed for you on discharge home from the hospital, and must be renewed by either our team or your primary care provider:

1.  Calcium (Citrate) with Vitamin D
2. Multivitamin
3. Folic Acid
4. Iron (sometimes this can be combined in your multivitamin)
5. Thiamine
6. Vitamin B12
7. Ursodiol – this is recommended for 3 to 6 months after surgery for patients who still have their gall bladder, to avoid formation of gallstones during the initial period where weight loss is at its greatest and your risk of cholecystitis is at its highest.
8. Ranitidine or Omeprazole – medications that reduce your risk of an ulcer

Medications that MUST be avoided after surgery:

1.  NSAIDS used for pain /BOSTON/services/images/NSAIDList.pdf
2. Steroids
3. Oral Bisphosphonates (medications used for osteoporosis)
4. Extended Release or Controlled-Release Medications
5. Products containing sucrose, corn syrup, honey, sorbitol – this can increase risk of the “dumping syndrome”
6. Medications that cause GERD
7. Medications that cause weight gain
8. Medications that can cause gallstones (such as Gemfibrozil)

Changes to Your Medications for Chronic Conditions

Many of our patients take medications for conditions that patients with obesity commonly suffer from – High Blood Pressure, Diabetes, High Cholesterol, and medications for arthritis.  This results in many medications, and it’s not unlikely for patients to take two or three medications for any given medical condition related to obesity. Patients who undergo WLS and successfully lose weight will notice a drastic change in regards to their medication requirements.  Medication lists tend to decrease as disease states improve. But, there’s a tradeoff—lifelong multivitamin supplementation.  The important thing to keep in mind is multivitamins have less side effects compared to prescription drugs, so this is indeed a positive tradeoff! 
Some of your medications will be stopped immediately after surgery, and others will be weaned and stopped as you lose weight after surgery.  These changes will be determined by the Bariatric Surgery team while you are in the hospital and mostly by your Primary Care Provider after surgery.

Different formulations of Medications after Surgery

Medication therapy is affected  after bariatric surgery primarily because drug absorption is interrupted. This varies on the type of procedure. In general, restrictive procedures,  such as the sleeve gastrectomy and Lap-Band, tend to have minimal absorption interference.  Procedures such as Roux-en-Y gastric bypass has a malabsorptive component and certain dosage formulations, such as long-acting medications, large size tablets, whole tablets, and enteric coated medications are not recommended post-operatively.  Fast-acting dosage formulation such as liquids, suspensions, chewables, sublingual, and injections are recommended to facilitate absorption. Some medications may be crushed and administered with food if no alternative formulation is available.

Useful links:

Bariatric Homepage
Considering Surgery?
Qualifying/Planning for Surgery
Preparing for Surgery
Pharmacy and Medications after Surgery
Non-surgical weight loss options
Meet Our Patients
Helpful Websites