Medications after bariatric surgery will vary significantly depending on the type of bariatric procedure you had as well as how rapidly your health improves. Obesity is associated with many health conditions, such as diabetes, hypertension, cancers, and arthritis. Studies have found that around 80% of bariatric patients had comorbidities in the pre-operative state, and most of those individuals were/are taking medications to manage these conditions. 

One of the benefits of bariatric surgery, aside from extreme weight loss, is reducing medication usage post-operatively. Around 84% of patients no longer required diabetic medications, 77% no longer needed to take cholesterol medication, and 50% of patients were cured of their hypertension. 

Yet these changes did not happen overnight, and some patients needed to continue their medication use for several months post-operatively. So what does that mean for your health and healing process after bariatric surgery? 

In general, all of the medications you are taking before weight loss surgery will need to be continued post-operatively. With any bariatric procedure, though, you will want to be careful when taking the medication from a size standpoint. Dysphagia, or difficulty swallowing, is a common side effect of restrictive bariatric procedures caused by eating too fast, too much, or not chewing thoroughly enough. Therefore, we recommend patients not take more than three pills at a time to avoid any difficulty swallowing or discomfort. 

Changes in Medications after Bariatric Surgery

Although your bariatric care team will work with your primary care doctor to evaluate your vitals, we recommend you seek advice from experts regarding specific medication adjustments. You should speak to your psychiatrist about psych meds, an endocrinologist involving thyroid medication, and if you take arthritis meds, you should talk to your rheumatologist.

As bariatric providers, we will be more hands-on with your entire care team to help get your adjustments and medications after bariatric surgery correct to ensure we find the right balance based on your needs.

Diabetic Medications

After bariatric surgery, around 60% of patients will be cured of their weight-related diseases, and, over time, 84% of patients will be able to discontinue their diabetic medications. With weight loss comes an improvement in blood sugar levels and diabetes management; therefore, you may find that your diabetic medication is too strong and needs adjusting. We recommend you go through your primary care doctor to make those adjustments.

Hypertension Medications

After weight loss surgery, about 50% of patients will no longer need to take hypertensive medications; therefore, dosages may need to be adjusted by your primary care doctor as you lose weight.

Thyroid Medications

Bariatric surgery is a metabolic procedure that impacts your metabolism and thyroid. Based on the type of bariatric procedure you had, the absorptive rate of these thyroid medications may be affected and thus need to be evaluated. If you take thyroid medications before weight loss surgery, we recommend you see your PCP or an endocrinologist to talk about adjusting this medication after your procedure.  

How Procedure Types affect Medications after Bariatric Surgery

Gastric Sleeve

The gastric sleeve is restrictive and does not create a malabsorptive effect like the gastric bypass and duodenal switch. Therefore, essentially nothing changes when it comes to the absorption of your medication. 

After a gastric sleeve procedure, you and your primary care can decide what medications and dosages are needed to make the appropriate adjustments based on your weight loss and health improvement.  

Gastric Bypass and Duodenal Switch

The gastric bypass and the duodenal switch are malabsorptive procedures, meaning you do not absorb everything you eat. Therefore, your medication dose may be prescribed at one level, but the effective dose (or the dose in your bloodstream) may be significantly lower than it would have been before your surgery. 

Monitoring medications after the gastric bypass and duodenal switch will require a little tighter adjustment than if it would with a gastric sleeve. Although absorption is relatively low following the procedures, as you progress after your gastric bypass or duodenal switch, the amount of absorption will increase. So the medications will need to be closely monitored and adjusted as needed. Typically your primary care doctor and other specialists will help with these adjustments, especially with your thyroid medication or any arthritis medications. 

Conclusion

Medications after bariatric surgery may need to be adjusted based on how you are doing from a physical and emotional standpoint. Typically, we recommend you visit your primary care doctor between follow-up appointments at your bariatric office. You will follow up with your bariatric care team two weeks and six weeks post-surgery, so we recommend you see your primary care physician four weeks and three months post-operatively. Your PCP office will have the same information regarding your vitals, and they can make appropriate adjustments to your medications as needed. 

This article was originally published on the Bariatric Centers of America website.