Table 2.

Changes in the pharmacokinetic parameters observed after bariatric surgery and gastrectomy.

Drug	Type of Surgery	Time after Surgery	Study Group Size	Changes in PK/PD	References
Acetaminophen	SG	4–6 months	9	↑AUC, Cmax and tmax	[17]
	RYGB	6–7 days	30	↓Cmax and AUC	[34]
Tramadol	RYGB	7–10 days	26	↓Cmax (eff) ↓tmax	[35]
Ketoprofen	total gastrectomy	6–11 days	15	↓Cmax and tmax ↑Vd	[6]
	partial gastrectomy	6–11 days	5
Morphine	RYGB	6 months	30	↑AUC, Cmax ↓tmax	[39]
Oxycodone	total gastrectomy		24	↓tmax	[40]
Rivaroxaban	SG	3 days	6	↑AUC and Cmax	[49]
	RYGB	3 days	6	↑AUC and tmax ↓Cmax
	SG	6–8 months	6	↑tmax	[50]
	RYGB	6–8 months	6	↑tmax ↓Cmax
Dabigatran	RYGB		9	↓Cmax	[52]
Warfarin	RYGB	6 months	12	Maintaining the INR level required lower doses	[56]
Tacrolimus	SG	9–12 months	12	↑AUC and Cmax	[63]
	RYGB		6	↓AUC:dose ratio	[61]
	RYGB		1	↑Cmax and AUC	[58]
Mycophenolate mofetil	SG	9–12 months	12	↓Cl/F ↑t1/2	[63]
Enteric-coated mycophenolate sodium	SG	9–12 months	12	↓Cl/F ↓tmax	[63]
Sirolimus	RYGB		6	↓AUC: dose ratio ↓AUC0–∞ and AUC0–12	[61]
MPA (active form of mycophenolate mofetil)	RYGB		6	↓Cmax and mean AUC0–12	[61]
Ciclosporin	RYGB		1	↓Cmax	[58]
Escitalopram	RYGB	2 and 6 weeks	4	↓C	[42]
Sertraline	RYGB	9–15 months	5	↓AUC0–10.5 and Cmax	[43]
Duloxetine	RYGB	9–15 months	10	↓AUC0–∞ and tmax	[45]
Vortioxetine	RYGB	91 days	1	↓C	[48]
Metformin	RYGB	≥3 months	16	↑AUC0–∞ and Cmax	[66]
Furosemide	RYGB	<12 months	13	↑tmax	[69]
Omeprazole	RYGB	<12 months	18	↓tmax	[69]
Levothyroxine	meta-analysis				[65]

SG—sleeve gastrectomy. RYGB—Roux-en-Y gastric bypass. AUC—area under the curve. AUC_0–∞—area under the curve from 0 to infinity. C_max—maximum concentration. t_max—time of maximum concentration. Cl/F—clearance. V_d—volume of distribution.