Friday, May 8, 2009

WLS and medication

I've got meds on the mind today.

WLS will affect the way that your body absorbs medication, that's a given. Bypass is a malabsorbative surgery, so the meds are not going to be absorbed as well as they were before. So if you're thinking about WLS and you are on prescription meds, talk to your doctor about any adjustments you may need.

Most of the meds I'm on (the handful each night) are for issues that will be soon resolved with WLS. HCTZ for blood pressure, Nexium for that little rash in my duodenum, Fenoglide for my ucky triglycerides. I'll be on Synthroid for the rest of my life, but no biggie's a tiny pill and dissolves quickly. Any adjustments with that will be simple.

My biggest concerns, and the ones I'll be focusing on when I talk to Dr. G on Tuesday, are my Wellbutrin and Buspar. I've sworn that I'll never be off the Wellbutrin, I'm a completely different person now that I'm on it. Honestly, I'm a bit afraid to ever go off it. I was having suicidal thoughts before, and while I know I'll never act on them...that's just scary. Wellbutrin has brought me closer to finally being myself than I had been probalby since...well...ever. The type I currently take, though, is a sustained release. The effects of the med last longer throughout the day, with a longer half life. My prescription says that I'm to take one tablet twice a day, but I only take one tablet once a day unless I otherwise need extra due to anxiety. As far as the Buspar, I only take it when I absolutely need it, and while it doesn't work as well as I'd like it to, it does work. I just have to take a full tablet as opposed to the 1/3 that's prescribed.

Buspar isn't all that big and can be cut, no problem, so that shouldn't be a huge issue. I just need to find out if I should take more when I need it. My worry is the Wellbutrin. SUSTAINED RELEASE MEDICATIONS SHOULD NEVER BE CUT, even the OTC meds. (So if you're taking Tylenol Arthritis, don't cut it. Either take less if you don't need the full dose, or take regular Tylenol.) After WLS, it's extremely difficult to take pills/tablets. In fact, our vitamins for the first long while are supposed to be chewable or dissolvable in liquids, and if we do have to continue taking a pill or tablet it needs to be smaller than the tip of our pinky finger. Wellbutrin SR, 150 mg is a fairly large tablet, almost a full centimeter in circumference. So I'm definitely going to need an adjustment. When I've finally found something that works well for me, though, the idea of transitioning to a med that may not work as well is daunting. I don't want to go back to being that person that I was. While I sometimes struggle now, it's nothing compared to where I was. So yeah, #1 topic on my list of stuff to talk to Dr. G about will be meds.

Here's a better explanation of controlled/sustained release medications. A good rule of thumb, if there's a score line on the tablet, it can be cut. If not, DO NOT CUT IT. (The job I just left was at a mail order pharmacy, I loved our pharmacists, they were so informative!)


Other medications are designed in a Controlled-Release (CR) format. This means that the tablet or capsule slowly degrades as it passes through your digestive system, so there is more drug in the pill, but the drug is introduced more slowly into your body. This can be a good thing because it may mean you have to take less doses per day, or even may help to prevent side effects. The hazards of crushing a controlled-release medication can be severe and sometimes fatal. This is like giving a drug you were supposed to absorb slowly over as long as one day, all in one shot in a matter of hours or even minutes. You can see why this might be dangerous. So, as a rule of thumb, do not crush or split controlled-release medications. Of course, there are exceptions to this rule, but you should ask about these exceptions individually with your prescriber or pharmacist.

The tricky thing about controlled-release medications are that they do not always clearly state "controlled release" or even "CR". There are some other short-forms that accompany drug names to look out for, that also mean "controlled release":

  • -CD (controlled-delivery)
  • -ER (extended-release)
  • -LA (long-acting)
  • -SR (sustained-release or slow-release)
  • -XR (extended-release)
  • -XT (extended-release)
  • -Contin and Eslon are both associated with specific brands of controlled release drugs such as OxyContin


Amy said...

It will be interesting to hear what your doc says. my coworker is over a year out (she had bypass) and takes pills everyday...but just vitamins and such. I think she was on chewables for about 8 weeks.