Shown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by SLS on December 26, 2008, at 6:30:09
Hi all.
A friend of mine is having bariatric surgery soon and will be left with a small vestigial stomach.
Someone on the treatment team told her that she could no longer take the sustained release preparations of Wellbutrin. She was told to use the IR immediate-release version only. No explanation was given. I'll need to do some homework for her, I guess. I get the feeling that it is just not necessary to make a switch to the IR.
Does anyone have information on this?
My friend has already made the switch to IR to see if it will sustain her 8-year remission of depression. The answer is no. She began to deteriorate within a week and is not doing too well. I convinced her to return to XL until she has her surgery in a few months. If her physicians are unsure as to the efficacy of sustained release versions of Wellbutrin, but are convinced that it will do her no harm, then it is a no-brainer but to try as an experiment its use.
- Scott
Posted by SLS on December 26, 2008, at 7:29:29
In reply to Wellbutrin SL and XL - Use After Bariatric Surgery, posted by SLS on December 26, 2008, at 6:30:09
Posted by Phillipa on December 26, 2008, at 10:57:15
In reply to Wellbutrin SL and XL - Use After Bariatric Surgery, posted by SLS on December 26, 2008, at 6:30:09
Quick guess only and no reasearching thinking if they remove part of upper intertinal tract if that's what they are doing that is where the sustained release releases the med so if that's the case I'm thinking they might be saying must be in blood stream from the stomach before the intestine. Is it the same intestine being somewhat removed? Phillipa
Posted by SLS on December 26, 2008, at 15:37:06
In reply to Re: Wellbutrin SL and XL - Use After Bariatric Surgery » SLS, posted by Phillipa on December 26, 2008, at 10:57:15
> Quick guess only and no reasearching thinking if they remove part of upper intertinal tract if that's what they are doing that is where the sustained release releases the med so if that's the case I'm thinking they might be saying must be in blood stream from the stomach before the intestine. Is it the same intestine being somewhat removed? Phillipa
Thanks.I'm not sure how much of the upper small intestine is excised or made unavailable for absorption. I don't think that it is very much. I do know that the duodenum is bypassed, but left intact. Gastric and duodenal secretions are thus routed to the intestine. Perhaps this produces an environment with conditions sufficient for digestion of the extended release pill. That's what I'm hoping, anyway.
- Scott
Posted by Phillipa on December 26, 2008, at 19:52:57
In reply to Wellbutrin SR and XL - Use After Bariatric Surgery » Phillipa, posted by SLS on December 26, 2008, at 15:37:06
Complicated. I hope so also. Love Phillipa
Posted by Phillipa on December 26, 2008, at 20:04:36
In reply to Wellbutrin SR and XL - Use After Bariatric Surgery » Phillipa, posted by SLS on December 26, 2008, at 15:37:06
Scott found this. Love Phillipa
MEDICATIONS
AFTER WEIGHT LOSS SURGERYGENERAL
All medications must crushed, chewed or in liquid form for 1 year after gastric bypass. Medications that are labeled SR (sustained release), XR (extended release) or the like cannot be crushed, so you will have to find an alternative. You should discuss this requirement with you pharmacist and the physician(s) who prescribes your medication(s) well in advance of your surgery date.
Posted by Vincent_QC on December 26, 2008, at 22:29:23
In reply to Wellbutrin SL and XL - Use After Bariatric Surgery, posted by SLS on December 26, 2008, at 6:30:09
> Hi all.
>
> A friend of mine is having bariatric surgery soon and will be left with a small vestigial stomach.
>
> Someone on the treatment team told her that she could no longer take the sustained release preparations of Wellbutrin. She was told to use the IR immediate-release version only. No explanation was given. I'll need to do some homework for her, I guess. I get the feeling that it is just not necessary to make a switch to the IR.
>
> Does anyone have information on this?
>
> My friend has already made the switch to IR to see if it will sustain her 8-year remission of depression. The answer is no. She began to deteriorate within a week and is not doing too well. I convinced her to return to XL until she has her surgery in a few months. If her physicians are unsure as to the efficacy of sustained release versions of Wellbutrin, but are convinced that it will do her no harm, then it is a no-brainer but to try as an experiment its use.
>
>
>
> - ScottHi ;-)
I had a gastric by-pass in 2001...mine work with "malabsorbtion" ...mean that they just remove 2/3 of my stomach and they reduce my intestine to 1 meter long only, the other 5 meter is cut and don't work anymore (we have more than 6 meters I think)...And yeah, I see a difference...I can't take the newer XR version of any drugs...the main problem is that in Canada IR version are often not avaible. Effexor come only in XR version, Wellbutrin come in SR and XR version only...the new cymbalta is a XR version also, Paxil goes XR also, Luvox XR also...For your friend, I don't know if a small stomach can affect the SR efficacity...??? Since drugs are most of the time absorb into the small intestine, I wonder if the Wellbutrin SR will not be as affective than before your friend got his surgery?
I ask several times my surgeon about this, and about the fact that the new formulation XR of drugs seem to not work on me, since at one point of my life I Was on more than 300mg of Effexor-XR, without feeling anything...it was not normal... The only answer I get was that he don't know...He said that statically, I maybe absorb only 30% of the drug in my blood stream...normal digestion cycle is 12 hours, mine is 3-4 hours...and since I get this surgery, I find that all the drugs are less effective...so it"s affect probably also the regular version as well...since they by-pass the first part of the intestine, the one where the fat absorbtion in the intestine is made, and it's the part where normally a drug is absorbed...but some drugs seem to be well absorb...probably something to do with where a drug is absorb and metabolised...they are all different I think...but my psychiatrist told me that AD drugs are mostly absorb by the first part of the intestine and are fat-solube...mean that i'm not surprise I don't answer well to antidepressants drugs...
Take my informations like you want, maybe i'm right or maybe i'm wrong, but a small stomach can't affect what happen in the intestine...If your friend take her Wellbutrin SR and swallow it, I see why it will not go into her intestine...so it will probably be absorb like usual in the intestine, since her surgery will not by-pass a big part of her intestine no???
Wish her good luck for me ok ;-) By-pass surgery is a very difficult step in the life of someone...and this surgery will make her more happy after and less depressive i'm sure ;-) Loosing weight is always very pleasant.
Posted by SLS on December 27, 2008, at 7:55:43
In reply to Re: Wellbutrin SL and XL - Use After Bariatric Surgery » SLS, posted by Vincent_QC on December 26, 2008, at 22:29:23
> > Hi all.
> >
> > A friend of mine is having bariatric surgery soon and will be left with a small vestigial stomach.
> >
> > Someone on the treatment team told her that she could no longer take the sustained release preparations of Wellbutrin. She was told to use the IR immediate-release version only. No explanation was given. I'll need to do some homework for her, I guess. I get the feeling that it is just not necessary to make a switch to the IR.
> >
> > Does anyone have information on this?
> >
> > My friend has already made the switch to IR to see if it will sustain her 8-year remission of depression. The answer is no. She began to deteriorate within a week and is not doing too well. I convinced her to return to XL until she has her surgery in a few months. If her physicians are unsure as to the efficacy of sustained release versions of Wellbutrin, but are convinced that it will do her no harm, then it is a no-brainer but to try as an experiment its use.
> >
> >
> >
> > - Scott
> I had a gastric by-pass in 2001...mine work with "malabsorbtion" ...mean that they just remove 2/3 of my stomach and they reduce my intestine to 1 meter long only, the other 5 meter is cut and don't work anymoreWow. That's quite a bit of pipe to be cut away. There are several different procedures available. For my friend, I am not sure how much small intestine will be unavailable for digestion. I am under the impression that most of it will remain intact. The duodenum is bypassed, but continues to secrete digestive enzymes that are routed back to the small intestine. In essence, a Y-pipe is constructed using some of the proximal small intestine. I have to find out more about it.
> I ask several times my surgeon about this, and about the fact that the new formulation XR of drugs seem to not work on me, since at one point of my life I Was on more than 300mg of Effexor-XR, without feeling anything...it was not normal... The only answer I get was that he don't know...He said that statically, I maybe absorb only 30% of the drug in my blood stream...normal digestion cycle is 12 hours, mine is 3-4 hours...and since I get this surgery, I find that all the drugs are less effective...so it"s affect probably also the regular version as well...since they by-pass the first part of the intestine, the one where the fat absorbtion in the intestine is made, and it's the part where normally a drug is absorbed...but some drugs seem to be well absorb...probably something to do with where a drug is absorb and metabolised...they are all different I think...but my psychiatrist told me that AD drugs are mostly absorb by the first part of the intestine and are fat-solube...mean that i'm not surprise I don't answer well to antidepressants drugs...
>
> Take my informations like you want, maybe i'm right or maybe i'm wrong, but a small stomach can't affect what happen in the intestine...If your friend take her Wellbutrin SR and swallow it, I see why it will not go into her intestine...so it will probably be absorb like usual in the intestine, since her surgery will not by-pass a big part of her intestine no???Thank you. You gave me much information to think about. I'll let you know what I come up with.
Be well.
- Scott
Posted by SLS on December 27, 2008, at 7:57:04
In reply to Re: Wellbutrin SR and XL - Use After Bariatric Surgery » SLS, posted by Phillipa on December 26, 2008, at 20:04:36
> Scott found this. Love Phillipa
>
> MEDICATIONS
> AFTER WEIGHT LOSS SURGERY
>
> GENERAL
>
> All medications must crushed, chewed or in liquid form for 1 year after gastric bypass. Medications that are labeled SR (sustained release), XR (extended release) or the like cannot be crushed, so you will have to find an alternative. You should discuss this requirement with you pharmacist and the physician(s) who prescribes your medication(s) well in advance of your surgery date.
Thanks for looking into this for me.:-)
- Scott
Posted by SLS on December 27, 2008, at 10:38:55
In reply to Re: Wellbutrin SR and XL - Use After Bariatric Surgery, posted by SLS on December 27, 2008, at 7:57:04
Here is a picture of the resulting GI anatomy after roux-en-y bariatric surgery. It is an amazingly elegant way to maximize the digestive potential of the proximal region of the small intestine. I would guess by looking at this that some extended-release preparations of various drugs would remain effective. It would depend on the delivery technology used. I am really intent on getting my friend to at least try using Wellbutrin SR instead of IR.
http://www.surgicalclinic.ms/images/Roux-en-y-large.jpg
- Scott
Posted by SLS on December 30, 2008, at 8:41:06
In reply to Re: Wellbutrin SR and XL - Use After Bariatric Surgery, posted by SLS on December 27, 2008, at 10:38:55
Happily, it seems that my friend has managed to recapture an antidepressant response using the Wellbutrin IR preparation. It took several weeks spent in a deteriorated state before her system returned to the state of remission accomplished previously by taking Wellbutrin XL.
I recommended to her that she take Wellbutrin IR every 8 hours to more closely approximate the steady blood levels produced by Wellbutrin XL. If it doesn't affect her sleep adversely, this strategy should prevent spikes and troughs in mental energy and mitigate the elevated seizure potential that Wellbutrin IR is known to produce. She takes 450mg: 150mg q8.
What a relief.
- Scott
Posted by Phillipa on December 30, 2008, at 21:18:20
In reply to Re: Wellbutrin SR and XL - Use After Bariatric Surgery, posted by SLS on December 30, 2008, at 8:41:06
Scott glad to hear it and give my best to your friend Phillipa
This is the end of the thread.
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