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IH-05: A preliminary comparison of sertraline plasma levels in post- bariatric surgery subjects compared to weight-matched control subjects
Abstracts: 2010 Integrated Health Main Session / Surgery for Obesity and Related Diseases 6 (2010) S85-S90
S87
IH-05
A PRELIMINARY COMPARISON OF SERTRALINE PLASMA LEVELS IN POST- BARIATRIC SURGERY SUBJECTS COMPARED TO WEIGHT-MATCHED CONTROL SUBJECTS James L. Roerig, Pharm.D, BCPP; Kristine J. Steffen, Pharm.D., Ph.D.; James E. Mitchell, MD; Ross D. Crosby, PhD; Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND; Clinical Research, Neuropsychiatric Research Institute, Fargo, ND; Background: The world currently faces an obesity epidemic which encompasses about 1.7 billion individuals. The only intervention that produces significant sustained weight loss is bariatric surgery. The procedure that is used most frequently in the United States is a restrictive/malabsorptive procedure (Roux-en-Y Gastric Bypass) that reduces the size of the stomach to approximately one ounce and bypasses a portion of the small intestine. With this procedure, a potential exists for alteration of medications’ pharmacokinetic parameters. Methods: To explore the extent and clinical impact of these changes, a cross-sectional pilot pharmacokinetic study was designed that compared the area under the plasma level, time curve (AUC) of a single dose of a probe drug, sertraline 100 mg, in 5 subjects that are 9 to 15 months post-gastric bypass and five subjects matched for current body mass index, age and sex to the post bariatric surgery group. Subjects were tested for genetic polymorphisms for the CYP2D6 and 2C19 metabolic enzymes. Poor metabolizers for either enzyme were excluded from the study. Sixteen blood samples were obtained over eleven hours. Results: Preliminary analysis of the data shows a substantial reduction of the sertraline AUC in the post-bariatric surgery subjects compared with the non-bariatric subjects. Conclusion: Larger prospective studies are indicated to enable practitioners to accurately prescribe medications in post-bariatric surgery patients. IH-06
INCREASED ATHEROSCLEROSIS PROGRESSION AND CARDIOVASCULAR-STROKE RISK IN BARIATRIC SURGICAL CANDIDATES Patricia Toor, RN; Sandra Reeder, BSN; Keith Kim, MD; Cynthia K. Buffington, PhD; Metabolic Medicine and Surgery Institute, Florida Hospital Celebration Health, Celebration, FL Background: The severely obese are at high risk for cardiovascular disease and stroke. Carotid intima-media thickness (IMT) is a surrogate marker for atherosclerosis and is a strong predictor of future stroke and CVD. In the present study, we measured carotid-IMT of severely obese bariatric surgical candidates and their age- and gender-matched lean controls and studied the association between these clinical measurements and known risk factors of CVD. Methods: The study population included 20 obesity surgical candidates, matched for age and gender to 20 lean controls. Left and right carotid IMT was determined by high resolution ultrasound and body size of patients was categorized by BMI criteria. CVD risk factors included glucose, lipids (triglyceride, LDL, HDL,
S87
IH-05
A PRELIMINARY COMPARISON OF SERTRALINE PLASMA LEVELS IN POST- BARIATRIC SURGERY SUBJECTS COMPARED TO WEIGHT-MATCHED CONTROL SUBJECTS James L. Roerig, Pharm.D, BCPP; Kristine J. Steffen, Pharm.D., Ph.D.; James E. Mitchell, MD; Ross D. Crosby, PhD; Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND; Clinical Research, Neuropsychiatric Research Institute, Fargo, ND; Background: The world currently faces an obesity epidemic which encompasses about 1.7 billion individuals. The only intervention that produces significant sustained weight loss is bariatric surgery. The procedure that is used most frequently in the United States is a restrictive/malabsorptive procedure (Roux-en-Y Gastric Bypass) that reduces the size of the stomach to approximately one ounce and bypasses a portion of the small intestine. With this procedure, a potential exists for alteration of medications’ pharmacokinetic parameters. Methods: To explore the extent and clinical impact of these changes, a cross-sectional pilot pharmacokinetic study was designed that compared the area under the plasma level, time curve (AUC) of a single dose of a probe drug, sertraline 100 mg, in 5 subjects that are 9 to 15 months post-gastric bypass and five subjects matched for current body mass index, age and sex to the post bariatric surgery group. Subjects were tested for genetic polymorphisms for the CYP2D6 and 2C19 metabolic enzymes. Poor metabolizers for either enzyme were excluded from the study. Sixteen blood samples were obtained over eleven hours. Results: Preliminary analysis of the data shows a substantial reduction of the sertraline AUC in the post-bariatric surgery subjects compared with the non-bariatric subjects. Conclusion: Larger prospective studies are indicated to enable practitioners to accurately prescribe medications in post-bariatric surgery patients. IH-06
INCREASED ATHEROSCLEROSIS PROGRESSION AND CARDIOVASCULAR-STROKE RISK IN BARIATRIC SURGICAL CANDIDATES Patricia Toor, RN; Sandra Reeder, BSN; Keith Kim, MD; Cynthia K. Buffington, PhD; Metabolic Medicine and Surgery Institute, Florida Hospital Celebration Health, Celebration, FL Background: The severely obese are at high risk for cardiovascular disease and stroke. Carotid intima-media thickness (IMT) is a surrogate marker for atherosclerosis and is a strong predictor of future stroke and CVD. In the present study, we measured carotid-IMT of severely obese bariatric surgical candidates and their age- and gender-matched lean controls and studied the association between these clinical measurements and known risk factors of CVD. Methods: The study population included 20 obesity surgical candidates, matched for age and gender to 20 lean controls. Left and right carotid IMT was determined by high resolution ultrasound and body size of patients was categorized by BMI criteria. CVD risk factors included glucose, lipids (triglyceride, LDL, HDL,