December 4th, 2018 – Medications After Bariatric Surgery

Whitney Venegoni is one of our Nurse Practitioners who serves as a Primary Care Provider as well. She sees patients before and after surgery, and does medication management for many of our patients after surgery. We have 2 Nurse Practitioners: Whitney works full time and Lori Reckrey, APRN, works part time in the office on the 3rd floor (Suite 305 in Building A).

Whitney talked about medications following surgery. She shared with us questions that most commonly come up about different types of medications.

• Extended Release or Slow Release: Whitney will often switch medications that end in XR or SR, as they are designed to be released slowly throughout the day. After surgery, they may not remain in the gut long enough to work that way, so she will often switch the medication to an immediate release medication given more frequently. If the drug is a heart medication, she will defer to a patient’s cardiologist and follow their recommendations.

• Diabetes medication is complicated. Because there are so many different types of medications for diabetes and they all work a little differently, she has to look at each patient and medication very individually.

  • Usually she will stop Metformin, Invokana, and Farzxiga after surgery.
  • She avoids using glipizide and glimepiride as they can lead to low blood sugars more often.
  • Some patients won’t be able to stop their medications immediately, but everyone goes home on a lower dose than before surgery.
  • If a patient is on insulin, she will usually stop all the short acting insulin and leave patients on a much lower dose of long acting insulin.
  • She tries to switch patients from insulin to an oral agent as soon as possible. It can take a few weeks of adjustments to make sure patients are either completely off medication or managed well on a lower dose.

• Some medications have the side effect of causing weight gain, and she stops those. She can switch patients to a medication with similar action that does not result in weight gain.

• Blood pressure medication is usually stopped if the patient is only taking 1 or 2 medications. If someone is currently on 4 or 5 medications for BP, she will usually eliminate 2 or 3, and then work on reducing the dosages as weight loss occurs. Some BP medications are called beta-blockers, and are used for heart rhythm problems. These may need to be continued.

• Diuretics (water pills) are usually stopped completely the first week, as they could cause dehydration. If swelling occurs in the legs and feet, she may add a lower dose back to help decrease the swelling, especially if it is related to heart failure.

• Cholesterol medications are almost always stopped right after surgery, and the body is given time to adjust to the surgery. Frequently they will no longer be needed after surgery.

• Medications that adjust moods are not usually changed as long as they are working well and don’t cause weight gain. Some antidepressants can cause weight gain, so she will work with patients to switch them to another drug with similar action that doesn’t cause weight gain. This may take some time to adjust.

• Medications for overactive bladder may cause dryness, and it is important for patients to make sure they are drinking enough fluids.

• What antibiotics can I take or not? Erythromycin is very hard on your stomach, so you should not take it. Cefalexin and Macrobid (Nitrofurantoin) should not be used as they don’t absorb well after surgery. Augmentin is fine and all antibiotics should be taken after eating and NOT on an empty stomach.

• I have trouble knowing when to take omeprazole. I am still on it for GERD: Try taking it 30 – 60 minutes before breakfast and dinner to see if that helps. If not, there are acid reducers that are stronger we can try.

• Are there any medications you can take if you are a couple of years out from surgery and have a little weight regain? Yes. There medications that can help with cravings, and some that can boost your metabolism. Whitney can prescribe medications based on the problem you are having.

Our next support group will be January 8 of 2019 at 5:30 pm. We will continue to have support groups twice a month. The 1st Tuesday of every month will be at 5:30. During odd number months, we will meet again on the 3rd Tuesday at 5:30. On even numbered months, we will have the second group on Saturdays at 10 am. Hope to see you there.