Malabsorption of psych meds? Or any meds?

[mediocreoblongata 16]

On 07/24/2019 at 14:31, froufrou said:

I will once I can get through to them - nobody is answering. So annoying! However, don't pharmacists know dosage better than doctors? I kind of trust them more... Doctor didn't mention anything about it absorbing any differently. I have a large suspicion he is just wrong.

Yup, doctors can definitely make mistakes but so can pharmacists :) hope it gets figured out soon!

[froufrou 678]

6 minutes ago, ZubaanJCP said:

The liquid does in fact absorb differently. I don't know how, but because it is in a liquid form, it doesn't dissolve in the stomach like before. It's probably also just an adjustment phase... see how you do on it. My doctor did the same thing for the first month.

No, I get that, but I honestly don't think that is his intention. He said see how you do on the full dose and if it's too much then you can do half that. If I did half the dose he is suggesting, that means I'd only be on 25mg of sertraline, where as before I was on 100.

1ml liquid = 20mg tablet

I'm on 100mg tablet, therefore I need to be on 5ml of liquid and not 2.5 he has prescribed. That defeats the purpose of me going in and telling him I'm not absorbing my full dose.

Edited July 24, 2019 by froufrou
adding info

[Briswife15 889]

Has anyone experienced their psychiatrist being very against bariatric surgery due to the perceived “malabsorption problems” associated with it?

Yes. My psychiatrist did not want me to have bariatric surgery. I did anyway. And she is very professional and still supports my decision. After all it was my decision!

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[Briswife15 889]

Hi - I went for my appointment. It was with a dr I don't know and I am having some issues... He gave me a prescription for liquid sertraline, but the pharmacist says that the amount that's been prescribed is HALF of my usual dose. I have called the doctor's office and they say it's the correct dose. The pharmacist says it's not. So... I'm confused. I can't get hold of the doctor's office today and so... not sure what to do now.

Thanks for the update. I'm going to ask for the liquid Zoloft, too. I hope you get the dosage straightened out. My only hesitation is that I currently take an SNRI, Effexor, and Zoloft is an SSRI. So, I wonder how the difference in brain chemicals will affect me.

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[april042019 105]

On 7/18/2019 at 10:45 AM, Darktowerdream said:

21 Medication Rules after Gastric Bypass

There are certain pills that you should not be taking after surgery because they will either irritate your pouch, such as all pills in the NSAIDs catagory or pills that just won't be absorbed like they should. Any pills with enteric coating (kind of like a candy coating) or any extended release type med may not be absorbed like it is supposed to. If any of your meds do fall into those catagories you will want to get them changed. Those meds need the gastric juices to break them down and after RNY those juices just aren't there to do the job until well down your intestinal system which won't be enough time to break those meds down.

So basicly, you want to avoid any meds that are extended release, delayed, controlled, sustained or any medication that is an NSAIDs.

Over-the-counter NSAIDs are:

Aspirin, Motrin, Advil, Aleve, Orudis KT, Ibuprofen, Excederin

Prescribed NSAIDs are:

Motrin, Naprosyn, Anaprox, Toradol, Lodine, Feldene, Indocin, Daypro, Relafen, Voltaren and Celebrex.

There is the belief by some surgeons out there that even one NSAIDs can cause some kind of damage to your pouch and they strongly recommend staying away from them, if possible. If medically there is a reason to be taking them, such as the use of low dose asprin for heart conditions, it is okay to take them but you should also be placed on some kind of protectant such as Carafate or Cytotec.

If you are unsure if any of the meds you are on fall into any of these catagories talk to your Pharmacist, they will know. It isn't a bad idea to let your Pharmacist know that you are a Gastric Bypass patient. They can list it in your information almost like an allergy so that if you are ordered a med that you shouldn't be on an alert will be generated. There are ALOT of physicians out there that don't know this kind of information it is our respondsibility to make sure they are aware of it.

Here are 21 basic rules we should all follow in regards to our meds:

1. If side effects appear or increase, consult your doctor or your pharmacist about dosage or other medication options.

2. First-pass effect medications may not provide effective absorption at the currant dosages. Check dosage or check for alternative medications that do not have first pass effect. (your Pharmacist will know if any of your meds are "first-pass" meds)

3. Medications that are in a liquid or solution form will be absorbed faster than those that are solids. Check for liquid forms of medications.

4. No extended-release, sustained-release, controlled-release, timed-release or osmotic pump medications.

5. Many medications can also have gastrointestinal side-effects like gas, diarrhea, Constipation or intestinal cramping.

6. Read the pamphlet attached to the prescription bag for potential side-effects.

7. You should not take any NSAIDs without a protectant such as Cytotec or Carafate. EVER!!!!

8. Be able to recognize an NSAIDs when you see one.

9. Use a protectant if taking daily low-dose aspirin for heart health or to prevent stroke.

10. Check all PMS over the counter medications (OTC) for NSAID ingredients.

11. Read all OTC medication packaging to check for NSAIDs ingredients.

12. Inhaled steroids for asthma are okay.

13. Taking steroids of any kind, even by injection, requires taking a protectant as well.

14. Medications commonly used in the treatment and prevention of osteoporosis such as Fosamax, Actonel and Boniva have the potential to cause gastrointestinal ulceration. Talk to your doctor or pharmacist about alternatives.

15. Do not continue to take medications that have been discontinued.

16. If dosages have been changed, do not finish out a previous dosage just because it is there. CHange the dosage immediately unless instructed otherwise by your physician.

17. Ask your doctor or pharmacist if any of your medications are fat soluble. If so, stay in touch with the prescribing physician and report your currant weight every month for possible dosage changes. (as the amount of fat in your body changes your dosages may also need to be changed)

18. Tell all medical providers about your status as a weight loss surgery patient. (Lap-Banders too!)

19. Keep all your scripts at one pharmacy if possible.

20. Meet and get to know your local pharmacists. They truly can be invaluable friends.

21. Remember to have everyone work as a team for you! You're worth it!

One other word of warning when it comes to taking Tylenol. You MUST watch the amount of Tylenol you are taking. No more than 4,000mg in a 24 hour period. You can cause yourself liver damage with Tylenol overdose. You need to read your labels. Look to see if things have Tylenol or acetamenophin in them. Vicodan has Tylenol so if you are taking Vicodan or Lortab make sure you aren't adding a lot of Tylenol on top of it. That is why it is important to read the information on those pharmacy bags and on otc medications.

Thank you so much! This is great!

[VirgoSocialWorker 5]

Thank you, thank you, thank you for this. I’m so very appreciative.

[VirgoSocialWorker 5]

I love this thread. Thank you for everyone that contributed! Shoutout to @darktowerdream @froufrou and @ZubaanJCP (Zuba, your transparency really inspired me and I’m forever grateful to you).



Idk if anyone is still active in this thread, but I suffer from anxiety and depression and I was prescribed 150 mgs Zoloft, tablet form. Now that I know that there is malabsorption, idk if I want to change it...like, my antidepressants affect me so differently now in a way that I love. My senses are more keen, I pay so much more attention to detail, and I’m able to concentrate and absorb more information...also, I don’t feel depressed anymore, I actually feel more hopeful than ever. The only cons that I’m aware of is waking up earlier than I’d like to..which, ugh, I wake up several hours before my alarm, and the rest of my day is kinda thrown off because I’m tired. I’m hoping that B12 is a remedy for that!

I don’t want to change this feeling. But I understand how it can be damaging to my insides possibly.

I don’t have a psychiatrist right now due to changes in my insurance so I’m operating on my old medication that I have until my insurance kicks in around March 16th-ish.


What do you guys recommend? I like this new affect. I lowkey feel like a superhero, like Spider-Man. I love my new spidey feelings.

[VirgoSocialWorker 5]

I should also note that:

-I had My VSG surgery in Mexico on 2/6/20

-I’m taking setraline that I bought while in Mexico to help me supplement my meds until my insurance kicks in (which, the pills are definitely not time capsule released because the skin of the pills (or the outside casing) is very thin.

[chalcrow 13]

In my preop preparation here in Manitoba it is made very clear to us that any psychiatric meds, esp. Time release meds are unlikely to work after surgery. In consultation with my family doc she supported me weaning off my venlafaxine before surgery and then reassessing post op, what the new action plan would be. I must say, withdrawal was really awful with the preop diet, but, in retrospect I am so glad I did it that way. I am 1 week post op, still having a bit of dizziness, and I hope that even though I feel more emotional I will be fine and maybe not need a new medication. Having said that, though, if I do start slipping emotionally, I will see the doc knowing the Extended release versions of drugs are not an option. Hang in there and work with your doc to find a solution. Best wishes to you. 🤗

[sarahSingh91 233]

On 07/18/2019 at 09:28, Briswife15 said:

I recently discovered, 4 months post RNY, that my antidepressant is no longer being absorbed. (I was having withdrawals).

Has anyone else experienced this? I have been crushing the meds and it seems to be helping, but I fear other meds are also not being absorbed!

Any tips or suggestions?

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I would defiantly mention this to tour team. Also talk to ur pharmacist about crushing your psych meds just because it can make the effect extreme or cancel them out. Some meds are not crushable.
A lot of people have very small malabsorption of medication. All of our Vitamins and prescriptions are absorbed in our intestines bowels etc. not in our stomach. They only mess with 1/3 or your bowels. So your still absorbing everything minus the 1/3. Which isn’t much considering how much bowel we have! Also sometimes if I’m a led for a long period of times you may need to switch it up. Just talk with your doctor