Taking meds post-op. Some things you need to know! - ThinnerTimes

MiladyB · 10-11-2007, 05:19 AM

I know this has been discussed in a couple other threads but I wanted to highlight this information in it's own thread. I feel this is important information, people and we all have the respondsibility to be aware of it AND to educate the doctors that we deal with outside of our bariatric physicians.

So here is the latest information about meds, post-op.

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 isn't going to do it's job. It will probably basicly go right on through you. 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 has been studies out there that ALL it takes is ONE dose of NSAIDs to cause some kind of damage to your pouch. Yep, that's right I said ONE!! That honestly is the latest word out there people, I know I'm not going to ignore it.

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!

(Used with permission of Little Victories Medical/Legal Consulting & Training. All rights reserved)

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.

Hello Katie · 10-11-2007, 09:53 AM

No Advil? I'm glad you shared this! I take Advil regularly now for cramps and headaches etc but I'm pre-op. What is ok to take for regular pain post-op?

MiladyB · 10-11-2007, 10:05 AM

Quote:

Originally Posted by Hello Katie

No Advil? I'm glad you shared this! I take Advil regularly now for cramps and headaches etc but I'm pre-op. What is ok to take for regular pain post-op?

I'm afraid to say, when it comes to over-the-counter medication it is pretty limited to Tylenol. With prescription meds you have more choices. Post-op usually patients are put on Lortab which is a liquid form of Vicodan. Post-op I started with the Lortab but didn't need it long and then went to the adult liquid version of the Tylenol.

draya77 · 10-11-2007, 04:04 PM

thank you Beth for this piece of information! i have printed it out and gave it to my husband i have also informed him in case of an accident he needs to inform the medical team of the fact that i have had the gastric bypass. I have heard of the bracelets for this surgery do you or anyone know where i can get one? Thanks you again

Quote:

Originally Posted by MiladyB

I'm afraid to say, when it comes to over-the-counter medication it is pretty limited to Tylenol. With prescription meds you have more choices. Post-op usually patients are put on Lortab which is a liquid form of Vicodan. Post-op I started with the Lortab but didn't need it long and then went to the adult liquid version of the Tylenol.

MiladyB · 10-11-2007, 08:08 PM

Quote:

Originally Posted by draya77

thank you Beth for this piece of information! i have printed it out and gave it to my husband i have also informed him in case of an accident he needs to inform the medical team of the fact that i have had the gastric bypass. I have heard of the bracelets for this surgery do you or anyone know where i can get one? Thanks you again

I know that you can purchase medical Alert ID bracelets at most Pharmacies. You can let them know what you want on it. I guess I would suggest your type of surgery, No NSAIDs and No blind scope. I personally don't wear one but carry a card in my purse that includes the following information.

1. Your Bariatric surgeon's name and phone number.

2. The type of surgery you had and when.

3. Your current medications with dosages, who prescribed them, and what they are for.

4. Any medication allergies or warnings (i.e. No NSAIDs without a protectant like Cytotec)

5. The name and number of the pharmacy that fills your scripts.

I prefer the card to the bracelet just because I can get more information on a card. But if you don't have your wallet or purse with you and something happens then a bracelet may be a good idea.

MiladyB · 10-17-2007, 05:08 AM

I am bumping this thread up because I am still seeing that people are unclear about meds post-op. I can't stress enough how important it is to be aware of this information!! You really owe it to yourself, each and everyone of you are worth it!

sdgrrl · 10-17-2007, 07:55 AM

Beth,
thanks for putting this list together--it is invaluable! Tell me, Nurse Beth, how do injectable meds do? For instance, I know that Toradol works fantastically IM, but is nothing more than an NSAID if taken orally. Does it still tear up our gut if it's injected? How about interractions? If I take something that is normally benign, are there meds that exacerbate or decrease the effects of the meds? Argggh. We need a pharmacist on board--there's so much to consider when you don't have a stomach. For instance I didn't know until last night that you have to take your iron by itself to be absorbed right. I'd just been tossing them all back at once.

There's just so much more to it than just eating high protein/low complex carb, isn't there?

fisher1000 · 10-17-2007, 08:03 AM

What about the absorption of the iron in multivitamins? I take the Optisource brand, per my doctor's instructions, and it says something on the label about additional iron for increased absorption. Are the multivitamins like that not good? Should I take something different and add additional iron, B-12, and calcium?

-Mike

MiladyB · 10-17-2007, 10:06 AM

Quote:

Originally Posted by fisher1000

What about the absorption of the iron in multivitamins? I take the Optisource brand, per my doctor's instructions, and it says something on the label about additional iron for increased absorption. Are the multivitamins like that not good? Should I take something different and add additional iron, B-12, and calcium?

-Mike

Mike, I take a prenatal multivitamin daily along with 1000-1200mcg of Calcium Citrate with Vitamin D. I appear to be absorbing the iron in the prenatal vitamin just fine. If your doctor hasn't started you on the Calcium by 4 weeks personally I would start it if I were you. I haven't needed any additional iron, well that is until I just had my plastic surgery. I did a lot of bleeding so my pcp has added iron into the mix. The B-12? I would highly recommend it. Even though my B-12 levels are normal I've opted to add in 1000mcg of B-12 twice a week. If you do that make sure it is sublingual, though. It will say it right on the bottle.

One additional note though is if you are taking a multivitamin with iron or additional iron you need to wait an hour before you can take your Calcium Citrate. ALSO you won't absorb any more than 600mcg of the Calcium at one time so you do have to split that 1000-1200mcg over 2 doses.

My routine is:

7am: All meds minus my Calcium
9am: Calcium w/ breakfast
Bedtime: Calcium

Here are a couple links of information you may find helpful:

http://www.bbvitamins.com/education.aspx

http://www.bbvitamins.com/Research.aspx

I highly suggest checking them out, there is some helpful info there.

Your surgeon should be checking your labs several times over the next year so that will help you judge if you are getting in what you need. Now that I am almost 2 years out my surgeon only checks them yearly. I see my pcp every 6 months though, so I have asked him to be checking additional labs every 6 months to make sure everything is still ok.

MiladyB · 10-17-2007, 10:11 AM

Quote:

Originally Posted by sdgrrl

Beth,
thanks for putting this list together--it is invaluable! Tell me, Nurse Beth, how do injectable meds do? For instance, I know that Toradol works fantastically IM, but is nothing more than an NSAID if taken orally. Does it still tear up our gut if it's injected? How about interractions? If I take something that is normally benign, are there meds that exacerbate or decrease the effects of the meds? Argggh. We need a pharmacist on board--there's so much to consider when you don't have a stomach. For instance I didn't know until last night that you have to take your iron by itself to be absorbed right. I'd just been tossing them all back at once.

There's just so much more to it than just eating high protein/low complex carb, isn't there?

Donna, I don't know this for a fact but I would suspect that IM Toradol would have the same effect on your pouch as the oral. I say this only because I know that IV steroids will effect your pouch so you must add in a protectant if you are receiving IV steroids. I would think that would probably hold true for the IM Toradol too but that is only speculation on my part. A Pharmacist would be the one to ask about that question.

In regards to the iron, if you are taking a multi vitamin with iron in it you should wait an hour before you take your Calcium Citrate.

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