MiladyB

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

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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 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!

(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.

Edited by MiladyB

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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.

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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'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.

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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.

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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!

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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? :confused:

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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

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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.

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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? :confused:

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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I have found one way to help the enteric coated meds to work, and it's probably not the best thing, but it works. I use a file or scissor blade to scrape off some of the coating on each side to give the med a chance to break down in my system. I can tell that it works. I haven't done it for SR or ER or timed release meds, as there are too many variables, but for the run of the mill meds--i.e. benedryl, scraping off a bit of the coating gives them a chance of absorption.

I have told my back doctor's idiot PA no less than 12 times that I can't take SR meds, but she insists on writing the Rx for them anyway. Then I have to have her rewrite the Rx, which infuriates her, and you can just imagine the high quality of care I enjoy there. She's terribly rude and I have now insisted that she not have anything to do with my care, which pisses off the office. So far the back doc has been mildly okay with me just seeing him, but he STILL has her write the Rx, so the game continues. I have a feeling that when I am healed from the surgery they are going to fire me as a patient, as I am "too difficult." It's a very tense situation, and I post about it as a cautionary tale regarding doctors' ignorance to our special needs with SR meds. :cool:

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You're right, Donna. So many doctors really aren't aware of restrictions on Bariatric patients when it comes to medication. One of the reasons I felt it was so important to post this information. We ALL need to be aware of it and basicly make a point of teaching the medical profession around this. I know that I will be going to my pcp with a handful of articles about medications post wls. I'm lucky that he is very open to learning and really embraces the fact that I come to him with information.

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I did not know any of this information.. it seems that if its so important your surgen should inform you.. as I have been taking Aleve quite often. Any information on what it actually does which can cause damage?

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It was sort of ironic that I read it here and within days I was reading the SAME thing in my 3 hour required nutrition consult. I think it's also in the book I'm reading WeightLoss Surgery for Dummies. Maybe give you doctor a call and see what he/she thinks?

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I did not know any of this information.. it seems that if its so important your surgeon should inform you.. as I have been taking Aleve quite often. Any information on what it actually does which can cause damage?

April, Aleve is a NSAIDs. It can cause ulcers in your pouch. Actually it can cause ulcers for ANYONE but because we have so much less stomach surface it just magnifies the damage to the pouch lining. It can eat right into the lining of the pouch.

We should NEVER be taking any NSAIDs without some kind of protectant like Carafate.

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April, Aleve is a NSAIDs. It can cause ulcers in your pouch. Actually it can cause ulcers for ANYONE but because we have so much less stomach surface it just magnifies the damage to the pouch lining. It can eat right into the lining of the pouch.

We should NEVER be taking any NSAIDs without some kind of protectant like Carafate.

It would seem to me that this is the sort of information that the doctor should be giving you. I was never told about this. Due to the fact I am in England right now I do not have my book on hand which they give you.. but on return I am going to look through that to see if by chance I missed it. I dont see where I could have but I will look. If I dont see it.. this is something I will for sure be pointing out as that is something I would of avoided all together, natually. :( Thank you for the information.. this is why its so important for us all to share and help others.

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These meds are gonna be my downfall. Now, does anyone suffer from migraines because I know that most migraine meds do have NSAIDS in them.

And also, I have terrible knee pain, I am going through physical therapy right now and UP until the day of surgery I will continue to... but they have me on Naprosyn for the inflammation. I know I'm going to continue to have this knee pain even after surgery, and i should contact my doc... but is/has anyone else gone through this?

Liquid vicodin? uckkkkk:p

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Dear Jersey Girl,

I do not know which is the problem you have with the knee. But I can only talk about my problem.

I had also a lot of pain in my knee (diagnosis, degeneration of the back meniscus, that could require surgery, if I want). Now after 4 weeks post-op, and 28.6 pounds less, when I walk I do not have pain anymore. However the pain is when I twist or do other moves. therefore wait to see, the lesser weight the better for all our joins. concerning the naprosyn, it is one of the classical NSAIDS, and not recommended after GBP, you will have to discuss about this with your physician. To replace the painkilling effect, paracetamol molecule is fine, to replace the antiinflammatory component, the physician will let you know which are the most appropriate drugs.

Take care

Marine LAPRYGBP Sep 21 07

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It would seem to me that this is the sort of information that the doctor should be giving you. I was never told about this. Due to the fact I am in England right now I do not have my book on hand which they give you.. but on return I am going to look through that to see if by chance I missed it. I dont see where I could have but I will look. If I dont see it.. this is something I will for sure be pointing out as that is something I would of avoided all together, natually. :( Thank you for the information.. this is why its so important for us all to share and help others.

I think what may happen sometimes is that the doctor tells their patient NO NSAIDs.....but most patients don't have any idea what drugs are considered NSAIDs. You hear so much about Motrin or Ibuprofen but you have to realize that many over-the-counter meds have Ibuprofen in them...Aleve being one of those. I really think all surgeons should be providing a list of over-the-counter and prescription meds that fall under the NSAIDs catagory. It is very important info!

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These meds are gonna be my downfall. Now, does anyone suffer from migraines because I know that most migraine meds do have NSAIDS in them.

And also, I have terrible knee pain, I am going through physical therapy right now and UP until the day of surgery I will continue to... but they have me on Naprosyn for the inflammation. I know I'm going to continue to have this knee pain even after surgery, and i should contact my doc... but is/has anyone else gone through this?

Liquid vicodin? uckkkkk:p

I'm afraid I haven't gone through either. I just know that my surgeon's office says that if you HAVE to be taking some kind if prescription NSAIDs, than you HAVE to be on something like Carafate or Cytotec. Those meds will help protect your pouch from hopefully getting ulcers.

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I agree with you Beth, or at least if they cannot provide with the list (as there are so many new drugs/names), at least to sensitize the GPB WSL patients, to ask their pharmacists if there are NSAIDs before buying any product. Or do you have also Over the Coutner also outside drugstores or pharmacies in US?

Cheers

Marine

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I agree with you Beth, or at least if they cannot provide with the list (as there are so many new drugs/names), at least to sensitize the GPB WSL patients, to ask their pharmacists if there are NSAIDs before buying any product. Or do you have also Over the Coutner also outside drugstores or pharmacies in US?

Cheers

Marine

Yes, you can buy over-the-counter drugs in the grocery stores in the US too, Marine, but I think it is important for doctors to stress the importance of reading ingredient labels and being attentive to the possibility of NSAIDs in medications that we buy.

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Beth, thanks so much for this post and the invaluable information you've provided.

I wanted to ask about steroids. I have severe contact dermatitis at times, and have to take a steroid shot to clear it up. I haven't broken out since my surgery (yet), but I probably will at some point since I'm alergic to so much. What kind of protectant is needed?

Carol

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Beth, thanks so much for this post and the invaluable information you've provided.

I wanted to ask about steroids. I have severe contact dermatitis at times, and have to take a steroid shot to clear it up. I haven't broken out since my surgery (yet), but I probably will at some point since I'm alergic to so much. What kind of protectant is needed?

Carol

Carol, if you will be taking a steroid, even in injectable form you will want to have your physician get you on something like Cytotec or Carafate, at least those are the 2 drugs of choice by my surgeon's group. There are other ones that can be used but these two seem to be my surgeon's preference, as being the most effective.

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