Bariatric patient & taking percs

[Eebb26]

Can u tell me if it's true that as a bariatric patient, I dint absorb meds the same . I take and have been taking a very high dose of percs. 2-3 10/325 every few hours. I function and work on these. I really believe I don't absorb these all the way. There are many posts all over the web with ppl saying the same but I was wondering if anyone knew for sure. I did use to take smaller doses and I know u build up a tolerance but I just am curious while I'm trying to taper off

[Eebb26]

Thanks. Sorry should of xlarified that I did have gastric bypass and yes there was intestinal length taken out but I don't know how much. So do u think this med has been going straight to my liver or metabolizing slower? Ty

[J T Junig, MD PhD]

It is difficult to reliably predict your absorption without knowing the exact nature of your surgery.  For example, having a 'wrap' or 'banding' procedure would not affect absorption, but a gastric bypass might.  Most medications are taken up in the proximal intestine, and from there go straight to the liver. Some medications are largely metabolized there, so gastric bypass may actually increase the effects of those medications.  But there is less overall intestinal length after some bypass surgeries, which may result in lesser absorption of some medications.  The absorption will also be affected by diet, and by whether the meds are taken on a full vs empty stomach.

There are individual differences between all of us when it comes to efficiency of absorption of medications, degree of metabolism by the liver, etc. The effects of tolerance likely have a much larger role in the effects of opioids than whether or not a person had bariatric surgery.  Every person will become tolerant to any dose of opioid if taken over a long period of time;  I have had patients come in for treatment taking well over 500 mg of oxycodone per day-- and feeling absolutely nothing after a dose of that magnitude.