Bioavailability of Methadone After Sleeve Gastrectomy: A Planned Case Observation

Abstract Objective Morbidly obese patients on opioid-replacement therapy may be at risk for treatment refusal with regard to bariatric surgery. However, patients on opioid replacement may have the personal skills to facilitate the lifestyle changes required for successful outcomes after bariatric su...

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Bibliographic Details
Published in:Clinical therapeutics 2016-06, Vol.38 (6), p.1532-1536
Main Authors: Strømmen, Magnus, RN, MSc, Helland, Arne, MD, Kulseng, Bård, MD, PhD, Spigset, Olav, MD, PhD
Format: Article
Language:English
Subjects:
Adult
Bariatric Surgery
Bioavailability
Biological Availability
Body mass index
Conflicts of interest
Diabetes
Drug abuse
Drug dosages
Female
Gastrectomy - methods
Gastrointestinal surgery
Heroin Dependence - drug therapy
Hospitalization
Humans
Internal Medicine
Laparoscopy
Medical Education
Metabolism
Methadone
Methadone - pharmacokinetics
Methadone - therapeutic use
Narcotics
Obesity, Morbid - surgery
Opiate Substitution Treatment
opioid replacement
Patients
pharmacokinetics
Postoperative period
Substance abuse treatment
Weight control
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Summary:Abstract Objective Morbidly obese patients on opioid-replacement therapy may be at risk for treatment refusal with regard to bariatric surgery. However, patients on opioid replacement may have the personal skills to facilitate the lifestyle changes required for successful outcomes after bariatric surgery. This planned case observation assessed the effects of sleeve gastrectomy on the pharmacokinetic properties of methadone. Methods A white woman in her 40s on methadone maintenance therapy and with morbid obesity was referred for bariatric surgery. Serial blood samples for methadone concentration measurements were obtained before and at 5 days and 1, 7, and 11 months after surgery. Findings Serum methadone concentrations increased from before to 5 days after surgery and continued to increase for 7 months thereafter. The predose measurement at 11 months postoperatively suggests a further increase compared with the previous predose measurements. Implications Clinicians should beware the potential for altered effects of methadone after bariatric surgery. We recommend that serum concentrations be routinely measured pre- and postoperatively, and that the dose be adjusted according to these measurements and regular clinical assessments.
ISSN:0149-2918
1879-114X
DOI:10.1016/j.clinthera.2016.04.033