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Adipositas - Ursachen, Folgeerkrankungen, Therapie 2018; 12(01): 24-31
DOI: 10.1055/s-0038-1636968
Originalarbeit
Schattauer GmbH

Änderungen der Pharmakotherapie nach Adipositas-Chirurgie - eine monozentrische Erhebung

Changes in pharmacotherapy after obesity surgery – a monocentric survey
A. Hansen
1   Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover
,
J. W. Mall
2   Klinik für Allgemein-, Viszeral-, Gefäß- und Adipositaschirurgie, KRH Klinikum Nordstadt, Hannover
,
S. Engeli
1   Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover
› Author Affiliations
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Publication History

Publication Date:
27 February 2018 (online)

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Zusammenfassung

Die Arzneimitteltherapie des adipösen Patienten wird durch vielfältige ungeklärte Fragen erschwert und die Situation wird noch komplizierter, wenn sich ein Patient einer gewichtsreduzierenden Operation unterzieht. Postoperative Änderungen der Medikation hängen nicht nur mit der veränderten Pharmakokinetik einzelner Arzneimittel zusammen, sondern auch mit der Änderung von Begleiterkrankungen. Unsere Akten- und Fragebogenauswertung ergab für 88 Patienten eines zertifizierten Adipositas-Chirurgie-Zentrums eine Reduktion des BMI um 18,4 kg/m2 ein Jahr nach Operation bei 71% Schlauchmagenoperationen. Wie erwartet, ging die Gewichtsreduktion mit einem signifikant reduzierten Bedarf an blutzucker- (-76%) und blutdrucksenkenden (-60%) Arzneimitteln einher, der Bedarf an Eisensubstitution stieg an. Entgegen unserer Erwartung blieb die antidepressive Therapie unverändert und die Verordnungen analgetischer Arzneimittel nahmen an. Die Verordnungsraten von Protonenpumpen-Hemmern veränderten sich dynamisch von 50% präoperativ zu annähernd 100% direct postoperativ zu 50% ein Jahr postoperativ, was auch durch die Prophylaxe zur Sicherung der gastrointestinalen Wundheilung zu erklären ist.

Summary

Pharmacotherapy of the obese patient is complicated by several unanswered questions and the situation is even more complex after weight reduction surgery. Postsurgical medication changes depend on changed pharmacokinetics of some drugs, but also on changes in comorbidities. We conducted an analysis of patient charts and questionnaires for 88 patients treated in a certified obesity surgery center. BMI reduction was 18.4 kg/m2 one year after surgery, although a high percentage of gastric sleeve procedures was performed (71%). As expected, weight reduction was associated with a significant decrease of antidiabetic (-76%) and antihypertensive (-60%) drug prescriptions, whereas the need for iron supplementation increased. We did not expect unchanged antidepressive drug therapy, and also not the increase in analgetic drug prescriptions. Proton pump inhibitor prescriptions changed dynamically from 50% before surgery to nearly 100% at discharge to 50% one year after surgery. The dynamic can be explained by postsurgical prophylaxis to enable gastrointestinal wound healing.

Schlüsselwörter

Pharmakotherapie - Antihypertensiva - Antidiabetika - Antidepressiva - Analgetika - Protonenpumpen-Hemmer - chirurgische Gewichtsreduktion - Schlauchmagen-Operation - Magenbypass-Operation

Keywords

Pharmacotherapy - antihypertensive drugs - antidiabetic drugs - antidepressive drugs - analgetic drugs - proton pump inhibitors - surgical weight reduction - gastric sleeve - gastric bypass
 

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