Pills, Meds, Capsules and Chewables?

Duodenal Switch, Gastric Band, Gastric Bypass, Gastric Sleeve, Recovery after Bariatric Surgery, Single Anastomosis Duodenal Switch

Medications in general can be quite confusing for the post-bariatric patient. You can be given confusing information regarding how to take medications such as: cut your pills in half, no capsules, nothing bigger than an M & M or only chewable. Some bariatric surgeons have made fortunes selling their own brand of chewable vitamins. In truth, it all depends on the procedure you had, the timeframe from the procedure and what medications you take.

If you have a gastric bypass, here are the rules and the reasons behind the rules. In a gastric bypass, you have connected a portion of small bowel to a small portion of stomach. That connection is called a stoma and initially, when created, about the diameter the size of a nickel. Immediately after the surgery, the stoma scars in a circular fashion narrowing the diameter to the size of an M&M. It achieves its narrowest diameter between 4 and 8 weeks. That is why initially, chewable vitamins are best. Pills should be cut to the size of an M&M during this time frame. After about 8 weeks, the scar tissue fades and returns to the size of the nickel. By that time, a patient should be eating meat, and if so, any pill, chewable or otherwise will go down uncut. Capsules are different for a bypass. We have used a long segment of intestine to connect the intestine to the stomach. Because capsules need to have the outer membrane melt to release the medication inside, sometimes, the capsules are not in the intestine long enough to release the intended dose of medication. It doesn’t mean you can’t take a capsule; it just may not be as effective as it once was when the intestines were not shortened.

Sleeves are a different story altogether. The outlet of the sleeve is the pylorus which is not disturbed during surgery. Sleeve patients should be able to take any medication readily without cutting, chewing, or worrying about capsules at any point in time after the surgery. Duodenal Switch and SIPS procedures are hybrid operations, and as such, have hybrid rules. The pylorus is not disturbed and therefore and pill or capsule should readily be acceptable. However, there is intestinal bypass involved so the capsule rules apply.

I would tell you to always follow your doctor’s recommendations regarding medications, but the understanding of why the recommendation is made can be useful for discussion with your medical professionals.