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Review
. 2024 Sep 26;25(19):10375.
doi: 10.3390/ijms251910375.

Molecular Mechanisms Affecting Statin Pharmacokinetics after Bariatric Surgery

Matea Petrinović  1   2 , Domagoj Majetić  1   3 , Miro Bakula  4 , Ivan Pećin  5   6 , Daniela Fabris-Vitković  7 , Marin Deškin  7 , Deša Tešanović Perković  8 , Maja Bakula  9 , Marina Gradišer  10   11 , Ines Bilić Ćurčić  1   12 , Silvija Canecki-Varžić  1   12   13
Affiliations
Review

Molecular Mechanisms Affecting Statin Pharmacokinetics after Bariatric Surgery

Matea Petrinović et al. Int J Mol Sci. .

Abstract

According to recent data, one in eight people in the world struggle with obesity. Obesity management is increasingly dependent on bariatric surgical interventions, as the combination of lifestyle modifications and pharmacotherapy could have a modest long-term effect. Surgery is recommended only for individuals whose body mass index (BMI) ≥ 40 kg/m2 and ≥ 35 kg/m2 in the presence of weight-related comorbidities. The most commonly performed procedures are sleeve gastrectomy and roux-en-Y gastric bypass. Pharmacokinetic and pharmacodynamic alterations occur as a result of the anatomical and physiological changes caused by surgery, which further differ depending on physicochemical drug factors and factors related to the dosage form. The following modifications are distinguished based on the type of bariatric surgery performed. Most bariatric patients have accompanying comorbidities, including dyslipidemia treated with hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors or statins. Significant improvements in the lipid profile are observed early in the postoperative period. The data reported in this review on statin pharmacokinetic alterations have demonstrated substantial inter- and intravariability, making it difficult to adopt clear guidelines. Based on the current literature review, reducing the statin dose to the lowest effective with continuous monitoring is considered an optimal approach in clinical practice.

Keywords: bariatric surgery; dyslipidemia; hydroxymethylglutaryl-CoA reductase; hypolipidemic agents; inhibitors; medication management; obesity.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Molecular changes affecting drug pharmacokinetics after bariatric surgery.
Figure 2
Figure 2
Summary of factors contributing to modified oral bioavailability of statin therapy following bariatric surgery. BS: bariatric surgery.
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