Systematic Review: Impaired Drug Absorption in Patients with Ostomy or Shortened Bowel
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Drug absorption may be a problem in patients with ostomies and shortened bowel. Malabsorption of certain drugs and drug products is possible due to the reduction in intestinal surface area as a result of surgical resection. Clinicians are often unaware of this problem when creating dosing regimens and there is insufficient literature on this topic. To systematically review published evidence of impaired drug absorption in patients with ostomy or shortened bowel. To make recommendations to clinicians for appropriate drug therapy in these patients. Studies were obtained through systematic literature searches of MEDLINE, SCOPUS, SciFinder Scholar, and SuperSearch databases (1983- 2010) for English articles with keywords: drug malabsorption, absorption, bioavailability, ostomy, ileostomy, short bowel, and drug monitoring. Two reviewers independently assessed studies for inclusion. Ten studies were identified investigating impaired absorption in patients with ostomies or shortened bowel. Evidence for diminished drug absorption was found in 3/10 studies examining ostomies and 7/10 studies involving shortened bowel, including problems with sixty-five drug products. Drug malabsorption appears to be more well-known in patients with shortened bowel over patients with ostomies. More studies are needed to evaluate the effect of potential drug malabsorption in patients with ostomies. Approaches to further research will be presented. Reduced drug absorption is very likely in patients with ostomies or shortened bowel, especially for sustained-release or extended-release products, and for poorly absorbed drugs. Individual dose-adjustment, selection of a different route of administration, and therapeutic monitoring of blood levels by clinicians may also be required.
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