“What medications do I take for pain if I have had bariatric surgery?”

The short answer? TYLENOL. Take Tylenol for minor pain. It’s effectiveness will surprise you as surgery has changed the physiology of your body. Remember that you are much lighter – even a single tablet works wonders when no longer morbidly obese. We are not to take the category of drugs called NSAIDS – non steroidal anti-inflammatory drugs – they can eat a hole through your stomach even if taken just once. 

Be Aware
After gastric bypass surgery it is important to be the steward of information that affects your life and health. This is an informal ‘kitchen table’ discussion of a medical topic – questions regarding your specific situation should always be directed towards your bariatric professionals – but it is YOUR body and it is important for YOU to know what meds damage your stomach. We are not doctors, but have known many bariatric post ops who were in ICU after NSAIDS ate a whole through a pouch or sleeve, so we know what we are warning you of.

Your dentist is not a bariatric expert and you should not rely on his knowing about your body modifications when he says that ‘Advil is fine’ for pain after a dental procedure. Ditto for your foot doctor. After having a minor in-office foot procedure, I was offered an NSAID for swelling. I told the doctor that I couldn’t take that category of drug after a gastric bypass, it initiated a discussion and now his office knows that bariatric patients cannot take Ibuprofen or Aspirin. It was not critical to my healing and I took Tylenol instead. I am the one who brought it up and said NO, because I am the one who is in charge of my body.

 

What drugs am I not supposed to take after bariatric surgery?

What are NSAIDS?
Since this is a common question, it is helpful to know what NSAIDS are and why we should not take them. Knowing not to take them is good, but to understand that these meds can eat a hole through the stomach pouch even when taken once, is a more powerful impression!

You have probably heard the term ‘Ulcers’ before but ‘Marginal Ulcers’ is the term used for someone who has had bariatric surgery and develops a nasty sore or hole in their pouch, normally where it was stitched or stapled. In someone with a band, these medications can cause the band to eat into or through the wall of the stomach. In someone with a gastric bypass, the ulcer can form in the remnant stomach, which is the part of the stomach that is no longer ‘hooked up’. Even topical gels and injections are a problem, as the ulcers are not formed through NSAID contact. The NSAIDS are systemic meaning they travel through the blood. This is how a gastric bypass remnant pouch can have terrible ulcers necessitating surgical removal when the NSAIDS did not directly travel through this part of the body.

Post-gastric bypass patients with Marginal Ulcers typically have symptoms including abdominal pain and burning, nausea, and vomiting. Many complain of burning when they eat or even when they drink water.

This condition represents nearly half of all postoperative complications and occurs in as high as 5% of gastric bypass patients, with 1. Smoking 2. Use of Non-Steroidal Anti-Inflammatory Drugs called NSAIDS and 3. Alcohol use, cited as main causes.

Even family physicians, orthopedists, internists, and practitioners do not always realize the need for us to avoid these particular medications after bariatric surgery and may mistakenly assure you that it is okay to use them when it is not.

If after great discussion with your doctor for alternatives, it has been determined that NSAIDS – non steroidal anti inflammatory drugs – are required, they should be accompanied by a proton pump inhibitor (PPI) medication such as Prilosec, Prevacid, Aciphex, Protonix, Nexium or Zegarid as protection. Some antacids that are not acceptable protection include Pepcid, Zantac, and Tagamet.

 

The Wrap Up
So, when you have a pounding headache, DO NOT take Aspirin, Advil, Motrin, or Aleve. We CAN use Tylenol, which is acetaminophen.

When buying cold medications and pain relief brands – read the list of ingredients to make sure it does NOT contain ibuprofen, aspirin, or naproxen.

THESE ARE THE SIX CATEGORIES THAT ARE OF ISSUE.

1. Aspirin should be avoided after gastric bypass – even use of baby aspirin to reduce risk in those with known risk factors or a strong family history of heart disease, must be weighed by your health professionals for risk versus benefit.

2. IBUPROFEN – a wide range of name brand products and include the main compounds IBUPROFEN which is in Advil and Motrin, and NAPROXEN which is the brand name Aleve. We often hear “I can’t remember which one I’m not supposed to take!” The answer is that we should not take Advil, Motrin and Aleve.

3. COX-2 inhibitors are also prescribed for pain and should not be taken. Currently Celebrex is the main brand that people know from this category.

4. Steroids delay healing in the stomach and impair the stomach lining’s ability to form the protective layer between the muscle wall and acid. This can lead to an ulcer, bleeding or perforation. Examples of steroids are prednisone, decadron, depo-medrol, and solu-cortef.

Steroids should be avoided the first 6 weeks after surgery and then if required should be accompanied by a proton pump inhibitor (PPI) medication. Steroid injections into a joint or the back don’t usually affect the stomach so don’t require taking PPI’s.

So if you must take steroids, you must take also take Prilosec, Prevacid, Aciphex, Protonix, Nexium or Zegarid as protection for as long as 30 days after your steroid treatment has ended. Some antacids that are not acceptable protection include Pepcid, Zantac, and Tagamet.

5. Osteoporosis & treatments – Studies have shown that gastric bypass patients have a higher incidence of osteoporosis leading to increased risk of fractures. It is fairly common for a Primary Care physician to see lab results of a bone scan and prescribe a bone building regimen, however ulceration of the small gastric pouch can cause death, therefore it is important to choose the treatment least likely to cause an ulcer. Bariatric surgeons often advise patients not to take these treatment meds unless as a last resort. Examples of these drugs are: Fosamax, Boniva, Reclast, Aclasta, and Actonel.

Studies show that Actonel (risedronate) appears be the safer drug for the treatment of osteoporosis in gastric bypass patients. Actonel is available in daily, weekly, or monthly dosing; this flexibility may induce better adherence. If you need this type of treatment, discuss monthly or yearly dose versions, make sure you remain upright for a period after the medication and be aware of any heartburn, indigestion or abdominal pain so you can stop taking it and report to your physician. If financially feasible, intravenous Reclast (zoledronic acid), should be considered.

6. Nicotine from smoking is one of the worst things patients can do after weight loss surgery, due to the high risk of ulceration of the stomach. Don’t smoke! I know a brilliant and charming businessman who 18 months after gastric bypass nearly died when nicotine ate a hole in his pouch and his stomach contents emptied into his abdominal cavity. He had quit smoking for his surgery, but started back. It took two surgeries and six months for him to recover.

THE ‘NO’ LIST – Medications for Bariatric Post Ops

aspirin – acetylsalicylic acid – BRAND NAMES: Aspirin, Anacin, Arthritis Foundation Safety Coated Aspirin, Asper~, Bayer Aspirin, Bayer Children’s Aspirin, Ecotrin, and many others Empirin, BC Powder, Vincent’s Powders

celecoxib BRAND NAMES: Celebrex

diclofenac – BRAND NAMES: Voltaren (pills and topical gel), Cataflam, Voltaren-XR, Cambia

ibuprofen – BRAND NAMES: Advil, Children’s Advil/Motrim, Advil Migraine, Motrin, Motrin IB, Motrin Migraine Pain, Liquigels, Nuprin, PediaCare Fever, Vicoprofen (combination with hydrocodone), Combunox (combination with oxycodone)

indomethacin – BRAND NAMES: Indocin, Indocin SR (discontinued brand in the US)

ketoprofen – BRAND NAMES: Orudis (discontinued brand)

ketorolac – BRAND NAME: Toradol (discontinued brand in the US)

methyl salicylate – BRAND NAME: Salonpas NOTE: Even though this is a patch the active ingredient can create ulcers similar to topical gels such as Voltaren

nabumetone – BRAND NAME: Relafen (discontinued brand)

naproxen – BRAND NAMES: Aleve, Anaprox, Naprosyn, Naprelan, Naprapac (copackaged with lansoprazole)

piroxicam – BRAND NAME: Felene

salsalate – BRAND NAMES: Amigesic, Salflex, Argesic-SA, Marthritic, Salsitab, Artha-G

sulindac – BRAND NAME: Clinoril (discontinued brand)

tolmetin – BRAND NAME: Tolectin (discontinued brand)

 

*There are many OTC Combinations with ibuprofen: Advil Cold And Sinus, Advil Cold, Advil Allergy Sinus, Children’s Advil Allergy Sinus, DIMETAPP, Sine-Aid IB, Children’s Motrin Cold. READ LABEL – CHECK ACTIVE INGREDIENTS

Other Drugs to avoid: Fosamax, Boniva, and Aclasta

Source: Mayo Clinic Health list of NSAIDS

 

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