Extended Release Drugs--who changes them?

I'm a wee bit confused from my packets of information regarding medicines. And, this is the current thing plaguing my anxiety (I really should have been born in the Victorian era so I could have "fainting spells" and complain about "my poor nerves").

Here is what I think:

1. If you are on an extended release (ER) medicine you need to have it changed to a non-ER formulation

2. If you are on a gigantic pill (larger than an M&M) you need to cru**** or find an alternative

Am I correct on the 2 points? (If no, explain please).

If yes, who do I talk to about changing the ER drug?

Do I go to my pharmacist and then he will send something to my GP to get a new Rx;

Do I go straight to my GP;

Or does the bariatric center (in my case, TWH) deal with this at the pre-op appointment? 

The doctor who manages your medications is the person you need to see to discuss this. As you know, some medications come in XR and also in regular, some don't. Some meds can be crushed, some can't. Etc., etc...... Having a doctor "coordinate" your meds (so that you are receiving the appropriate amounts of medication that won't interfere with each other, etc.) is pretty crucial.

If I can make a suggestion, do it now. That way your meds and doses and such are all worked out well in advance and your body has had ample time to adjust and amendments to meds can be worked out

Please rest assured you are doing all the right things, the issue of your meds will be assessed again prior to surgery as they have a pharmacist that is there for that very reason.

they will give you the proper alternative you need as your family Dr. May not be familiar with the best substitute that you require. As for the size of your pills again they do this every day and will look after what you need . 

You will require a script when you go home and they will provide you with that. 

So your story is amazing and you need to concentrate on yourself and have no anxiety as you are in good hands.

good luck and all the best success in the future 

I've had to do the exact same thing 

Simon

I can advise on my experience re: your first question. Pre op, I was on an extended release 60mg dosage of medication. I was advised by twh to go to my GP (prescribing physician ) and have it changed. Unfortunately the medication had to be spilt into two 30mg doses, so I've added another pill to my arsenal of vitamins for the day. 

I hope this is helpful. 

I am on Effexor XR and I had a talk with my family doctor in regards on how to deal with it post op.  We discussed cracking the capsule open to get to the granules and I would take the dose twice a day instead of daily.  The doctor's at TWH agreed the family doctor.

We also discussed pills sizes and if the pills are round (like an M&M) we would split it.  But if they are oblong (like a Tylenol) we wouldn't break it because the pill will travel like a tower and not tumble down the throat.  She said we are concerned about the diameter of things going through the stoma.

Hopefully this helps (or confuses you even more LOL)

So the general consensus, thus far, is talk to your GP but know the pharmacist at TWH is there as back up.

My concern is that my GP doesn't know "what's best" for a RNY patient. I don't want him recommending something that puts me in the hospital because it got stuck somewhere along the way down.

Anyway--this has been particularly concerning for me because at the 1 on 1 meetings, I get very different advice as well. I've brought 1 of each pill that I take to my appointments and they said they're not too big, but they are kind of huge (much larger than an M&M), hard (not encapsulated), and oblong. 

I'll meet with my GP and, once again, bring the pills with me when I meet the official pharmacist at TWH. All I can do is hope for the best.

I am having a similar situation.  I am having RNY surgery in Ottawa, probably within the next 6 months.  I am also taking Effexor among other meds. Spoke to my GP , but he doesn't want to deal with any medication changes for my depression.  Saw my psychiatrist, but he has never had a patient undergo a bypass.  He is not sure what to change to, and is concerned re how and where the drugs are absorbed.  So he doesn't know what to do. 

At the ottawa hospital, do they help you with these things.

At the time of my surgery, I was on Effexor. I was directed to open the capsule and take the contents (tiny little beads) with water. DO NOT CRUNCH THEM, swallow them whole. No issues at all doing it that way.

With my centre they have special protocols for psych meds. At least, lithium and valproate (mood stabilizers) need to be monitored post-op because the absorption changes so drastically in Bariatric patients. The psychologist I met with consulted with the psychiatrist and they sent a protocol to my GP for monitoring my blood post-op. If you have not had your psych appointment yet be sure to bring up any other psych meds you nay be on.

i just met with my pharmacist today because this was freaking me out. None of my meds are ER. But, he didn't know about the need to monitor mood stabilizers.