Psych meds post DS
That seems like a very good point. Since the research on RNY pouch deems the problem to be lack of stomach acid working on the tablet coating preventing proper dissolving (thus ultimately absorption) problems, why doesn't the same thing apply to the PPI meds for non-pouch stomachs?
The "best" answer that I can find is that it depends on the design of the coating. No matter what the XR drug is, if it's designed to dissolve in acids, it's not going to work as well without that acid, and it wouldn't matter why the acid is absent. If it's designed to dissolve in a more alkaline environment or in the presence of specific enzymes, then alterations to the intestines are going to come into play. This is yet another area where the specific differences in DS and RNY would make a difference. DS doesn't bypass the duodenum or jejunum, and any normal excretions of that area would remain, just as they do in the stomach. But if the coating requires an enzyme or the alkaline that comes from the bile, the medicine isn't going to dissolve until it gets to the CC. This would bring CC length into play. Those who have longer CC's, as do Dr. Anthone's patients, will still have more time for the coatings to dissolve. Those who have the very short (100-65 cm) CC's are going to have much less time for the coating to dissolve and for the medicine to be absorbed.
My conclusion thus far is that we need to talk to the pharmacist (!!) about the exact meds we need to take and how any XR coatings would be affected by our specific intestinal alignmnet. Those of us who understand the anatomical changes that have been made can probably come to a fairly accurate conclusion.
This would also explain why there are people who do just fine continuing their extended release meds.
The question is probably pretty much moot for people who don't have a problem remembering to stop during the day to take more pills. I am not one of those people. I have a very long CC and require little supplementation, and it's a darned good thing. I generally remember morning pills, sometimes remember evening pills, and hit-or-miss (mostly miss) on anything require throughout the day.
You gotta understand, the whole ADHD issue, for me, brings massive challenges to compliance to a medicine regime. The easiest answer, "Just don't take XR meds ever" isn't easy or even doable for the most part. I wouldn't have any other choice if this is the only true answer, but there seems to be enough caveats to the XR issue that they may still be in play. Therefore, I need information in order to make the best of the situation and work closely with my doctor for the help I need.
