Question:
Extended Release Medications

I've been reading the library to see if anyone had any success taking Ambien CR, but couldn't find anything. I told my doctor my concern about taking extended release medications, but she said that the absorbtion of most medications happens in the gastrointestinal tract and not the stomach and that some time released medicines (including Ambien CR) are aborbed by the gi tract and then later released in the blood. Yeah, this makes sense to me, but I'm no doctor. She said unless I read some type of studies, I shouldn't believe those "rumours." So are there any studies out there? I think she is getting annoyed with me saying I can't take this and I can't take that.    — Lisa N M. (posted on November 29, 2005)

November 28, 2005
I thought we couldn't take extended release because the part of our intestines that make this pills work has been bypassed. Did you have the rny surgery where they bypassed a portion of your intestines?
   — ckreh

November 28, 2005
It is your gastrointestinal tract that has been bypassed if you had the RNY or BPD or BPD-DS. Specifically the Duodenum and for a lot of folks the Jejunum <sp?> as well was bypassed. This is dependent upon how proximal or distal you are. This section is no longer operational. So if a medication is supposed to be absorbed and/or released in this area, and a lot of the drug companies that have literature on this will tell you that it is released in this area, it won't be. Small amounts of it may be depending upon how much you have been bypassed but it varies person to person. By and large most folks with malabsortive surgeries do not use time -, suspended- or extended- release medications. Think about it : This is the same section that certain fat-soluable vitamins or minerals such as iron or calcium won't absorb very well in and its why we have to take so much more of them. So unless she wants to give you 3-5 times as much, and good luck convincing your insurance company to pay for that, I'd stick to the regular formulation. Ask her what part of having had your intestines bypassed does she not understand? Of course if you had a VGB, sleeve or lap band done then yes your doctor is right on the money. In your post you did not specify which surgey you had.
   — Michelle E.

November 29, 2005
I talked to my dr. about Ambien CR and after discussing it for awhile, we decided to put me on the regular Ambien rather than the CR. It has worked great for me.
   — freetofly

November 29, 2005
I was told by my surgeon (who has performed 100's of bypasses and has 4 other surgeons in his practice that do the same surgery and care for as many patients) that extended release wont be effective for us because of the changes in our intestinal tract. I call that a bit more than a 'rumor' as your doctor put it. Studies. Unfortunately, you'll be hard pressed to find one. The surgery is pretty 'new' and true, independant studies are hard to come by. Basically, we are all walking case studies at this point. But honestly, your doctor sounds a bit irresponsible and ignorant to Wls (as most pcp's are). You may want her to speak directly with your surgeon before coming up with a plan of action for you. Wishing you well
   — Rachelq

November 29, 2005
Thanks for the responses. I had the RNY and it was proximal. Not sure how much was bypassed. The regular ambien works for me and since it is first absorbed in the gi tract, then I would guess the doctor is correct. The problem is I don't stay asleep. She said if I don't have a problem with the regular ambien, I won't have a problem with this as after it is absorbed then it is released in intervals through the blood. The tablet does not stay intact for a long time. She said as long as it does not need stomach acid then it would be fine. It's not a life & death medication, so I'll give it a try. Just wanted to know if there are any clinical studies. I googled it and got varying responses from different bariatric centers. I think the best answer was the website that said no one really knows.
   — Lisa N M.

November 29, 2005
I did want to respond to Rachel. My doctor is not ignorant when it comes to WLS patients. Her husband is a bariatric surgeon and I chose her after I had my surgery, because of her knowledge. She has a lot of patients. Since there are no studies, then really there is no right or wrong. Most doctors are going by their own personal experiences. There are too many variables. From reading the Q&A's here, I learned that the pill does not last in the stomach long enough to be absorbed. But, the website says its absorbed in the GI tract, so that should not matter. Then someone wrote that I don't have enough GI tract to absorb it, but I have absorbed it before, so that must not be true. Too many variables. I just don't think we should take such hard stances on these things when they are only opinions.
   — Lisa N M.

November 29, 2005
you didnt say which dr it was you were dealing with, is it your primary or your surgeon? I would go on the advice of the surgeon. He has the expertise, should be up to sate on all actricles, and has other patients to draw reference from. Do what your doctor says is best.
   — rmc5605

November 29, 2005
I tried the Ambien CR which is extremely expensive and not covered by my insurance. The doctor had given me some samples which appeared to work really great. Unfortunately, after only taking the couple of samples, I filled the prescription and now am getting no more sleep from them than from the regular Ambien. I fall asleep right away and then am wide awake after about 3-4 hours. And that's it for the night. Wish I had never spent the $4 per pill to get the prescription filled. Good luck, Kathy
   — kathyb

November 29, 2005
Boy what is it with us and sleep. I am also on Ambien and have the same problem of not staying asleep. I was going to ask my doctor about the cr but guess I will just stick with what I have.
   — tdickson

November 29, 2005
Lisa, Call your surgeon's nurse and ask her if there is a list of meds you can't take because of your surgery. If there is get a copy to your doctor. Don't forget you are paying them and if her attitude continues find another doctor!!!!! Tomanip
   — TomanipP

November 29, 2005
Lisa, I have to commend you for figuring out that no one really knows the answers. Unfortunately, you will find that for most things regarding this surgery. People can recite about studies proving one thing, but you can find the studies that prove the opposite too! Or, as you found out....studies that are inconclusive! My best advice to most people with the RNY surgery is.....try it. If it works for you, then wonderful! If it doesn't work for you, then try something else! Good luck! I too take the regular Ambien....sometimes it works great, other times it doesn't work well at all. I've considered the Ambien CR but I'm in Germany and stuck with the Military Pharmacy which doesn't always have some of the newer meds. Carmen
   — kccjer

November 30, 2005
Lisa, tremendus insomnia here...I was up to 20 mg of ambien a night...I am now trying the Ambien CR..for me it works about the same...I agree it is more expensive...(a three months supply of regular ambien is $60...the ambien CR is $110)...but as far as the absorbition goes...I know it works...but I can't say it works better...or worse for that matter...and about 5 hours is all I get out of them too... (maybe it's Karma...all the years we spend being sedintary...now that our body is healthier...our body wants to make up for lost time...giggle) hope this helps Russ
   — [Deactivated Member]

December 1, 2005
I was curious about them. The usefulness of XL, XR, SR, all that is so dependent on the mechanism the medication uses to release. What I believe is that the result of a timed release med is unpredictable. You can predict how it is for you after YOU use it. I have used regular Ambien for awhile. Got samples of the CR and used it. I wasn't impressed enough to ask for an rx. Please try samples and make your judgment based on how they work for you after maybe 7 days of each? The sleep issues seem to be something we get free with the surgeries. I've been trying to figure it out nutritionally for years and can't make any sense of it. I was ALWAYS an insomniac, since I was a kid, so it's not particularly new to not fall asleep, but not STAYING asleep is new. B12 can cause problems, but many of us On Grad who are discussing sleep issues all have excellent B12 levels and never became deficient, ever. So, we ruled that one out. Is there another element we malabsorb that we don't know about yet? <shurg> Who knows? But sleep issues do follow us. They way I look at it is that it beats sleep apnea.
   — vitalady

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