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Low hydroxychloroquine blood levels in patients who have had gastric bypass surgery

Gastric bypass surgery, also called Roux-en-Y gastric bypass (RYGB), can result in the malabsorption of medications, requiring the use of higher than usual doses in order to achieve a therapeutic effect. We describe the results of hydroxychloroquine (HCQ) blood levels in three patients with systemic...

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Autores principales: Thomas, Donald E, Lyons, Jonathan S, Greene, Barry S, Petri, Michelle A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6577310/
https://www.ncbi.nlm.nih.gov/pubmed/31275579
http://dx.doi.org/10.1136/lupus-2019-000335
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author Thomas, Donald E
Lyons, Jonathan S
Greene, Barry S
Petri, Michelle A
author_facet Thomas, Donald E
Lyons, Jonathan S
Greene, Barry S
Petri, Michelle A
author_sort Thomas, Donald E
collection PubMed
description Gastric bypass surgery, also called Roux-en-Y gastric bypass (RYGB), can result in the malabsorption of medications, requiring the use of higher than usual doses in order to achieve a therapeutic effect. We describe the results of hydroxychloroquine (HCQ) blood levels in three patients with systemic autoimmune disease taking standard HCQ doses and their associated disease activity levels. This is a retrospective review of all patients who had undergone RYGB and were taking HCQ in a rheumatology community-based practice. Two patients with SLE and one patient with primary Sjogren’s syndrome had previously undergone RYGB. All three had subtherapeutic HCQ blood levels and active disease. Increasing their HCQ doses above the recommended 400 mg a day dosing resulted in therapeutic HCQ levels in all three patients and better disease control in two of the three patients. RYGB patients may not absorb HCQ adequately, resulting in subtherapeutic HCQ blood levels and inadequate disease control. Patients who have undergone RYGB and are taking HCQ should have drug levels monitored. RYGB patients may require higher than recommended doses of HCQ in order to achieve better disease control and avoid unneeded additional immunosuppressive agents.
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spelling pubmed-65773102019-07-02 Low hydroxychloroquine blood levels in patients who have had gastric bypass surgery Thomas, Donald E Lyons, Jonathan S Greene, Barry S Petri, Michelle A Lupus Sci Med Case Report Gastric bypass surgery, also called Roux-en-Y gastric bypass (RYGB), can result in the malabsorption of medications, requiring the use of higher than usual doses in order to achieve a therapeutic effect. We describe the results of hydroxychloroquine (HCQ) blood levels in three patients with systemic autoimmune disease taking standard HCQ doses and their associated disease activity levels. This is a retrospective review of all patients who had undergone RYGB and were taking HCQ in a rheumatology community-based practice. Two patients with SLE and one patient with primary Sjogren’s syndrome had previously undergone RYGB. All three had subtherapeutic HCQ blood levels and active disease. Increasing their HCQ doses above the recommended 400 mg a day dosing resulted in therapeutic HCQ levels in all three patients and better disease control in two of the three patients. RYGB patients may not absorb HCQ adequately, resulting in subtherapeutic HCQ blood levels and inadequate disease control. Patients who have undergone RYGB and are taking HCQ should have drug levels monitored. RYGB patients may require higher than recommended doses of HCQ in order to achieve better disease control and avoid unneeded additional immunosuppressive agents. BMJ Publishing Group 2019-06-16 /pmc/articles/PMC6577310/ /pubmed/31275579 http://dx.doi.org/10.1136/lupus-2019-000335 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Case Report
Thomas, Donald E
Lyons, Jonathan S
Greene, Barry S
Petri, Michelle A
Low hydroxychloroquine blood levels in patients who have had gastric bypass surgery
title Low hydroxychloroquine blood levels in patients who have had gastric bypass surgery
title_full Low hydroxychloroquine blood levels in patients who have had gastric bypass surgery
title_fullStr Low hydroxychloroquine blood levels in patients who have had gastric bypass surgery
title_full_unstemmed Low hydroxychloroquine blood levels in patients who have had gastric bypass surgery
title_short Low hydroxychloroquine blood levels in patients who have had gastric bypass surgery
title_sort low hydroxychloroquine blood levels in patients who have had gastric bypass surgery
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6577310/
https://www.ncbi.nlm.nih.gov/pubmed/31275579
http://dx.doi.org/10.1136/lupus-2019-000335
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