It should be noted that post-bariatric patients should not take medications formulated as extended-release (Item 138-1). —Judi Townsend, PA-C, Scarsdale, N.Y.

This is a theoretical consideration. Because of the shortened length of the small intestine after surgery, absorption of an extended- or delayed-release preparation may not be complete before the drug is passed into the colon, leading to decreased efficacy (although not toxicity). I was also remiss in neglecting to point out that concerns have been raised about nonsteroidal anti-inflammatory drugs and salicylates in this patient group. The concern is that the smaller stomach size will be more susceptible to ulceration, and although only one such case has been described in the literature, practitioners should therefore be wary of these medications after bariatric surgery (Am J Health Syst Pharm. 2006;63:1852-1857).—Reuben W. Zimmerman, PA-C (140-13)