Absorption of Medication with Ileostomy?

Dear Ostomy Community,

I am planning on undergoing surgery for an ileostomy later this spring. One pressing question I have is how the ileostomy affects absorption of medication since I'm on numerous meds for other conditions.

I so very much appreciate in advance your insights and knowledge.

Thank you!

Philomela

Hello Philomela,

Welcome to the site.

Here is a good place to ask questions, for there is such vast experience spread over the wide membership - many folk will be able to share their experience.

Personally, I do not take much pharma - and when I do on occasion, it is usually on a PRN [as necessary] basis.

But I have found, over the years of having my ileostomy, that medication can be prescribed as either having an enteric coating to the tablet, or in the case of capsules/tablets, they also come in 'gastro resist' form - so I guess your GP will be able to help - in conjunction with your professional clinicians as regards your bowel/ileostomy management.

I believe - in general - you may find that your existing conditions may be able to be effectively managed - albeit by perhaps an adjustment in prescription to help 'protect' and balance your remaining parts of your digestive tract.

It is true that if one loses one's large bowel, then medication and material do not remain in the body for the same length of time as when the body is complete with an intact colon. However, I guess that as you have arrived at the point whereby you are facing bowel surgery, then you already have some measure of these points. The good news, I guess, is that the diseased parts that will be removed will cease to affect you in the current ways you are experiencing.

Individual diet management and times of eating and regularity/quantity of food ingested is a personal recipe of 'test and note and adapt and adopt.' I do feel for your concerns, as it is always the 'unknown' elements that we ruminate over prior to being able to move forward with appropriate change.

Good luck with your future surgery. You may be agreeably surprised once you have undergone the initial adjustment. It takes time to settle, and we all deal with this in different ways - we are ALL individual - there is no standard set of answers.

I am sure you will have many informative replies from the membership, as the management of concomitant conditions is not unusual.

BW

Jayne

Thank you so much for your thoughtful reply—I appreciate it so much!

Jayne, one follow-up question if I may: Do you mean that enteric-coated medications are preferable for those who have an ileostomy, or are to be avoided?

Thank you!

Philomela

Within my own experience, I have found that the enteric-coated versions have provided me with a longer delay before breakdown of the medication, and thus have been best, for they have not become a 'chemical soup' too soon on their way through my system.

But do, please bear in mind - we all have a different acidity and absorption balance at any one time - so this is not a 'rule for all'.

Be patient - others will contribute. I am not the best person as I do not take a complex chemical mix for chronic pharma treatment. I prefer meditation for pain relief and also focused visualizing too, because that works for me to a point. All of that said, however, I DO take antibiotics on a course-by-course basis when there is an exacerbation of inflammation, but AB treatment is never prolonged over a long time frame as such extended chemical toxicity is, I fear, usually counterproductive.

General exchange of experience can never be a substitute for a person's individual prescription or recommended treatment options because we are all different.

......

So sorry - ambiguity remains

;-)(

BW

Jayne

Philomela, nothing coated and no time-release tablets. Tablets and capsules are both fine, as is “fast acting.”

Philomena

I have never had much in the way of medication, but I do recall slow-release types ending up in the bag before dissolving while I was in the hospital. I did take antibiotics for a while, and the doctor suggested grinding them to powder and putting them in water to take. It tasted awful but worked, but always check with the doctor before proceeding. At the end of the day, it should be fairly easy to detect if any meds are passing straight through into the bag.

Hi Philomela, in the early days after surgery, your output will be more on the liquid side, so meds will pass through quicker. Once your system settles down and you can control it some with foods like peanut butter, applesauce, and mashed potatoes, you will be able to figure out what meds stay in your system better to get the full effect from them. Good luck.

Thank you so much to the community for these helpful replies—very much appreciated.

Philomela,

I have a high output ileostomy for over a year now and take 14 different medications daily for numerous chronic conditions. For me, anything enteric-coated, slow-release, or modified-release is a waste of time and money. They just come out whole in the bag and get flushed. Consult your pharmacist and GP for alternate delivery. Also important for your GP to monitor the effectiveness of your medications post-ileostomy.

Following surgery, you may be fitted with a clear bag so your stoma and output can be observed. I understand many ostomates change to opaque bags ASAP, but I found the clear bags useful, firstly to identify what medications are not being absorbed and secondly to understand the impact of your diet on output, and therefore avoid known issues.

It will take some adjustment to life with an ileostomy, but your surgeon, stoma nurse, and GP should be able to help you. This site contains a wealth of information that can assist and lots of good people for advice and support.

Best wishes, Rob.

G'day Philomela, this is a good place for answers on things that some of us have been through, but this is a question for a doctor or better still the chemist at what you call the drug store. Regards, IGGIE

Hi Philo,

I think it's explained above very well. Here's just a link to a site that goes into a bit more detail. https://www.capsulcn.com/different-types-of-capsules-guide

After your surgery, how and where you absorb meds will depend on how much of your bowel is left, or which sections are removed. Your doc can order you some empty pill shells that you can take to see if they fully dissolve or not when you take them. That doesn't tell you where they dissolved, but it's a good indicator of them not dissolving if they come out whole. Drugs can be compounded for different shells, but not all drugs can be put in all shells. It depends on how they need to be released and if they're chemically compatible with the shell material. You also have to be careful about taking meds that are not designed to be released in your stomach, as those can cause other problems. Between your doc and your pharmacist, they should be able to get you what you need. For supplements, you also have the option of getting many in sublingual form, where you put a fast-dissolving tablet under your tongue and it gets absorbed there quickly. So you have options.

;O)

Bob

I'm overwhelmed by the generosity of this community. Thank you all for such helpful replies.

Hi Philo,

Almost forgot... that will be $749.35, please. To make it easier for us to divide up, please send 7 checks for $107.05 each, care of this site. If you hold off on asking any more questions, we're running a buy one get one free for the month of February, so you can save some money.

;O)

I was prescribed Premarin (estrogen) because of the hysterectomy portion of the crap I went through. When I was switched from colostomy to ileostomy, I guess no one took that into consideration. So, one day as I'm in the bathroom, I looked down at my bag and saw what looked like a white bean in there. I racked my brain thinking, now I know I didn't eat any beans. A couple of days of this, then I realized it was the Premarin. It's enteric-coated, so no time to absorb and went right on through and into the bag. So, as others have said, no enteric-coated pills. (Sometimes there are alternatives like patches or gels.) I don't know about time-released pills—I would imagine it to be the same—other stuff seemed to be fine. Hope you have a nice day!

Nine out of ten doctors think you will be okay - the tenth one thinks you still have money left… w30bob was the tenth. jb