This topic is about understanding how two specific medications, mirtazapine and pregabalin, are absorbed in the body of someone with an ileostomy. An ileostomy involves the removal of the colon, and this can affect how medications are processed. Here are some helpful insights and advice for those in this situation:

1. **Pharmacokinetic Basics**
- Mirtazapine is absorbed mainly in the upper part of the small intestine and reaches its peak in the blood about two hours after taking it. The colon is not needed for its absorption.
- Pregabalin is absorbed throughout the small intestine and the beginning of the colon. Its absorption is consistent and proportional to the dose for the immediate-release version.

2. **Formulation Matters**
- Controlled-release or time-release medications are generally not suitable for people with an ileostomy because the transit time is too short, and the medication may pass through without being fully absorbed.
- Immediate-release Lyrica (pregabalin) capsules usually dissolve quickly enough, but it's important to monitor their effectiveness.
- Gel-caps and soft-gels often pass through undigested, so liquid, crushable, or tablet alternatives are better options.
- Both mirtazapine and pregabalin are available as oral solutions, which might be more effective if absorption is a concern. Consult with a pharmacist about these options.

3. **Practical Self-Monitoring**
- Use a clear pouch to easily spot any undissolved medication.
- Keep track of how well your symptoms are controlled. If you notice increased pain, low mood, or other symptoms, it might indicate poor absorption even if you don't see pills in the pouch.
- If you see whole pills, beads, or capsules in the pouch, or if the medication seems less effective, report this to your doctor or pharmacist right away.

4. **Working with Professionals**
- Pharmacists can help determine where each drug is absorbed, whether it can be crushed, and what liquid or immediate-release options are available.
- Regular reviews of your medications can help remove any that are only being used to counter side effects or are no longer needed.

5. **Additional Tips**
- Extremely bitter liquid medicines can be made more palatable by mixing them with juice or soda.
- Reliable information can be obtained from pharmacists, published data, and personal observation. Many people have learned which formulations don't work by noticing intact pills in their pouch.