Slow-release Medications & Ileostomy - Absorption Concerns?

Hi all,

I am new to this forum, so apologies if I have posted this in the wrong category.

I had a loop ileostomy done less than a week ago, and I have a question about medications, specifically about slow-release antidepressants. I am on Effexor XR, 150mg, per day. I believe it's the slow-release type. Does anyone know if these slow-release types of medications are absorbed by the stomach/body properly still after having an ileostomy, or are they simply excreted without being absorbed?

My reason for asking is because while I've been in the hospital, I was given some slow-release painkillers which didn't work - when I emptied my bag, the painkillers came out digested and whole. When I showed the nurse, she said, "Oh yes, the doctor shouldn't have given you those as slow-release medications can't be absorbed by people who have ileostomies/stomas." That made me quite worried because if that's the case, it means my antidepressants aren't being absorbed either and therefore I'm not managing my mental health appropriately. (Might also explain why my anxiety is going through the roof right now).

If anyone has any info on this or could share their experience or even just an opinion, I'd be really grateful. I know the obvious answer here is to ask the doctors, and I plan to - but it's a long weekend here, I'm stuck in the hospital without seeing the doctor and surgeon who did my ileostomy until Monday, and I don't want to spend my entire weekend overthinking this in my head. So if anyone wants to share some info, I'd be grateful.

Thank you :) x

Hi Georgiesgirl,

When I was in your situation, exactly the same thing happened. I ended up grinding the medication in a pestle, tipping it into a glass with some water, and then drank it. It tastes like crap, but it worked.

Axl

Hello Georgiesgirl.

Thank you so much for inviting us to share opinions as well as experiences for this is where my own responses emanate. 

Firstly, I would say that your new-best-friend woud be the nurse that told you the Doctor should  not have prescribed that medication. She obviously knows what she is talking about and might be able to help you rectify the doctor's mistakes.

Secondly, it does seem that asking the doctor about this would be a sound move, but only if the doctor is aware of the problems and is willing to adjust their practice accordingly.

Thirdly, your mental health is just as important as any other part of your wellbeing. The people who prescribe for mental health issues are not necessarily versed in the ways of ileostomies so your nurse/friend could be useful here too. 

Fourthly, if you don't want to spend the whole weekend 'overthinking' this issue, it might be an idea to spend some time finding out more information via the internet, so that when you talk to the doctor, you can point them in the right direction for the correct information in this regard.

I hope that some others will chip in with experience and advice, as this is an area that is often neglected in the training of doctors. The surgeons often don't have any experience of problems arising post operation- which is where the experience of stoma nurses can be very helpful. On this point, sometimes a good pharmacist with knowledge in this area can be useful in pointing doctors in the right direction regarding their prescribing. 

Personally, I nearly always look these sort of things up in the medical journals and elsewhere before confronting doctors. They may not like what I have to say, but as I usually have it all written down for them to keep, I find that they take things much more seriously. 

Lastly, bear in mind that the health services are yet another form of 'bureaucracy' (See HenryM's recent post). They thrive on 'paperwork' and if things are in writing, they are almost obliged to reply in writing. I have never needed to threaten them with 'litigation' because the written word implies that this might be a potential outcome of of any correspondence. Sometimes, using your own GP to correspond your concerns to the other prescribing doctors  can be an effective method of rapid communication. 

Alternatively, I sometimes find that a rhyming verse, expressing my 'feelings' on a subject is less confrontational, but highly effective in putting a particular point across ( but that is perhaps a different 'skill').

Best wishes

Bill

Hi Georgie, I had the same issue with a heart med when I had resection surgery, and the nurse said the same thing. So, being aware of the problem, she would grind up the med and mix it in with some applesauce for me.

Hi, welcome to the site.

I have an ileostomy and find that the capsules don't dissolve and come out whole in the bag. I have not had any issues with tablet form though. XX

Words of Encouragement from Ostomy Advocates I Hollister

Hi georgiesgirl,

I've had my ileostomy for 11 years. I too was concerned about meds passing through and not working. My family doctor, now retired, told me that if I dropped a pill in a glass of water and it didn't dissolve within 30 minutes, it would pass through. Hope this helps.
Charleston guy

Hi!

I've been told by my surgeon, GI doc, pharmacist, and other ileostomates that time-/slow-release medications are not good ideas for us ileostomates - and for the exact same reason that the nurse explained.

I take all of my one-per-day meds and supplements with my dinner so my stomach and small intestine have time to absorb as much as possible while I'm lying down, asleep. (Would you believe that, while standing, gravity helps everything move through our GI tract FASTER?! LOL) Larger, solid pills I do cut down with a pill splitter to make it easier and faster for my system to break them down in my GI tract. It works for me!

Feel better soon!

Lily17

Hi Georgies,

Your solution is as you stated in the end of your post. Ask your doc. It doesn't matter that it's a weekend, tell the nurse taking care of you that you want to talk to the physician on call who's responsible for you. If he/she doesn't know the answer to your question, it's their job to contact your doc and figure it out. You're not inconveniencing anyone. I guarantee if you wait and tell your doc on Monday about your concerns, he/she's going to say you should have told the doc on call! Ask your nurse ASAP to have the doc on call come talk to you!!

The Effexor XR is coated to resist stomach acid, so crushing it will just result in it being destroyed by your stomach. It's designed to be released slowly in your bowel, where it's absorbed and ends up in your liver, where it's expelled through your urine. Even if it did survive your stomach, you don't want it all being absorbed quickly... it's not safe. Depending on what your transit time of food is when you eat (meaning how long it stays in your intestines before hitting your bag), it's probably only releasing a little bit before it's expelled into your bag. They do have this medicine in IV form, which although inconvenient when you leave the hospital, should be easy to administer while they have an IV in you. A simple discussion with the doc on call could make that happen in minutes... which is why you should never hesitate to express any medical concerns with the attending physician.

I used to be just like you, never wanting to bother doctors, especially when they weren't there... but you have to remember they work for you. They signed up to be available 24/7, and if not, then they have someone covering for them. I used to call my original gastro at his house... anytime day or night... because he wanted me to if I had any issues. His wife would pick up the phone and instantly say... "Oh hi Bob... hang on, I'll get Tom... he's out in the yard" and he was always grateful that I called instead of waiting and making things worse.

So hit that call button... and tell the nurse your concern. Then make sure you see or talk to a doc in the next couple of hours. Nurses are stupid busy and will send a note to the attending physician... and then she's on to her next emergency... so if you don't hear from the doc shortly... ASK AGAIN. Squeaky wheel gets the grease! Get you some grease!!!

Regards,

Bob

It is true....

If it's a capsule, I usually open it and put everything on my tongue, then take it with a glass of water....

Dear GeorgiesGirl,

The surest way to find out about your ability to absorb any antidepressant is to have the prescribing psychiatrist order a blood level of that medication. That way, if you do not have a therapeutic blood level of the antidepressant in your system, your doctor will know he or she must find a different antidepressant for you or change your dosage. Or you can just suggest your doctor make the change. In general, timed-release medications are not predictably absorbed by those of us with ileostomies. It might be that you will need a higher dose of a given medication in order to achieve a therapeutic result. The serum concentration level of the medication can help your doctor determine how much you will need to get a therapeutic effect. I do not know if crushing your medication and taking it with water will be the answer or not. Since antidepressant medications are crucial, it would make sense not to guess but to either not be on a timed-release antidepressant or get blood levels.

It's great that you are on top of this and planning on advocating for yourself.

All my best,

Eve

Hi Georgiesgirl, I have found and you will find that surgeons, in many cases, know very little about the day-to-day operations of an ostomy in the real world. They may be a genius on the mechanics of it, in taking your guts out and putting them back in the right place, but the day-to-day ostomy stuff is beyond them. That's fine, I want him to be an expert on cutting me up and removing or installing bits of my anatomy, that is his job. My GP was not very knowledgeable on the day-to-day stuff either. She would always give me plenty of time to talk and explain the not-so-obvious problems we face. One of those was the fact that our gut transit is way too fast for most time-release medication to be dissolved and absorbed by the body. You have a loop ileo which can cause problems not seen in an end ostomy. I have a J pouch still inside me but disconnected and inactive. The side of the loop that goes down to the J pouch can sometimes suck in food particles from very liquid output when you are lying down. Your stoma has two holes, not just one as in an end ostomy. I found bits of carrot in the toilet when I was having extremely bad, painful pelvic cramping and felt like something was inside my butt and sat on the toilet. Usually, it is just mucus which is normal. Finding the carrot was a revelation for me. I realized that some food was getting into the internal J pouch from the stoma instead of going into the bag. These food particles must have been fermenting in the J pouch and causing pain similar to pelvic inflammatory disease in women, horrible, horrible cramps that had me folded in two on the floor and calling my local doc to beg her to come and give me a pain shot, which she did. When I figured out what was happening by myself, I explained it to my GP and she was fascinated by my explanation and the logic of my idea. It had never occurred to her that the loop ileo could have this painful result, but I convinced her. The solution was to take Cipro and Flagyl together to fight the bacterial infection that was causing my pain. I found the solution myself and when I explained, she believed in me and prescribed Cipro and Flagyl. I had this problem for years and nobody could explain it. The surgeon who gave me the J pouch had the nerve to tell my brother that I must be making it all up and there was no reason for what I said I was feeling, he simply lied or did not know enough about the workings of a real-life ostomy after he cut me and stapled me back together.

I thought my loop ileostomy info might be useful to you. Ask people on this site and you get the info right from the horse's mouth so to speak!! Many people on here know more than your GP or your surgeon about the real world of the ostomate.

Hang in there and it will get better. I have suggestions if you look at my Photos Page, pics of loop ileo are very informative about the mechanics of it.

Hope you feel better soon.

E. AKAMister Magoo.

Best not to grind up extended-release medications as that may give you an overdose. They're meant to release in a different location of the GI system or break open slowly. A better plan is to speak to your pharmacist. Let them know you have an ileostomy and they can advise about alternatives or speak to your physician.

Very good point MBT, a flood of a med that's meant to be a trickle could definitely be problematic, good catch MBT!! I was given a time-release pill to help me sleep. After some reading, I found that this was an antidepressant which is used for sleep but only in controlled doses. Taking it out of the slow-release capsule could have been a problem. I asked my doc and we settled on something different. People should always ask the doc if you have any doubts or questions about a med, much safer.

Eamon.

Thank you everyone for your replies to my post and helpful suggestions. I am still being bounced back and forth between the medical doctor, the surgeon, the pharmacist, the ward nurses and as of half an hour ago, a psychiatrist that they brought in to see what his opinion was.

I admit I got a bit bewildered by the psychiatrist being there - I didn't need one of them. I'm simply on antidepressants for my anxiety and depression. But they were treating me like a moron for asking a perfectly valid question about getting my meds absorbed properly when in reality, none of them could answer the question.

As it stands, they've got me emptying the capsule into applesauce each morning now until a proper solution can be found. It's not an answer and I'm planning to see a compound pharmacist as soon as I am discharged by the hospital.

Thanks everyone for your input, stay well x

Oh dear, it sounds like you are being messed around with a simple question. If they bothered to look on the leaflet that you get in all medicine, then they would have come across a number they could have rung to get more information on the tablets/capsule or any other form. I hope that you get sorted soon. Keep us updated XX

I was taking Flomax before my surgery and it is a slow-release. After the stoma, I noticed that it was not fully dissolved when it came out. The doctor ended up prescribing a double dose to take one in the morning and one in the evening assuming half is digested each time. The doctor and pharmacy were adamant not to crush it as it is too much at once. Good luck!

Hi OB, when I mentioned that to my doctor a few years ago, he said when I can't go anymore, he will up my dosage to twice a day.