Absorption of Mirtazapine and Pregabalin with an Ileostomy

I wonder whether mirtazapine and pregabalin are absorbed with no colon? Thanks for any help.

Yes, mirtazapine is primarily absorbed in the small intestine, specifically the proximal part, reaching peak plasma concentrations within around 2 hours after oral administration.

Pregabalin is absorbed in the small intestine and proximal colon in a linear and dose-proportional fashion. However, differences have been noted between pregabalin controlled-release and immediate-release formulations.

Controlled-release forms of medications are not generally recommended for ileostomates.

Wow. You go, girlie 🙌🏻. What a wealth of information.

Welcome Sunnyblue1!

I also have an ileostomy, and for many years, I have been taking 600 mg per day of pregabalin (Lyrica) for chronic pain generated by damaged nerves in my spine. The capsules look like they are time-released, so you've brought up a very good point. Are they doing the same job they used to do?

I am going to ask this same question of my own medical team and will get back to you (and everyone) when I have their answer.

M

xo

Thanks for this important info, Infinity! A lot of us are dealing with more than one medical condition, and we can sometimes forget how one drug for "this" affects "that".

M

xo

How to Manage Ostomy Leaks with LeeAnne Hayden | Hollister

Excellent information, Infinity. I know you deal with a wealth of issues yourself, but it does not stop your willingness to help others. You place a high value on helping others, and I pray for you to be blessed as you bless others.

"There's no downside to acting on your values, doing what you care about, because even if it doesn't succeed, you'll know that you acted and took up a cause you believed in.”
— Seth Goldman

Thank you. I try to help when I can. If I can.

It is important to know where a drug is absorbed to determine if it is going to help or not. But the best way to know is to be self-aware. Do you feel better or get benefits from this drug or that drug? Be aware of whether the pills are coming out in your bag. Things like that.

I do deal with a lot of medical conditions as well as having an ileostomy. I try to research the meds I take and find out where they are absorbed and if they are going to help me or not. I don't just want to take a pill to take a pill if it isn't going to help me. I have taken time-release medications before to no benefit. I used to wonder why that was. Now I know that those are not recommended for people with ileostomies because they don't stay in your system long enough to take effect and be effective. I used to see pills come out whole in my bag. Also, I know gel caps don't work well for ileostomies. They tend to come out in your bag too. This is why I wear clear bags. I want to see what is coming out, and if a medication is coming out, then I know I need to make a med change. I had to do that with fish oil when I used to take it. First, I took it in gel caps. They kept coming out in my bag, so I had to switch to liquid fish oil (which, by the way, tastes nasty). Now I don't have to take it anymore, and I'm glad. But I learned from experience. I had the same experience with time-released Pristiq, an antidepressant. It just popped out in my bag whole and hard. I wasn't feeling a benefit from it, so I stopped taking it. If you know yourself, you will know if you are getting any benefit from a medication. If you don't feel like you are getting any benefit from taking something, talk to your doctor.

Exactly. I've been prescribed Lyrica for many years, so I'm not sure if the drug's effect has been diminished by having an ileostomy a year ago. While there are no pills coming through the pouch (they are capsules with tiny beads that dissolve), I've never thought to ask any medical professional whether its absorption has been affected. I have been challenged with more nerve pain than before, but I never thought that the ileostomy would have an impact.

You are one smart cookie, girl!

Hi, I am wondering where you get your info about drug absorption? I have been looking everywhere; I'm a pharmacist and couldn't find any sources of info. Yours is brilliant; thanks so much.

Hi Sunnyblue1,

Much to my dismay, when I first got my ileostomy and my medications started coming out completely undigested, floating in the toilet, I sat down with my pharmacists, who explained to me that most medications (especially long-acting ones) are designed for people who have a large bowel.

I think it depends on how much bowel you have left, though - I need to take most of my medications in liquid form, and even then I don't always absorb it all as I suffer from rapid transit.

If you have any concerns about your absorption of Mirtazapine and Pregabalin, talk to your pharmacist; both medications do come in liquid form.

All the best from New Zealand,

Gracie

I have to take my pain relief medication (an opioid) in liquid form - the very first time that I was given it in the hospital, I spat it straight out again, as it tastes so disgustingly bitter - I figured out very quickly that by diluting it in a glass of juice or soda, I can manage to get it down.

I actually appreciated reading that you suffer from other medical conditions, as well as having an ileostomy. Before I joined this group, I had never met another person in real life who also had a bag (although many people know that I am ill and have been chronically ill for a very long time, I never tell people that I have an ileostomy - not because I'm embarrassed but because this is a private subject for me).

I used to have a very long list of medications that I once took, but I sat down with my GP and we cut a lot of medications out, as part of the reason why I had such a long list was to do with side effects, for which my doctors in the hospital would simply prescribe another medication to help cope with the side effects.

I actually studied to be a herbologist; although I have never practiced, I do use a lot of herbal medications with my doctor's permission.

I'm also very lucky that I have a very good pharmacist who will check first if my doctor wants to try a new medication. He'll check how it will interact with my existing medication and whether or not I am likely to absorb it, whether or not the medication can be crushed, as many a tablet has ended up in my bag completely intact - and these days most of my medication is in liquid form; and not all taste fantastic....