Ask the Colorectal Surgeon

Dr. Beck is board certified in general and colon and rectal surgery and is a Clinical Professor of Surgery at Vanderbilt. Dr. Beck conducts research into colorectal diseases, has authored and edited nine medical textbooks, and written over 350 scientific publications. He was the President of the American Society of Colon and Rectal Surgeons (ASCRS) from 2010-2011. Dr. Beck is a nationally recognized expert in inflammatory bowel disease, anal, rectal and colon cancer, stomas, adhesions, bowel preparation, sphincter saving surgery for cancer, laparoscopic surgery, and postoperative pain management.

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Medication in Liquid Form

I was told I need an ileostomy and that medications are poorly absorbed. I have Sjogren’s. My gastroenterologist told me to ask all of my doctors to prescribe liquid medications. The problem is these doctors don’t know how much to prescribe in liquid form.

I need an authoritative source that lists the percent of decrease absorption of each medication. For example, is Diazide absorbed 50% less? So then doctors must prescribe 50% more? Would the liquid form stay on 25mg? I need my meds and this doesn’t seem easy trying to find liquids.

An ileostomy by itself usually doesn’t significantly alter the absorption of most medications as the length of the small bowel, where most of the absorption occurs, is about the same. Some of the confusion is that some medications are put into capulets (or carriers) and the medication is absorbed but the carrier comes out the stoma looking intact (without a stoma it would be mixed in with the stool).

With most medications, we dose to effect. For blood pressure, we start with a dose and see how it affects the blood pressure. If the result is not adequate we just increase the dose or try another medication. For some medications, we can also measure blood levels (ie. Thyroid, some Crohn’s disease medications, etc,). Most physicians start at the recommended dosage whether it is a pill or liquid and monitor the patient. The dosage can then be modified as needed. Your pharmacist is also a good source of information about your medication.
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