What Medications Are Taken Prior to Surgery and Which Ones Should Be Avoided?

You should inform your surgeon, anesthesiologist, and anyone else caring for you of every prescription and non-prescription medication, herbal remedy, or health supplement you take, and discuss with them which medications to stop, and when to stop them, before surgery. As a general rule, medications necessary for control of ongoing health problems usually are taken on schedule; those more elective may be temporarily omitted, and some should be avoided.

Some common situations:

Anti-Hypertensive (blood pressure) medications: generally all are taken as usual, except that diuretics (fluid pills) should not be taken immediately prior to operation.

Cholesterol lowering agents: generally taken on schedule. The usual practice of taking these in the evening makes empty stomach issues less of a consideration.

Anticoagulants:

Drugs given to control blood clotting obviously present potential problems during surgery. Care must be individualized weighing the risk of bleeding vs. problems with undesired blood clotting.

Aspirin is generally omitted for 5 – 7 days before a procedure if the patient is taking it because of a desire to minimize heart attach or stroke. If one has not had a serious problem, it usually is indeed safe to omit the medication for a few days. If one has had a transient ischemic attack (mini-stroke -- TIA), heart attack etc., it may well be more prudent to continue the medication; the surgeon may well take additional steps beyond the routine to achieve hemostasis (control bleeding)

Other antiplatelet drugs such as clopidogrel (Plavix) present more danger of bleeding, and Plavix in particular cannot be reversed; it takes about a week for the drug to be fully metabolized and clotting returned to normal.

Warfarin (Coumadin) presents may difficulties. Depending on the operation the dose might be reduced, the drug stopped for a few days, or in higher risk patients, the Coumadin is stopped and heparin administered to keep anticoagulation in place until just before surgery, Heparin can be reversed, and then after operation heparin is resumed until the usual Coumadin dose is reestablished and the drug level is therapeutic

Diabetes Medications:

Insulin is given in appropriate doses considering the patient’s oral intake. With modern long-acting basal insulins, the basal dose is given but the short-acting insulin omitted while oral intake is compromised.

 Oral agents are difficult, and often insulin will be substituted in the perioperative phase.

Of particular concern is metformin (Glucophage). Metformin is potentially dangerous when patients receive intravenous contrast agents for X-ray studies such as CT scans or angiograms. The drug must be avoided for at least 48 hours after such a procedure, and not given immediately prior.

Vitamin supplements are not essential and generally are omitted prior to operation.

Herbal medications: Generally should be omitted. What is particularly important is that surgeons and anesthesiologists need to be aware of their use and of other non-traditional medications you are using, as they often do have serious interactions with anesthetic agents and other medications.

Birth control pills and other hormone based contraceptives: Generally these may be taken on schedule, realizing that there is a slightly increased risk of deep venous clotting and thromboembolism when on these agents. In high risk cases, and for operations at high risk for venous clotting problems, they should be stopped well before operation and other methods of contraception used. Remember that if stopped, withdrawal bleeding may occur, and the pills generally should not be relied on for contraception until at least seven days after resuming treatment.