Medications to Avoid Before Surgery

If you are scheduled to undergo a surgical procedure, your primary care physician and surgeon will give detailed instructions on how to prepare in the days leading up to your surgery. You may be asked to continue taking some of your routine medications until the morning of your surgery. However, your doctors may advise you to discontinue or adjust certain medications before your procedure. Besides prescription drugs, over-the-counter products such as dietary supplements, and herbal medicines, can complicate your procedures by increasing risks of bleeding problems or interfering with anesthesia used during surgery. Whether it is a same-day procedure or a major surgery, you should fully inform your surgical team about your current medications. Please continue reading to learn about some of the medications to avoid before surgery.

What medications should you stop before surgery?

The type of medication, surgery, and your health history are some of the factors that determine when and if you have to stop taking certain medications prior to your surgery. Some medications need to be stopped a week before, others 2-3 days before, and others 24 hours before surgery. You must do exactly as instructed by your surgeon to prevent complications during and after the surgery.

Blood thinners

Anticoagulants and antiplatelets are different types of blood thinners. These medications increase your risk of bleeding problems; therefore, you would need to stop taking them several days before surgery. Both your surgeon and your primary care provider will tell you when to stop your home anticoagulants; these oral medications may be replaced with injectable forms temporarily (intravenous medications).

Examples of prescription anticoagulants include warfarin (Coumadin), enoxaparin (Lovenox), rivaroxaban (Xarelto), apixaban (Eliquis), and dipyridamole (Persantine). Clopidogrel (Plavix), an antiplatelet, is another commonly-prescribed blood thinner.

Patients who have taken anticoagulant therapy cannot receive regional anesthesia such as an epidural or spinal block.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) can cause bleeding problems during and after surgery. Examples of prescription NSAIDs include mefenamic acid (Ponstel), celecoxib (Celebrex), and diclofenac (Voltaren). Over-the-counter NSAIDs include aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve).

Monoamine oxidase inhibitors (MAOIs)

This class of drugs includes most anti-Parkinson drugs and certain antidepressants and antibiotics. Your surgeon will ask you to stop taking MAOIs 7-14 days before surgery because they can interfere with medications used during anesthesia.

Examples of MAOIs include phenelzine (Nardelzine, Nardil), tranylcypromine (Sicoton, Parnate), selegiline (Deprenyl, Eldepryl), rasagiline (Azilect), isocarboxazid (Marplan), and linezolid (Zuvox).

Weight loss medications

Your surgeon may ask you to avoid weight loss drugs and diet pills for 7 days before surgery because of their interactions with anesthesia drugs. Examples of these medications include phentermine (Adipex-P, Fastin, Lomaira, Zantryl), phentermine-topiramate (Qsymia), phendimetrazine (Melfiat), and naltrexone bupropion (Contrave). Your care team will instruct you on how to taper down the dose of certain medication, if necessary.

Pain and anxiety medications

Medications such as tramadol (Ultram), hydrocodone (Vicodin), oxycodone with acetaminophen (Percocet), diazepam (Valium), and pregabalin (Lyrica) may need to be held before surgery because they can interfere with pain control after surgery.

Medications used to treat alcohol and opioid use

Medications such as naltrexone (Vivitrol) usually need to be stopped 2-3 days before surgical procedures because they can interfere with pain management after surgery.

Diabetes medications

In the days leading up to your surgery, you should take your diabetic medication as usual. Talk to your primary care doctor about your plan for the surgery. Your primary care provider will provide you with guidance on how to best manage your diabetes prior to your surgery. You should communicate this plan with your surgeon. Make sure your doctor tells you how to adjust the dose or hold certain diabetes medications such as insulin, insulin glargine (Lantus), metformin, pioglitazone (Actos), dulaglutide (Trulicity), and empagliflozin (Jardiance).

Diuretics (water pills)

Diuretics or water pills are used to treat high blood pressure, heart failure, liver failure, and swelling. Your doctor may ask you to hold these medications on the morning of your surgery to avoid dehydration. Examples include hydrochlorothiazide (HCTZ), furosemide (Lasix), and spironolactone (Aldactone).

Substances for medicinal or recreational use

Nicotine, alcohol, marijuana, and cannabidiol (CBD oil) products can cause problems with heart rate, blood pressure, and pain control during and after surgery. You should avoid using them in the days before your procedure. Your doctor can advise you on the most effective ways to quit smoking.

Supplements

A vitamin E dietary supplement and herbal products like turmeric, garlic, ginger, ginkgo biloba, feverfew, fish oil, and St. John’s Wort should be stopped one to two weeks prior to surgery as they can increase the risk of bleeding problems.

Other supplements that should be stopped several days before surgery include echinacea, ephedra, kava, and valerian root. Some of these supplements can increase the risk of bleeding, while others can affect blood pressure and heart rate, and yet others can prolong the sedative effects of anesthesia.

Can you take blood pressure medications before surgery?

In general, you can take blood pressure medication up until the morning of your surgery. Your doctor will give you more detailed instructions.

Should vitamin D be stopped before surgery?

You may not need to stop vitamin D before surgery. Studies have shown that patients with vitamin D deficiency have higher mortality rates after ICU admissions. Also, patients who underwent non-heart surgery and had high vitamin D levels have been found to have significantly lower mortality rates. Therefore, high vitamin D levels may be associated with a lower risk of serious cardiovascular events, infections, and hospital deaths in ICU patients.

Which medications should you continue before surgery?

It can be unsafe to stop many drugs, such as beta-blockers, statins, inhalers for asthma, anti-seizure medications, proton pump inhibitors for acid reflux, and antibiotics before surgery.

Certain psychiatric medications, including anti-depressants, anti-anxiety drugs, and medications used to treat bipolar disorder and schizophrenia can cause an altered response to drugs used during anesthesia, leading to increased anesthesia requirements. However, your primary physician and surgeon may ask you to continue taking tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, and antipsychotic drugs throughout the perioperative period (before and after surgery) to prevent withdrawal symptoms or relapse.

Talk to your healthcare team if you are not sure which medications to discontinue before a surgical procedure.

References: