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From what clothes to wear to how to prepare – we know there’s lots to think about when getting ready for an operation. Understanding which medications you can keep taking and which ones you’ll need to avoid is high up the list.
So, to make things easier for you (because we’re nice like that!), we’ve put together a load of helpful information about medication before surgery. You can use it to tick one more thing off your list.
Please remember though, this guide is here to provide general information, not tailored medical advice. Your surgeon or healthcare provider will be able to give you the best instruction on what’s right for you. Talk to them if you have any concerns or questions about your medications.
Why do I need to stop medication before surgery?
First off, we need to make it clear you don’t need to stop all medication before surgery. Some medication is absolutely fine to keep taking, whereas others will need to be stopped.
There are a number of reasons why you may need to avoid certain medications during pre-habilitation for surgery. These include but are not limited to:
- Preventing excessive bleeding – Some meds, especially blood thinners and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), can increase the risk of bleeding during surgery
- Anaesthesia management – Certain meds can interfere with how general anaesthetic works, either by making it less effective or causing bad reactions
- Managing blood pressure and heart rate – Some medications can affect your heart and blood pressure, leading to dangerous changes during surgery. This can be risky and make the procedure more complicated
- Maintaining kidney and liver function – Meds that impact the kidneys and liver can be problematic. These organs are vital for processing anaesthesia and other drugs during surgery
- Controlling blood sugar levels – For diabetic patients, managing blood sugar levels during surgery is key. Some diabetes meds might need adjusting to avoid hypoglycemia or hyperglycemia.1
This list may sound alarming but there’s no need to worry. As long as you talk to your surgeon or health provider about the medicines you are currently taking, they will be able to advise you on the best course of action to ensure the safest possible surgical procedure.
Medications to stop before surgery
Knowing which medications to avoid before surgery is essential for ensuring a safe and successful operation.
You should always talk openly with your healthcare provider about all the medications and supplements you’re taking. If you’re on a lot of medication, it may be worth making a list to make sure you don’t miss anything off. Your healthcare provider will give you specific instructions on what to stop and what you can continue to take. In the meantime, here are some general guidelines:
1. Blood thinners
Common medications: Aspirin, Warfarin, Clopidogrel, Heparin, Prasugrel, Ticagrelor and newer anticoagulants
Why to avoid: Blood thinners can increase the risk of excessive bleeding during and after surgery. While they’re great for preventing clots in everyday life, they’re not so great when you’re about to have a procedure that needs precise blood control. Aspirin can sometimes be taken before surgery, but always ask your healthcare provider before doing so.2
2. Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
Common medications: Ibuprofen, Naproxen, Diclofenac.
Why to avoid: NSAIDs can thin your blood too, making you bleed more. They can also interfere with your kidney function. NSAIDS are best avoided if you are undergoing neuro, spinal, cardiac, or orthopaedic surgery.
3. Herbal supplements
Common supplements: Ginkgo Biloba, Garlic, Ginseng, St. John’s Wort, Echinacea.
Why to avoid: Herbal supplements can interfere with anaesthesia and other meds used during surgery. Some can increase bleeding risk or mess with your blood pressure and heart rate. It’s best to stop taking these at least two weeks before surgery (3) but always check with your doctor or surgeon first.
4. Certain antidepressants
Common medications: MAOIs (Monoamine Oxidase Inhibitors) like Phenelzine and Tranylcypromine.
Why to avoid: MAOIs can negatively affect anaesthesia and other surgery meds. This can lead to dangerous spikes in blood pressure or other issues.
5. Diabetes medications
Common medications: Insulin, Metformin, and other oral hypoglycemic agents.
Why to avoid: These meds affect your blood sugar levels, which need to be stable during surgery. Your doctor might tweak your dosage or timing. Diabetic patients will be given specific advice.
6. ACE inhibitors and ARBs
Common medications: Lisinopril, Ramipril, Enalapril, Perindopril, Captopril, Fosinopril, Trandolapril
Why to avoid: These meds can sometimes cause a drop in blood pressure when combined with anaesthesia. This can lead to complications.
Medications you can take before surgery
We’ve looked at the medications you may need to avoid before surgery, now it’s time for those considered to be safe. The information below is general guidance on medication you can continue to take but remember – always consult with your healthcare provider for personalised advice.
1. Blood pressure medications
Common medications: Beta-blockers (e.g., Metoprolol, Atenolol) and Calcium channel blockers (e.g., Amlodipine, Diltiazem).
Why you can take them: Managing your blood pressure is crucial, even before surgery. These medications help keep your blood pressure stable, which is important for a safe surgical procedure.
2. Thyroid medications before surgery
Common medications: Levothyroxine, Carbimazole.
Why you can take them: Thyroid hormones are essential for maintaining your body’s metabolism. Continuing to take these medications helps avoid fluctuations in your hormone levels, which can complicate surgery and recovery.
3. Asthma medications
Common medications: Inhalers and Steroids.
Why you can take them: Keeping your airways open and reducing inflammation is vital, especially during surgery when you need optimal lung function. Continue using your prescribed inhalers and steroids unless advised otherwise by your doctor.
4. Anti-seizure medications
Common medications: Phenytoin, Levetiracetam, Sodium valproate.
Why you can take them: Maintaining control over seizures is crucial. Stopping these medications can increase the risk of a seizure. This can be particularly dangerous during surgery.
5. Pain medications before surgery
Common Medications: Codeine/co-codamol (Zapain), tramadol, morphine (MST, Zomorph), oxycodone (Longtec/Shortec), buprenorphine patches, paracetamol
Why you can take them: Unlike NSAIDs, opiates don’t affect blood clotting and are generally safe to take for pain relief leading up to surgery. Always confirm with your doctor, as your specific condition may have different requirements.
6. Antidepressants
Common medications: SSRIs (e.g., Sertraline), SNRIs (e.g., Venlafaxine).
Why you can take them: Mental health is just as important as physical health. Most antidepressants are safe to continue before surgery. Always check with your team, especially if you’re taking Monoamine Oxidase Inhibitors (MAOIs).
What happens before surgery?
Your journey to the operating room starts with a pre-operative consultation. This is an important meeting where you’ll discuss your health history, current medications, and any concerns you may have with your surgeon and / or healthcare team.
You’ll receive detailed guidance on which medications to continue and which to stop in the weeks before your surgery.
Your healthcare team may ask you to follow an NBM (Nil-by-Mouth) policy. This means you should not eat or drink for a certain period while preparing for surgery.
- Fasting guidelines: usually, you’ll be asked to stop eating and drinking at least 6-8 hours before surgery
- Clear liquids: in some cases, you may be allowed to drink clear liquids (such as water or black coffee) up to a few hours before surgery
- Medication with water: if you need to take essential medication during this fasting period, you can usually do so with a small sip of water, but only if your doctor approves.
This meeting is the perfect time to ask any questions about the surgery, the anaesthesia, and the recovery process.
Below, we’ve put together a few articles that cover the questions you may want to ask before certain operations.
- Questions to ask before knee replacement
- Questions to ask before hip replacement
- Questions to ask before cataract surgery
Medication given before surgery (pre-operative medications)
Before heading into surgery, you may be given specific medications to help prepare your body.
- Sedatives: these may be given to help you relax. This can help reduce anxiety before surgery and make you feel more comfortable
- Antibiotics: to prevent infections, you might receive an antibiotic through your IV. This is typically given shortly before surgery begins
- Antiemetics: these are medications to prevent nausea and vomiting, especially if you’re prone to motion sickness or have had issues with anaesthesia in the past
- Blood pressure medications: If you take blood pressure medication, you might be instructed to take it on the morning of surgery, depending on your doctor’s guidance.
Medication given during surgery
Once in the operating room, the surgical team will administer several medications to ensure your procedure goes smoothly.
- Anaesthesia: the anaesthetist will administer anaesthesia, which may be general (putting you to sleep), regional (numbing a large area of your body), or local (numbing a small area). This ensures you don’t feel any pain during surgery
- Muscle relaxants: If necessary, muscle relaxants might be given to ensure your muscles are completely relaxed during the procedure
- Pain management: Depending on the surgery, additional pain relief medication might be given to keep you comfortable.
Medication given after surgery
After the surgery, you’ll be given medications to help with recovery and to help manage any discomfort.
- Pain relief: Once you’re in the recovery room, you’ll receive pain relief medications. This will either be through an IV or orally
- Antibiotics: If there’s a risk of infection, you might continue to receive antibiotics after surgery to prevent complications
- Antiemetics: To prevent postoperative nausea, you may be given antiemetic medications. You’re more likely to be given this if you received general anaesthesia
- Blood thinners: Depending on the type of surgery, blood thinners might be prescribed to prevent blood clots during your recovery.
So, when it comes to taking medicine before surgery, it’s always best to ask your healthcare provider. They are best placed to give you the right advice.
Stay informed, stay safe, and here’s to a successful surgery and speedy recovery!
Sources and references
1 https://bnf.nice.org.uk/treatment-summaries/surgery-and-long-term-medication/
2 https://cavuhb.nhs.wales/files/pre-assessment-files/pharmacy-traffic-light-guide/
Acknowledgements
James is an anaesthetic specialist practitioner trained in the Royal Air Force and later through Birmingham City University and Peninsula School of Medicine and Dentistry. He specialises in anaesthesia and takes a special interest in resuscitation and teaching as well as surgical pre-habilitation.
FAQs about drugs to stop taking before surgery
Not quite found the answer you’re looking for? Perhaps our frequently asked questions can help.
What drug is given before surgery to relax?
A sedative is sometimes given before surgery to help you relax and reduce anxiety.
What drugs interfere with anaesthesia?
Several drugs can interfere with anaesthesia, potentially causing complications:
– blood thinners: Increase the risk of bleeding
– herbal supplements: Such as St. John’s Wort, which can affect how anaesthesia works
– certain antidepressants: Especially Monoamine Oxidase Inhibitors (MAOIs), which can lead to dangerous blood pressure changes
– alcohol and recreational drugs: Can alter how anaesthesia affects your body.
Can I take anti-anxiety medication before surgery?
Yes, but it’s important to inform your healthcare provider before doing so. They may prescribe a specific medication to help you relax before the procedure.
Can I take anti-nausea medication before surgery?
Typically, anti-nausea medications are given by your medical team just before or after surgery, depending on your needs. If you’re prone to nausea, let your doctor know so they can plan accordingly.
Can I take blood pressure medication before surgery?
In most cases, you should continue taking your blood pressure medication before surgery. Some medications might need to be adjusted, so it’s always worthwhile checking with your team for specific instructions.
What medications should be stopped before cataract surgery?
Before cataract surgery, you should typically stop:
– blood thinners such as Warfarin or Aspirin, as advised by your surgeon
– alpha blockers which can affect the eye’s response during surgery.
Always follow your surgeon’s specific guidance on when to stop these medications.
What medications to stop before hip replacement surgery?
Before hip replacement surgery, the following medications are usually stopped:
– blood thinners such as Warfarin, Clopidogrel, or newer anticoagulants
– NSAIDs such as Ibuprofen
– certain supplements including fish oil and Vitamin E. These can increase bleeding risks.
Your surgeon will provide a detailed list to help you prepare for hip surgery.
What medications to stop before knee replacement surgery?
Similar to hip replacement surgery, you should stop:
– blood thinners to reduce the risk of bleeding
– NSAIDs: Which can also increase bleeding risk
– certain supplements such as Ginkgo Biloba, Garlic, and others that can inhibit clotting.
