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Medications to STOP Before Surgery

INSTRUCTIONS FOR MEDICATIONS PRIOR TO SURGERY

Before your surgery, you will talk to your Physician(s) as to which medication you will need to discontinue taking prior to surgery. Here is a reference list of SOME commonly used medications to discontinue. 


On the morning of surgery, take all your medications with a small sip of water

EXCEPT FOR THE FOLLOWING: 

  • Stop any vitamins or herbal supplements 7 days prior to surgery 

  • Stop any anti-inflammatories 7 days prior to surgery (Advil, Ibuprofen, Aleve, Naproxen, Mobic, Celebrex, etc)

  • Stop all blood thinners as discussed with your surgeon (and outlined below)

  • HOLD any/all diuretic medications the morning of surgery

  • You may take Tylenol as needed up until surgery (recommend: 2 extra strength tabs, 3x daily, not to exceed 3000mg/day)

  • Please continue the vitamins that were prescribed to you by your surgeon

  • If you use an inhaler, please bring it with on day of surgery 


Diabetic Medications:

-HOLD all oral hypoglycemic medications the morning of surgery

            -HOLD Metformin the day before and morning of surgery

            -Insulin Management: 

                        -No rapid acting insulin on morning of surgery 

NovoRapid (insulin aspart), Humalog (insulin lispro), Apidra® (insulin glulisine)

                        -Intermediate acting insulin (Humalin N, NPH, Novelin N)

                                    -Evening before surgery: take 75% of normal dose

                                    -morning of surgery: take 50% of normal dose

                        -Long acting insulin (Lantus, Levemir)

                                    -if 1x/ day dosing: take 75% of PM dose before surgery, none on morning of surgery

                                    -if 2x/ day dosing: take 100% of PM dose, 50% dosing on morning of surgery


Narcotic Pain Medications

            -if you are taking chronic pain medications, please take your usual dose with a sip of water the day of surgery

-If you are taking Suboxone, you must be seen by your prescribing pain provider and establish a planned discontinuation/ substitution prior to surgery

-If you are taking Methadone, continue to take as directed


Blood Thinners: Discontinue as directed by your surgeon or Cardiologist/Internist

PLAVIX (CLOPIDOGREL) – stop 7 days prior                     ASPIRIN – stop 7 days prior

FONDAPARINUX (ARIXTRA) – stop 4 days prior               LOVENOX (ENOXAPARIN) – stop 24hrs prior

COUMADIN (WARFARIN) – stop 5 days, goal INR <1.2     RIVAROXIBAN (XARELTO) – stop 3 days prior

ELIQUIS (APIXABAN) – stop 3 days prior                         EDOXABAN (SAVAYSA) – stop 3 days prior

DABIGATRAN (PRADAXA) – stop 5 days prior                  PLETAL (CILOSTAZOL) – stop 2 days prior


Rheumatic Disease Medications

DMARD’S (Disease Modifying Ant-Rheumatic Drugs): OK to CONTINUE these medications through surgery: 

Methotrexate, Sulfasalazine, Hydroxychloroquine, Leflunomide (Arava), Doxycycline

Biologic Agents: These MUST be held for a specific time interval prior to surgery, typically one cycle. We will work with your rheumatologist/ primary prescriber to determine the safest time to stop and re-start your medications.

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