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Medications to STOP Before Surgery

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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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