Last Updated on November 26, 2025 by Bilal Hasdemir

Managing medication before surgery is key to avoid risks. The Medical organization Journal of Medicine notes that managing noninsulin glucose-lowering medications before surgery is tough. It suggests stopping drugs like metformin, sulfonylureas, and SGLT-2 inhibitors to prevent problems. Learn which surgery medications to stop or continue before an operation for safe anesthesia and recovery.

Liv Hospital focuses on patient care, making sure each medication decision fits your surgery needs. Knowing which preoperative drugs to keep or stop is essential for a good outcome.

Key Takeaways

• Carefully manage medication before surgery to reduce perioperative risks.
• Identify which preoperative drugs are safe to continue and which should be stopped.
• Follow guidelines for holding certain medications like metformin and SGLT-2 inhibitors before surgery.
• Tailor medication decisions to your unique surgical needs.
• Minimize risks associated with surgical procedures through proper medication management.

The Critical Role of Medication Management Before Surgery

Managing medications before surgery is very important. It affects how safe the surgery is and how well it goes. Doctors review all the medicines a patient takes to decide which ones to keep or stop before surgery.

Why Proper Medication Management Matters

Managing medicines right is key because some can mess with anesthesia or raise the chance of problems during surgery. For example, blood thinners and anticoagulants can make bleeding worse. Some diabetes medications might need to be changed to avoid blood sugar problems during surgery.

The American Society of Anesthesiologists stresses the need for checking medicines before surgery. They want to make sure patients are safe. This means looking at all the medicines a patient takes to find any risks and figure out how to avoid them.

Potential Risks of Improper Medication Management

Not managing medicines right before surgery can cause big problems. These include too much bleeding, bad reactions to anesthesia, and other risks. A study showed that problems with medicines are a big reason for bad outcomes in surgery.

The Impact on Surgical Outcomes

Good management of medicines before surgery makes patients safer and helps surgeries go better. By cutting down on risks from medicines, doctors can make surgeries more successful.

Guidelines for medicines before surgery help lower risks. By following these, doctors can give patients the best care and help them get the best results from surgery.

Understanding Surgery Medications and Perioperative Protocols

Managing medications before, during, and after surgery is key to reducing risks. It’s important for healthcare providers and patients to work together. This ensures medications are handled correctly.

Defining Perioperative Medication Management

Perioperative medication management is about planning and managing meds before, during, and after surgery. It involves checking the patient’s current meds, deciding which to keep or stop, and watching for interactions or complications.

Key components of perioperative medication management include:

• Reviewing the patient’s medication list
• Identifying medications that may interact with anesthesia or surgical procedures
• Deciding which medications to continue or stop before surgery
• Monitoring for possible bleeding risks or other complications

The Physician-Patient Partnership in Medication Planning

It’s important for healthcare providers and patients to work together. Patients should tell their healthcare team about all meds they’re taking. This includes prescription drugs, over-the-counter meds, and supplements.

Good communication helps avoid misunderstandings and prepares patients for surgery.

Evidence-Based Approaches to Medication Management

Research shows that using evidence-based methods in perioperative medication management improves outcomes. Guidelines from medical organizations help healthcare providers make informed decisions.

The following table summarizes key evidence-based recommendations for perioperative medication management:

By following these evidence-based approaches, healthcare providers can improve perioperative medication management. This leads to better patient outcomes.

8 Critical Medications to Stop Before Surgery

Before surgery, it’s important to know which medicines to stop taking. Stopping certain drugs can lower the chance of problems during and after surgery.

Blood Thinners and Anticoagulants

Blood thinners and anticoagulants stop blood clots. They’re key for preventing stroke or deep vein thrombosis. But, they can make bleeding more likely during surgery. Common ones include:

• Warfarin (Coumadin)
• Aspirin
• Clopidogrel (Plavix)
• Dabigatran (Pradaxa)
• Rivaroxaban (Xarelto)
• Apixaban (Eliquis)

It’s best to stop these medicines a few days before surgery. The exact time depends on the drug and the surgery type. For example, warfarin is often stopped 5-7 days before, while aspirin may be stopped 7-10 days prior.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs can also increase bleeding risk during surgery. They reduce inflammation and pain but affect platelet function. This makes it harder for blood to clot. Common NSAIDs include:

• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve)
• Ketorolac (Toradol)

It’s wise to stop NSAIDs at least 3 days before surgery. The exact time may vary based on the NSAID and the patient’s health.

Other Medications That Increase Bleeding Risk

Other drugs can also raise bleeding risk during surgery. These include:

• Herbal supplements like ginkgo biloba and garlic
• Certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs)

Patients should tell their healthcare provider about all medicines and supplements. This helps assess the risk of bleeding.

Diabetes Medications

Some diabetes medicines need to be adjusted or stopped before surgery. For example:

It’s key for patients to work closely with their healthcare provider to manage their diabetes medicines before surgery.

8 Essential Medications to Continue Before Surgery

Before surgery, it’s key to know which medicines to keep taking. Some medicines should stop before surgery to avoid risks. But, others are vital to keep up with as directed.

Cardiovascular Medications

Medicines for the heart are often important to keep taking before surgery. The American Heart Association says to keep taking certain heart medicines. Beta-blockers control heart rate and lower heart risks during surgery. Statins help keep arteries stable.

• Beta-blockers (e.g., metoprolol, atenolol)
• Statins (e.g., atorvastatin, simvastatin)
• Antihypertensive medications (e.g., ACE inhibitors, calcium channel blockers)

Respiratory Medications

For those with lung issues like asthma or COPD, it’s vital to keep taking lung medicines before surgery. Bronchodilators and corticosteroids keep lungs working well and prevent lung problems. Always tell your doctor about your lung medicines and follow their advice before surgery.

• Bronchodilators (e.g., albuterol, salmeterol)
• Corticosteroids (e.g., prednisone)

Neurological and Psychiatric Medications

Medicines for the brain and mind are also important to keep taking before surgery. Antiseizure medications stop seizures, and antidepressants and antipsychotics keep mental health stable. Stopping these medicines suddenly can cause withdrawal or make conditions worse.

• Antiseizure medications (e.g., phenytoin, carbamazepine)
• Antidepressants (e.g., SSRIs, MAOIs)
• Antipsychotics (e.g., risperidone, olanzapine)

Other Essential Medications

Other important medicines to keep taking before surgery include thyroid medicines and some stomach medicines. Thyroid medications keep the thyroid working right, and stomach medicines help with conditions like acid reflux.

• Thyroid medications (e.g., levothyroxine)
• Gastrointestinal medications (e.g., proton pump inhibitors)

Working closely with your doctor is key to figuring out which medicines to keep taking before surgery. This ensures a safe and successful surgery.

Timing Considerations: When to Stop or Adjust Surgery Medications

Adjusting medications before surgery is key to avoid risks and ensure a smooth process. Managing surgery medications needs careful planning to prevent complications during and after the surgery.

Long-Term Medication Adjustments (7+ Days Before Surgery)

Some medications need to be adjusted or stopped early before surgery. For example, blood thinners like warfarin should be stopped 5 to 7 days before to reduce bleeding risks. Also, herbal supplements and vitamins that affect bleeding should be stopped 7 to 10 days before surgery.

SGLT-2 inhibitors for diabetes should be held for at least 3 days before surgery. Some guidelines suggest stopping them even earlier, depending on the medication and surgery type.

Medium-Term Adjustments (3-5 Days Before Surgery)

Some medications need adjustments 3 to 5 days before surgery. For instance, certain anticoagulants and antiplatelet drugs should be stopped in this timeframe. The exact timing depends on the medication’s half-life and the patient’s kidney function.

Short-Term Adjustments (24-72 Hours Before Surgery)

In the short term before surgery, it’s important to review medications that could interact with anesthesia or affect surgical outcomes. For example, some antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs) may need to be adjusted or stopped 24 to 72 hours before surgery.

Morning of Surgery Guidelines

On the morning of surgery, patients should follow specific guidelines for their medications. Most medications can be taken with a sip of water, but always confirm with the healthcare provider. Cardiovascular medications, like beta-blockers and antihypertensives, are usually continued unless instructed not to.

Patients must work closely with their healthcare providers to manage their medications for surgery effectively. Understanding the timing for stopping or adjusting operation medication helps ensure a safe and successful surgery.

Special Considerations for Different Types of Surgeries

Different surgeries need special medication management strategies for safety. The type of surgery affects the pre-operative meds.

Cardiac Surgery Medication Protocols

Cardiac surgery patients have complex meds due to heart issues. Beta-blockers and antiplatelet drugs are kept until surgery to lower heart risks. But, managing anticoagulants is key to avoid bleeding and clotting.

Orthopedic Surgery Considerations

In orthopedic surgeries, managing anticoagulant medications is vital. It helps prevent DVT while reducing bleeding risks. Patients may need to adjust their meds a few days before surgery.

Neurological Surgery Requirements

Neurological surgery patients need careful anticonvulsant management. It’s important to plan the use or stop of these meds to avoid seizures or other issues.

Gastrointestinal Surgery Preparations

Gastrointestinal surgery patients might need changes to diabetes medications and other meds. It’s also important to manage fasting and meds that could impact surgery results.

High-Risk Patient Medication Management

Managing medications for high-risk patients before surgery is key to a successful outcome. This includes those with many health issues, the elderly, kids, and pregnant women. Each group needs special attention and planning.

Patients with Multiple Chronic Conditions

Patients with many health issues face big challenges with their meds. They often take a lot of drugs, which can lead to bad interactions. It’s important to carefully review and adjust their meds to lower these risks.

The American Geriatrics Society stresses the need for careful medication management. They suggest a detailed review to avoid harmful interactions and side effects.

Elderly Patients and Polypharmacy Challenges

Elderly patients face big problems with taking too many meds. This can increase the risk of falls, memory loss, and other bad effects. It’s key to simplify their meds and watch for side effects.

The American Geriatrics Society says polypharmacy is a big worry for the elderly. Healthcare providers need to keep a close eye and adjust meds as needed to reduce risks.

Pediatric Medication Considerations

Kids need special care when it comes to meds. They often need different doses because of their size and how they metabolize drugs. We also have to think about how long-term use might affect their growth and development.

Managing meds in kids means carefully figuring out the right doses and picking safe drugs. Talking to pediatric specialists is often a must to get the best results.

Pregnancy and Surgery Medication Safety

Pregnant women facing surgery have unique challenges with meds. We must think about the safety of both mom and baby when choosing meds. It’s vital to weigh the risks and benefits to make sure surgery is worth it.

Choosing safe meds during pregnancy is critical. Talking to obstetric specialists is essential to manage meds safely and effectively during pregnancy.

The Healthcare Team’s Role in Pre-Operative Medications

Managing medications before surgery needs teamwork from healthcare providers. This teamwork helps patients get the best care before, during, and after surgery.

Primary Care Physician Coordination

The primary care physician is key in managing medications. They:

• Keep track of the patient’s medications
• Work with specialists to adjust medications
• Teach patients about managing their medications

Surgeon and Anesthesiologist Recommendations

Surgeons and anesthesiologists decide the best way to manage medications before surgery. They:

1. Stop medications that could increase surgery risks
2. Adjust medication dosages
3. Choose the right anesthesia based on medications

It’s important for surgeons and anesthesiologists to work together for patient safety during surgery.

Pharmacist Consultation Benefits

Pharmacists are experts in pre-operative medication management. They:

• Check for medication interactions
• Guide on medication timing and dosage
• Find alternative medications when needed

Pharmacist consultations can greatly reduce medication-related risks during surgery.

Nurse Practitioners and Medication Reconciliation

Nurse practitioners are vital in medication reconciliation. They:

• Take detailed medication histories
• Check medication lists against surgical protocols
• Teach patients about their medications

The healthcare team works together to ensure safe pre-operative care. This teamwork is key to improving surgical outcomes and reducing medication risks.

Patient Responsibilities and Preparation Checklist

Patients have a big role in keeping themselves safe before surgery. They need to manage their medications well. This means taking several important steps to help doctors make the best decisions for their care.

Creating a Complete Medication List

One key task for patients is to make a detailed list of their medications. This includes:

• Prescription medications
• Over-the-counter drugs
• Vitamins and supplements
• Herbal remedies

They should share this list with their healthcare provider. This helps identify any possible problems with their medications and the upcoming surgery.

Questions to Ask Your Healthcare Provider

Patients should prepare a list of questions for their healthcare provider. Some important ones include:

1. Which medications should be stopped before surgery, and when?
2. Are there any specific medications that need to be continued up to the day of surgery?
3. How will my medications be managed during the recovery period?

These questions help patients understand their medication plan. They ensure a smooth transition into the surgical period.

Documentation and Emergency Contact Information

Patients should make sure their healthcare provider has the latest contact info and medical documents. This includes:

• A list of emergency contacts
• Any advance directives or living wills
• Previous surgical records or relevant medical history

Having this information ready can help healthcare providers make quick and informed decisions in emergencies.

Post-Surgery Medication Plan Preparation

Understanding the post-surgery medication plan is key for a good recovery. Patients should:

• Review their medication list with their healthcare provider
• Understand the dosage and timing of their medications post-surgery
• Be aware of possible side effects or interactions

By being prepared, patients can reduce risks. This ensures a smoother recovery process.

Conclusion: Ensuring Safe Surgery Through Proper Medication Management

Managing surgery medications is key to reducing risks before and during surgery. It’s important for safe surgical results. Healthcare providers and patients must work together to handle preoperative drugs and medication surgery plans.

Knowing which medications to stop before surgery and which to keep is critical. This knowledge helps lower the chance of complications. Guidelines and teamwork among healthcare teams are essential for managing surgery medications well.

Patients need to team up with their healthcare team to make a plan. This includes a list of all medications and a plan for after surgery. This teamwork helps ensure patients get the best care, reducing risks linked to medication surgery.

FAQ

U.S. Food and Drug Administration. (2024). Drug safety communication: SGLT2 inhibitors and risk of diabetic ketoacidosis with surgery. U.S. Department of Health and Human Services. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-risks-ketoacidosis-surgery-patients-taking-sglt2-inhibitors-diabetes-medicines