10 supplements and certain medications to pause before surgery

Roxana Esfahani, M.P.A.S., PA-C
Anesthesiology and Pain Management

More than half of American adults take an herbal or dietary supplement, and many more use over-the-counter or prescription drugs to manage maladies ranging from the occasional headache to chronic health conditions or mood disorders.

For many, it is part of their daily routine. But if you’re planning to have surgery, you may need to take a break from some supplements and medications that can interfere with anesthesia. Surgical complications could include heart or bleeding problems, prolonged anesthesia effects, or increased blood pressure.

This is one of the most important reasons why every patient should keep a list of current medications. If you need emergency surgery, keeping a current medication list might save your life. For planned procedures, your doctor(s) will need the drug list to advise you what to stop and what not to stop.

UT Southwestern patients who are planning for surgery get an extra layer of support through our Pre-Surgical Testing Clinic. We use your medication list to create a plan of presurgical care based on the drugs you take, the procedure you’re having, and the type of anesthesia you’ll get:

• General anesthesia: A combination of medications given through an IV or mask that puts you in a deep sleep. You will not feel pain during the surgery or remember the procedure. Most surgeries are done under general anesthesia for your comfort and safety.
• Regional anesthesia: This type of pain management numbs a specific part of the body, such as from the waist down or one limb. Common types of regional anesthesia include spinal blocks, epidurals, and nerve blocks. You may get regional anesthesia for an orthopedic surgery of the arm, hand, or leg, for example.
• Sedation: This is also known as “monitored anesthesia care” and sometimes referred to as “twilight anesthesia.” You are given medication by IV or a mask to make you feel relaxed. Various levels of sedation may keep you responsive or make you sleepier. This is the type of anesthesia you get for a colonoscopy.

Medications to pause before surgery

Medications that pose the most risk during surgery are those that increase the chance of bleeding and interfere with anesthesia medications. This is especially important for patients who will be getting regional anesthesia, such as a spinal block or epidural.

Each patient and surgery is unique. In general, we ask patients not to take some common medications and supplements for 1-2 weeks before surgery. Those include:

Anticoagulants, more commonly known as blood thinners, reduce the body’s ability to clot and increase the risk of serious bleeding. Blood thinners come in prescription and over-the-counter form:

• Prescription: warfarin, heparin, Xarelto, Eliquis, and Plavix, among others.
• Over the counter: aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

Certain psychiatric and weight loss medications can cause potentially harmful interactions with anesthetic medications. Please let your surgeon and anesthesia team know if you are taking these before surgery.

If you take diabetes medication, we will give you instructions based on your specific medications and dosages. Because you won’t be eating on the day of surgery, we may ask you to hold or decrease many of these medications.

Of course, with some medications, stopping would be unsafe. A few drugs we should know about – but likely won’t ask you to stop taking – include beta blockers for high blood pressure, proton pump inhibitors for acid reflux, statins, inhalers for asthma, anti-seizure medications, antibiotics, and acetaminophen (such as Tylenol).

10 supplements to avoid before surgery

Unlike prescription and over-the-counter medications, herbal and dietary supplements aren’t as heavily regulated by the U.S. Food and Drug Administration (FDA). The amount of ingredients in a product can vary, so it’s difficult to tell exactly how much of each you’re getting.

These are 10 of the common supplements we ask patients to skip at least seven days before surgery:

1. CBD oil: While more research is needed, preliminary studies suggest CBD oil can increase the risk of bleeding.
2. Echinacea: Used to boost the immune system, this herb can harm the liver.
3. Ephedra: This herbal appetite suppressant can cause high blood pressure and erratic heart rate during surgery.
4. Garlic: Used to lower blood pressure and cholesterol, garlic in supplement form can increase the risk of bleeding.
5. Ginkgo: This herb is used to improve memory but can increase the risk of bleeding.
6. Ginseng: Used to boost energy, ginseng can cause increase the risk of bleeding.
7. Kava: Used to relieve anxiety but can prolong the effects of anesthesia.
8. St. John’s wort: This herb is used to relieve depression and anxiety, but it can interfere with anesthesia medicines and prolong their effects.
9. Valerian: Used to relieve anxiety or as a sleep aid, this herb can interfere with anesthesia medicines, prolonging their sedative effects.
10. Vitamin E: This vitamin can increase the risk of bleeding.

Please note that this is not an all-encompassing list of supplements to avoid prior to surgery. Talk with your doctor about all the supplements you take, so you can work together to reduce your risk of surgical complications.

Like medications, there may be circumstances in which we ask you to continue taking a supplement. For example, your doctor might ask you to keep taking vitamin D or calcium if you’re having thyroid or parathyroid surgery, or an iron supplement if you have iron deficiency anemia.

Helping you prepare for surgery

If your surgery is planned at UT Southwestern, you’ll be referred to the Pre-Surgical Testing Clinic. My colleagues and I work with specialist teams throughout the hospital to develop guidelines for safe surgical preparation based on the type of surgery you need.

For example, patients undergoing heart surgery will work with their heart surgeon, a specialized team of nurses, and an anesthesiologist with expertise in the types of anesthesia used in cardiovascular surgery. Because we operate in subspecialized units, we can tailor presurgical planning to the patient’s unique health needs, surgery type, and type of anesthesia.

Your Pre-Surgical Testing Clinic appointment will revolve around your personal preparation plan. We’ll discuss your health history, make a plan for pausing/resuming medications and supplements, and answer your questions about anesthesia. After the visit, we’ll send you home with printed and digital instructions through MyChart.

It’s a good practice for every patient to make a list of their medications and supplements – and keep it current. This list will make preparing for planned surgery easier, and it could help prevent serious bleeding or heart complications if you ever need emergency surgery.

To visit with a presurgical testing clinician, call 214-645-8300 or request an appointment online.