Medication and Surgery: Before Your Operation

Your medications may have to be adjusted before your surgery.¹ It is important to fully inform your surgical team about all of the medications you are taking before your surgery, including prescriptions, vitamins, minerals, herbs, drugs, or any other supplements. Even though you are not eating, you may be able to take your routine morning medications with a small sip of water.

Your medications may have to be adjusted before your surgery.

Medications to discuss with your doctor:

Blood thinning medications
Diabetes (blood sugar) medications
Pain, anxiety, and depression medications
Nicotine, alcohol, marijuana, or other cannabidiol (CBD) products

Download a medication list to fill out

Anticlotting (Blood Thinning) Medications

Antiplatelet medications: Help to prevent blood cells called platelets from clumping together to form a clot. Examples: aspirin (ASA), enteric-coated aspirin (Ecotrin^®), clopidogrel (Plavix^®)
Anticoagulant medications: Thin your blood to slow down the process of clotting. Examples: warfarin (Coumadin^®), heparin, apixaban (Eliquis^®), rivaroxaban (Xarelto^®)
Non-steroidal anti-inflammatory drugs (NSAIDS): Reduce inflammation, pain, and fever. Examples: aspirin (ASA); celecoxib (Celebrex^®); diclofenac (Voltaren-XR^®) ibuprofen (Advil^®, Motrin^®), naproxen (Aleve^®)
Herbs: Plants used for medicinal purposes. Examples: Natural ginkgo biloba, vitamin E, feverfew, garlic, ginger, ginseng, omega-3 fatty acids, fish oil, St. John’s wort, turmeric

Ask Your Doctor

What is my risk of a blood clot and does my medication have to be stopped or changed before surgery? Your risk for a clot is higher if you have surgery within 3 months of a recent clot and if you are having a long or complex surgery.
What is my risk of bleeding? Dental, skin, and low-risk procedures likely will not require you to stop taking your medications.
Do I have to stop taking my herbal medication? Some supplements can affect blood clotting, increase your risks for internal bleeding, or interact with other drugs you are taking.²

Other Medications

Medications	Examples	Notes
Diabetes (blood sugar)	Insulin, metformin, dulaglutide (Trulicity®), empagliflozin (Jardiance®), pioglitazone (Actos®), insulin glargine (Lantus®)	Since you will not be eating before surgery, most diabetic medication is usually adjusted—pioglitazone may not be stopped before surgery and Lantus will be reduced by 50%.
Pain, anxiety, depression, or sleep	Hydrocodone (Vicodin®), tramadol (Ultram®), oxycodone with acetaminophen (Percocet®), pregabalin (Lyrica®), diazepam (Valium®)	These can affect your pain control plan and side effects from opioid use.³ Go to facs.org/safepaincontrol for more information.
Nicotine, alcohol, marijuana or cannabidiol (CBD) products (used for medicinal or recreational use)	Smoking, vaping, patch, oral	Use of any of these products may affect your heart rate, blood pressure, and pain control during and after your procedure.^4–6 Go to facs.org/quitsmoking to help you quit smoking before your surgery.

References

Hornor MA, Duane TM, Ehlers AP, et al. American College of Surgeons' Guidelines for the Perioperative Management of Antithrombotic Medication. J Am Coll Surg. 2018 Nov;227(5):521-536.e1. doi: 10.1016/j.jamcollsurg.2018.08.183. Epub 2018 Aug 24.
Wong A, Townley SA. Herbal medicines and anaesthesia. Continuing Education in Anaesthesia Critical Care & Pain. 11(1): February 2011;14–17. doi.org/10.1093/bjaceaccp/mkq046.
National Institute on Drug Abuse (NIDA). Misuse of Prescription Drugs. https://www.drugabuse.gov/publications/misuse-prescription-drugs/overview. Accessed April 1, 2018.
Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2017 Jan;224(1):59-74. doi: 10.1016/j.jamcollsurg.2016.10.029. Epub 2016 Nov 30.
Huson H, Granados T, Rasko Y. Surgical considerations of marijuana use in elective procedures. Heliyon. 2018 Sep 15;4(9):e00779. doi: 10.1016/j.heliyon.2018.e00779. eCollection 2018 Sep.
Salottolo K, Peck L, Tanner IA, et al. The grass is not always greener: a multi-institutional pilot study of marijuana use and acute pain management following traumatic injury. Patient Saf Surg. 2018 Jun 19;12:16. doi: 10.1186/s13037-018-0163-3. eCollection 2018.

Resources

American College of Surgeons Glucose Control Checklist

Guidelines

American College of Surgeons Guidelines for the Perioperative Management of Antithrombotic Medication

American Society of Hematology 2018 Guidelines for Management of Venous Thromboembolism: Optimal Management of Anticoagulation Therapy

Anticoagulation and Antiplatelet Therapy in Urologic Practice: ICUD and AUA Review Paper

Current Recommendations for Anticoagulant Therapy in Patients with Valvular Heart Disease and Atrial Fibrillation: The ACC/AHA and ESC/EACTS Guidelines in Harmony…but not Lockstep!

Perioperative Management of Patients on Anticoagulants

Peri-Operative Management of Anticoagulation and Antiplatelet Therapy

Perioperative Management of Antithrombotic. American Academy of Ophthalmology

Revised May 2019

This information is published to educate you about preparing for your surgical procedures. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with your situation. It is important to remember that each individual is different, and the reasons and outcomes of any operation depend upon the patient’s individual condition.

The American College of Surgeons is a scientific and educational organization that is dedicated to the ethical and competent practice of surgery; it was founded to raise the standards of surgical practice and to improve the quality of care for the surgical patient. The ACS has endeavored to present information for prospective surgical patients based on current scientific information; there is no warranty on the timeliness, accuracy, or usefulness of this content.