Medications

It can be confusing to know what to stop and what to keep taking, and you may receive different information from different sources. Below is a guide, please email or call for individualised advice.

  • Drugs for blood pressure should generally not be taken on the morning of surgery. Bring them with you to hospital.

  • Drugs for heart rhythm should generally be taken on the morning of surgery. Bring them with you to hospital.

    If you have seen a cardiologist in the last 5 years, it is important their latest letter and reports have been provided to the office.

Cardiovascular drugs

  • If you have had a heart attack or stent within the last 12 months, a stroke, a TIA, a blood clot or a mechanical heart valve you need individualised advice, please contact us

  • Generally otherwise it is safe to stop oral anticoagulants 3 days prior to your surgery (e.g. Eliquis, Xarelto)

  • Aspirin and clopidogrel (Plavix) have a minimum 5 days washout time, please seek advice on whether these need to be stopped

  • Warfarin has special instructions, please ask us

  • Some operations like eye surgery or skin cancer surgery do not require you to stop taking thinners.

    If in doubt, please ask. This is a complex area and may require input from both the surgeon and anaesthetist.

Blood Thinners

  • Type 1 diabetics - please contact us for indivual advice

  • Any drug name ending in “-gliflozin” e.g. empagliflozin in Jardinance needs to be stopped 3 days prior to surgery. Failing to do this may result in cancellation on the day.

  • Insulin - generally half dose of any night time insulin before the day of surgery, and no insulin on the morning of surgery

  • Oral anti diabetic drugs (apart from the “gliflozins” ) e.g. metformin, gliclazide do not take on the day of surgery. Bring your tablets to the hospital.

  • Semaglutides e.g. Ozempic / Mountjaro need 7 clear days of no injections before your day of surgery.

  • Other non insulin diabetes injectable medications may be continued as normal.

    As always, please ask us if you have any concerns.

Diabetes medications

Pain killers and anti-inflammatories

  • Please continue to take paracetamol if you would normally. Let us know if you have taken a dose on the day of surgery

  • Non steroidal anti inflammatories (Neuofen, Voltaren, Celebrex, Mobic) can be an issue for some surgeries. if your surgeon has asked you to stop please do so at least 5 days prior to surgery.

  • Any opiates (e.g. oxycodone/Endone, tramadol, tapentadol/Palexia, codeine/Panadeine) within the 7 days prior to your surgery will reduce the efficacy of your pain relief after surgery. Please discuss with your anaesthetist.

  • Treatments for rheumatoid or psoriatic arthritis should generally be continued without interruption

  • CBD oils / THC preparations - generally for chronic pain, may be continued. Please mention to your anaesthetist if you are still taking and bring to the hospital with you.

Drugs for the nervous system

  • Parkinsons disease - it is very important no doses are missed or delayed. Please take as normal, even in fasting times. Always bring your medications to the hospital.

  • Anti anxiety and depression medications can be taken as normal including on day of surgery.

  • Drugs to treat Multiple Sclerosis should be continued without interruption

    As always, please ask us if you have any concerns.

Drugs for the respiratory system

  • Puffers should be taken as normal, including on the morning of surgery. Please bring with you to hospital, we will often ask you to take an extra dose before going into theatre

  • Having surgery is a good opportunity to quit smoking. If this has not been possible , please ensure no cigarettes within at least 48 hours of your anaesthetic. Use lozenges or patches to help you.

  • Home oxygen or breathlessness at rest is not generally compatible with safe anaesthesia in an elective setting. Please discuss with your anaesthetist.

Drugs for the immune system

  • Steroids at 5mg / day or greater need special management around surgery. Please notify your anaesthetist

  • Most immune modulating drugs used to treat conditions such as Crohn’s, Lupus, Rheumatoid Arthritis, Multiple Sclerosis can be continued without interruption.

  • Immunosupressant drugs for transplant recipients must not be interrupted. they should be taken at the normal times even during fasting.

    As always, please ask us if you have any concerns.

Drugs for the urinary and reproductive systems

  • Hormone replacement therapy and the oral contraceptive pill can generally be continued as normal. Be aware that a common anaesthetic drug can interact with the contraceptive action of the pill and an alternative method must be used for 4 weeks after surgery.

  • Drugs for testosterone replacement and urinary flow in men can generally be continued without interruption.

  • Gender affirming hormone therapy can be continued without interruption.

Drugs for the digestive system

  • Reflux is an important issue for anaesthesia. Please take any prescribed anti reflux medication on the morning of surgery and notify your anaesthetist

  • Continue immune modifying treatments for Crohn’s disease and Ulcerative Colitis unless otherwise advised by your surgeon.

  • Constipation can be an issue following an anaesthetic, be sure to be proactive in taking stool softeners if required after surgery.

    As always, please ask us if you have any concerns.

Vitamin and mineral and “lifestyle”supplements

The content and active ingredients of these medications can be unpredictable.

Some examples of unwanted effects are:

  • Fish oils, evening primrose oil, alovera, ginko and echincia can cause increased bleeding tendency.

  • Protein and body building supplements can cause abnormal liver and kidney function tests

  • St John’s wort interracts with many drugs, enhancing their removal from the body and reducing the effectiveness of anaesthetic and pain reliving drugs

    For this reason we ask no supplements are taken for 2 weeks prior to surgery and anaesthesia.