From: http://anesthesia.uchicago.edu/public_intranet/meddiscont.php
Drug Information Website
Vitamins, Minerals, IronDiscontinue on day of surgery (DOS)
Topical medications (e.g. creams & ointments)Discontinue on DOS
Oral diabetic agentsDiscontinue on DOS
Anti-hypertensive medicationsPatients undergoing certain procedures or who have medical conditions where hypotension is particularly dangerous it may be prudent to discontinue angiotension converting enzyme inhibitors (ACEI) or angiotension receptor blocking agents (ARBs) prior to surgery. The following are possible indications (especially if more than 1 apply to any given patient) to hold ACEI & ARBs 12-24 hrs prior to surgery:
Patients on multiple anti-HTN meds,
Patients with well controlled BP
General anesthesia planned
Lengthy surgery planned
Procedures involving significant blood loss or fluid shifts
InsulinType 1 DM patients should take a small amount (usually 1/3) of their usual AM long-acting insulin (e.g. lente or NPH) the DOS. Patients with Type 2 DM should take none or up to ½ dose of long acting or combination (70/30 preparations) insulins on DOS. Patients taking ultra long-acting insulin such as glarine, Lantus either at night or in the AM should continue as scheduled (including DAS) as long as the does is <= 1 u/kg. Patients who benefit the most from taking some insulin are those with poorly controlled diabetes, who are overweight or who may benefit from tighter control on the DOS (those at risk of cerebral hypoxia or hypoperfusion). Patients with an insulin pump should continue their lowest (typically night-time) basal rate. Discontinue all intermittent regular insulin (insulin not delivered by a pump)on DOS for all patients. Advise patients to check their AM blood sugar and hold insulin if BS<100.
Viagra or similar drugsDiscontinue 24 hrs prior to surgery
NSAIDsDiscontinue 48 hrs prior to the DOS
Warfarin (coumadin)Discontinue 5 days prior to surgery except for Patients having cataract surgery without a bulbar block
Aspirin ( - read JACC article)Continue aspirin unless the risk of bleeding outweighs the risk of thrombosis. Generally aspirin should be continued when used for secondary prophylaxis (patient with known vascular disease) except for surgeries where the risk of bleeding or the consequences of bleeding are high. If reversal of platelet inhibition is necessary then aspirin must be stopped 5-7 days before surgery. Do not stop aspirin in patients having vascular surgery or cataract surgery with topical or general anesthesia. Do NOT discontinue aspirin in patients who have drug-eluting coronary stents (DES) until they have completed 12 months of anti-platelet therapy unless the patient, surgeon and cardiologist have discussed the risks of stopping aspirin. The same applies to patients with bare-metal stents (BMS) until they have completed 1 month of anti-platelet therapy.
Plavix (clopidogrel - read JACC article)Continue clopidogrel unless the risk of bleeding outweighs the risk of thrombosis. If reversal of platelet inhibition is necessary then clopidogrel must be stopped 5-7 days before surgery. Do not stop clopidogrel in patients having cataract surgery with topical or general anesthesia or if the surgeon has indicated a willingness to operate with continued clopidogrel. If clopidogrel must be interrupted strong consideration should be given to continuing or starting aspirin. Do NOT discontinue Plavix in patients who have drug-eluting coronary stents (DES) until they have completed 12 months of anti-platelet therapy unless the patient, surgeon and cardiologist have discussed the risks of discontinuation. The same applies to patients with bare-metal stents (BMS) until they have completed 1 month of anti-platelet therapy.
Herbals and non-vitamin supplementsDiscontinue 7 days prior to surgery
DiureticsDiscontinue on the DOS (exception is triamterene or HCTZ, when taken for hypertension these should be continued on the DOS)
Autoimmune medicationsContinue methotrexate on DOS unless risk of acute renal failureDiscontinue etanercept (Enbral) 2 weeks prior to surgeryDiscontinue infliximab (Remicade) 6 weeks prior to surgeryDiscontinue adalimumab (Humira) 8 weeks prior to surgery
Estrogen compounds Discontinue medications containing estrogens when used to control vasoactive symptoms of menopause or for osteoporosis when patient is seen in APMC. These drugs should be continued if used for birth control or as part of cancer therapy.
MAOIsPatients on these antidepressant medications need an anesthesia consultation prior to surgery (preferably 3 wk's prior to surgery)
