Quick Answer:
Some medications should be taken, some should be stopped, and some need special instructions. Always follow your surgeon or anesthesia provider’s guidance.
Continue to take most medicines even the morning of surgery except for supplements, ACE Inhibitor (like lisinopril) or ARB (like losartan) blood pressure medicines, NSAIDs (like ibuprofen), blood thinners, diabetes medicines (like metformin, insulin (take half), or Ozempic).
Tell your surgery and anesthesia team about all medicines you take and when you last took them.
Medications You Should Usually Take
These are commonly continued—even the morning of surgery—with a small sip of water:
1. Blood Pressure Medications
- Most are safe and recommended
- Help keep your blood pressure stable during surgery
Examples:
- Lisinopril (often held—see below)
- Amlodipine
- Metoprolol
Exception: Many providers hold ACE inhibitors or ARBs the morning of surgery.
2. Heart Medications
- Important for maintaining heart rhythm and function
Examples:
- Beta blockers
- Anti-arrhythmics
Stopping these suddenly can be risky.
3. Thyroid Medications
- Usually safe to take as normal
Example:
- Levothyroxine
4. Acid Reflux Medications
- Often encouraged to reduce stomach acid
Examples:
- Omeprazole
- Famotidine
Medications You May Need to Stop
These can increase bleeding risk or interfere with surgery/anesthesia.
1. Blood Thinners
These often need to be stopped days before surgery.
Examples:
- Warfarin (Coumadin)
- Apixaban (Eliquis)
- Rivaroxaban (Xarelto)
- Clopidogrel (Plavix)
Important: Never stop these without medical guidance. Do NOT resume taking them after surgery until told to by your surgery or anesthesia team.
2. NSAIDs (Anti-Inflammatory Drugs)
These can increase bleeding.
Examples:
- Ibuprofen
- Naproxen
Typically stopped 5–7 days before surgery.
3. Herbal Supplements
Many patients don’t realize these can affect surgery and increase bleeding risk.
Common ones to stop:
- Garlic
- Ginkgo
- Ginseng
- St. John’s Wort
Usually stopped 1–2 weeks before surgery.
Medications That Need Special Instructions
These aren’t always stopped—but they need a plan.
1. Diabetes or Weight Loss Medications
Why adjustments are needed:
- You’ll be fasting before surgery
- Risk of low blood sugar
Examples:
- Insulin (dose may be reduced)
- Metformin (often held)
- Ozempic or Mounjaro (held for at least 1-2 weeks)
- Continuing to take these decreases how quickly your stomach processes food and increases your risk of vomiting under anesthesia and experiencing aspiration
2. Steroids
If you take chronic steroids:
- You may need a stress dose during surgery
3. Psychiatric Medications
Most are continued, but some require review.
Examples:
- Antidepressants
- Anti-anxiety medications
What About Pain Medications?
- Acetaminophen (Tylenol): Usually safe
- Opioids: Often continued if prescribed
- NSAIDs: Usually stopped (see above)
What Should I Take the Morning of Surgery?
Typically:
- Take approved medications
- Use only a small sip of water
- Do NOT take anything you were told to stop
Bringing a complete medication list helps your care team keep you safe.
Include:
- All prescriptions
- Over-the-counter medications
- Vitamins and supplements
This helps your anesthesia team tailor your care.
What If I Forget and Take the Wrong Medication?
Don’t panic:
- Tell your care team immediately
- Do NOT hide it
- They will decide if it’s safe to proceed
Sometimes surgery may be delayed for safety.
Bottom Line
Medication management before surgery is all about balancing safety and stability.
- Some medications protect you and should be continued
- Others increase risks and must be stopped
- Many require individualized planning
When in doubt, always ask—your anesthesia team is there to guide you safely through the process.
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