MEDICATIONS and SUPPLEMENTS TO AVOID PRIOR TO SURGERY
Nowadays, many patients are taking nutritional supplements in increasing amounts. While generally beneficial and safe, their use around the time of surgery may not be desirable. Certain nutritional supplements may cause adverse reactions during or after surgery, including prolonged bleeding, interference with anesthesia, cardiovascular disturbances, and interactions with prescription drugs.
To ensure surgical safety, please discontinue the use of the following nutritional supplements two weeks prior to surgery and two weeks after surgery:
- Bilberry (Vaccinium myrtillus) – Contains compounds called anthocyanosides and flavonoid compounds that strengthen blood vessels, improve circulation, and can be useful in treating eye disorders. Bilberry can affect blood cells called platelets and may increase bleeding.
- Cayenne (Capsicum frutescens) – Also known as red pepper, cayenne lowers levels of cholesterol in the blood, which can help to lower blood pressure. Cayenne may affect platelets and an overdose can cause a significant drop in body temperature.
- Dong Quai (Angelica sinensis) – An all-purpose women’s herb used to provide energy and regulate female hormones. An active constituent in Dong Quai is a coumarin-like compound, which may increase existing anticoagulant (blood-thinning) medications.
- Echinacea (Echinacea augustfolia) – Used to boost the immune system and for infections of the respiratory tract. Echinacea may negatively affect the liver when general anesthetics or certain other medications are used.
- Feverfew (Tanacetum parthenium) – From the Latin word febrifuge, which means fever-reducing, the herb is used mainly to treat migraine headaches. Feverfew may increase bleeding, especially in patients taking certain blood-thinning medications.
- Fish Oil – The Omega-3 essential fatty acids found in fish oil are beneficial for lowering blood pressure, cholesterol, and triglyceride levels and reducing the risk of heart disease. Fish Oil has blood-thinning properties, which can be problematic during surgery.
- Garlic (Allium sativum) – Used therapeutically to prevent and treat atherosclerosis (hardening of the arteries) and elevated cholesterol. Garlic may augment the effects of blood thinners, like Coumadin® (warfarin) and non-steroidal anti-inflammatory drugs (NSAIDs), causing abnormal bleeding time.
- Ginger (Zingiber officinale) – Stimulates the digestive system and helps relieve motion sickness, nausea, and vomiting. Use of ginger may alter bleeding time and interfere with cardiac and anticoagulant medications.
- Ginkgo Biloba (Ginkgo biloba) – One of the oldest living tree species and one of the best researched herbal medicines. Ginkgo biloba improves blood circulation by strengthening the vascular system and inhibiting platelet aggregation. Ginkgo is also used to help prevent mental deterioration in the elderly. Ginkgo has significant blood thinning activity, which is three times stronger than Vitamin E.
- Ginseng (Panax quinquefolium/Panax ginseng) – Ginseng is a so-called adaptogen (increases physiological resistance to stress) and an antioxidant. Commonly taken to enhance physical and cognitive performance. Ginseng acts as an anticoagulant and may interact with cardiac, high blood pressure medications and blood-glucose lowering medications.
- Hawthorne (Crataegus laeviga ta) – Hawthorne is used for deteriorating heart function and may be helpful for angina, arteriosclerosis, and some mild types of abnormal heart rhythm (arrhythmia). Hawthorne can enhance the effects of the heart medication digitalis (Lanoxin or Digoxin).
- Kava Kava (Piper methysticum) – Kava root preparations reduce stress-related anxiety and the effects of anxiety disorders. Kava kava may potentiate the effects of medications, including barbiturates, alcohol, antidepressants, antipsychotics, and general anesthetics.
- Licorice Root (Glycyrrhiza glabra) – Traditionally used for coughs and as a soothing remedy for the skin. Glycyrrhizic acid in real licorice may cause high blood pressure, lower potassium levels in the blood, and enhance tissue swelling (edema).
- Ma Huang (Ephedra sinica) – More widely known as ephedra, the herb was found in weight loss and energy supplements until it was banned by the Food & Drug Administration (FDA) in 2003. Although some products have substituted ephedra with bitter orange, both herbs have similar effects on the cardiovascular system, including hypertension, rapid heart rate, cardiomyopathy (heart muscle inflammation), and abnormal heart rhythm.
- Melatonin – A hormone that is secreted by the pineal gland located in the brain. Since melatonin controls the body’s sleep-wake cycle, it is often used to counteract sleeplessness and jet lag. Melatonin may potentiate the central nervous system effects of barbiturate drugs (produce relaxation and sleep) and general anesthetics.
- Red Clover (Trifolium pratense) – An herb that is a rich source of isoflavones and used to treat a number of conditions associated with menopause. An active constituent in Red Clover includes coumarin derivatives, which may potentiate existing anticoagulant medications.
- St. John’s Wort (Hypericum perforatum) – An herbal medicine used to treat mild to moderate depression and seasonal affective disorder (SAD). Since St. John’s Wort works like the antidepressants called monoamine oxidase (MAO) inhibitors, it may interact with these drugs. In addition, many other drug interactions have been reported with St. John’s Wort.
- Valerian (Valeriana officinalis) – Valerian eases insomnia, stress-related anxiety, and nervous restlessness. Valerian is a sedative herb and may increase the effects of other anti-anxiety medications or prescription painkillers.
- Vitamin E – Vitamin E is a fat-soluble vitamin that is a strong antioxidant and may protect cells from free-radical damage. This nutrient may play a role in the prevention and treatment of cardiovascular disease and other aging-related degenerative disorders. Vitamin E also has anti-clotting activity can prolong bleeding time during surgery.
- Yohimbe (Corynanthe yohimbe) – As a natural “Viagra®”, yohimbe is touted as a sexual stimulant and as a potential treatment for male impotence. Yohimbe can raise the heart rate and blood pressure, and increase the potency of anesthetics.
To date, there have been few systematic examinations of the effects of dietary supplements when taken with prescribed anti-thrombotic (anticoagulant or anti-platelet) therapies. According to the Natural Medicines Comprehensive Database, approximately 180 dietary supplements have the potential to interact with warfarin, a common blood thinner, and more than 120 may interact with aspirin and other anti-platelet agents, such as clopidogrel, ticlopidine, and dipyridamole. Dietary supplements include herbal remedies, vitamins, minerals, other botanical products, fibers, amino acids, proteins, organ tissues, and metabolites for digestion.
Known interactions with prescribed anti-coagulants and their effects include:
- Anise and Dong Quai have anti-coagulant effects;
- Omega 3-fatty acids in fish oil, ajoene in garlic, ginger, Ginkgo, and vitamin E have anti-platelet properties;
- Fucus and Danshen can have a heparin-like blood thinning effect;
- St. John’s Wort and American Ginseng alter drug metabolism;
- Other supplements, such as high dose Vitamin E, Alfalfa, and Coenzyme Q10 may affect blood clotting.
It is often best not to ingest any brand of aspirin or any of the following aspirin containing MAO inhibiting and serotonin drugs for 14 days prior to surgery and 14 days after surgery. Although some medications may be deemed safe for your consumption by your surgeon and anesthesiologist only (i.e. Prozac, Zoloft, etc.). Just let them know. Disclose EVERY medication, oil, supplement, suspension, etc. – your life depends upon it. Aspirin and aspirin-containing products, as well as some supplements and “nutraceuticals,” may inhibit blood clotting and cause difficulties during and after surgery. If you need an aspirin-free fever reducer and pain reliever, it is suggested to take Tylenol. Also, if you smoke, you shouldn’t smoke at least 2 weeks prior and at least 2 weeks after your surgery date. Smoking significantly reduces the quality of blood circulation and impedes vascularization. This means difficulty in bringing much-needed oxygen to your tissues for proper healing.
A Accutrim, Acetidine, Acetilsalicylic Acid, Aches-N-Pains, Actifed, Actron, Acuprin, Adapin, Addaprin, Adipex, Adprin- B Tablets, Adult Analgesic Pain Relievers, Advil, AK Spore – HC, Aggrenox, Alka Seltzer, All Arthritis Medicines, Allergy Relief Medicines (A.R.M.), Alpha Omega (fish oil), Aluprin, Aleve, Amigesic Argesic-5A, Amigesic Capsules, Amitriptyline, Amoxapine, Anacin, Anacin Arthritis/P, Anafranil, Anahist, Ansaid Tablets (generic brand of Ansaid is Flurbiprofen), Anodynos Tablets, Analval, Anaprox, Anaprox-DS, Anaproxen, Anaproxen Anodynos, Anexia, Anisidione, Ansaid, Anturane, APAC Improved, APC, Argesic Tablets, Arthra-G, Arthralgen Tablets, Arthritis Pain Formula, Arthritis Strength Bufferin, Arthropan, Arthropan Liquid, As-caff, Ascodeen, Ascriptin, Ascriptin AID tablets, Ascriptin with Codeine Tablets, ALL ASCRIPTIN PRODUCTS, Ascription, Asendin, Aspir-lox, Asperi-mox, Aspirbuf, Aspercin, Aspergum, Asprimox products, Aspirin (of any kind), Aspirin Suppositories, Aspirin with Codeine, ASpirTab, Asprimox Tablets, Asproject, A.S.A. Tablets, A.S.A. Enseals, Aventyl, Axotal, Azdone Tablets, Azulfidine B B-A-C Tablets, Backache Maximum Strength, Bayer Aspirin, Bayer Children’s Aspirin Tablets, Bayer Children’s Cold Tablets, Bayer Timed-Release Aspirin Tablets, Bayer Select Pain Formula, BC Powder/Tablets, Bextra, BextraBilberry Tablets, Bocadren, Bromo-seltzer, Bromo-quinine, Brufen, Buf Tab, Buff-A-Comp, Buff-A Comp No.3 Tablets with codeine, Buffaprin, Buffasal, Bufferin, Bufferin 37%, Bufferin Arth, Bufferin X/S Butalbit, Buffets II, Buffex, Buffinol, Buropion, Buropion HCL, Butazolidin C C-Advil Cama, Cama Arthritis Pain Reliever, Cama Inlay Tabs, CataFlam Tablets, Carisoprodol Compoud Tablets, Cartol, Cayenne, Celebrex, Cephalgesic, Cheracol Tablets, Children’s Advil Suspension, Children’s Aspirin, Children’s Motrin Suspension, Choline, Chromium, Chromium Picolinate, Claritin, Clinoril, Clinoril C, Clomipramine, Concerta (for ADD/ADHD), Condroitin, Congespirin, Contac, Cope, Corgard, Coricidin Tablets, Coricidin “D” Decongestant Tablets, Coricidin, Coricidin Demilets Tablets for Children, Coricidin Mediets Tablets for Children, Corididin, Cortisone, Coumadin D Dalteparin Inj., Damason-P, Darvon, Darvon with ASA, Darvon Compound, Darvon Compound-65, Darvon w/Apspirin, Darvon-N with Apsirin, Dasin, Desipramine, Dipryridamole, Disalcid, Choline, Diurex, Doan’s, Dolcn, Dolobid, Dolphirn #3 Tablets, Doxepin, Drinopehn, Dristan, Dristan Sinus, Duoprin-S Syrup, Duragesic, Duradyne Tablets E Vitamin E, E-aspirin, Easprin EC, Echinacea, Ecolrin, Ecotrin Tablets, EFFEXOR® XR, Elavil, Emagrin, Empirin, Empirin with Codeine, Emprazil, Endodan Tablets, Enoxaparin, Epromate Tablets, Enteric, Ephedra, Equagesic, Equazine-M, Etafon Products, Excedrin, EFFEXOR® XR (venlafaxine HCl) Extended-Release, ExPrazi F Feldene, Fenoprofen Tablets, Fenphen, Feverfew, Fiogesic Tablets, Fioricett, Fiorinal, Fiorinal with Codeine, Fish Oil, Flagyl, Florgen PF, Fluoxetin, Flurbiprofen Tablets, Fragmin, Furadantin, 4 Way Cold Tablets, 5-Aminoslicylic Acid G garlic (allium sativum) tabs & do not eat garlic excessively (some say not at all – but if you accidentally get some or have a little garlic toast, I am sure it’s okay, it’s more for garlic tablets), Genaced, Genacote, Gelpirin Tablets, Genprin, Gensan, Ghemnisym, Gingko, Ginbko Biloba, Gennin, Ginger, Gingko, Ginkobiloba, Ginseng, Glucosamine, GNP aspirin, Goldenseal, Goody’s Headache Powder, Goody-s Extra Strength H Halfprin Tablets, Haltran, Heparin, Hismanal, Hydroxycut, Hydrocortisone I IBU, IBU-Tab, Ibuprofen, Ibuprin, Ibuprohm, Imipramine, Inderal, Inderide, Indocin, Indochron E-R Capsules , Indomethacin Caspules, Indomethacin Suspension, Infantol Pill, Inhiston, Isollyl Improved Tablets & Capsules J Janimine K Kava, Ketoprofen Capsules L Lanorinal, Levatol, Licorice Root, Limbitol, Liquinprin, Lodine, Lortab ASA, Lovenox Inj., Ludiomil M MAO inhibitors, Macrodantin, Magan, Magnaprin, Magnasprin, Magsal, Maprotiline, Marnal, Marthritic Tablets, Maximum Bayer Aspirin, Measurin, Meclomen, MecloFenamate Capsules, Medigistic-Plus, Medipren, Meditren, Melatonin, Mellaril, Menadol, Meprogesic Q, Micraninin, Midol/Midol 200, Midol Original, Midol PMS, Milk Thistle, Miradon, Mobidin, Mobic, Moblgesic, Momentum Back Ache Formula, Monogesic, Motrin, Motrin IB, Multi-Vitamin N Nalfon, Nardil, Nardilzine, Naprosyn, Neomycin, Neogesic, Norgesic, Norgesic Forte, Nortryptyline, Norwich Extra Strength Aspirin, Nov-naproxen, Nuprin, NyQuil/NyQuil P.M. O Orphenagesic, Orphenagesic Forte, Orudis, Oruvail Capsules, Oxycodine, Oxycodone P P-A-C, Pabalate-SF, Pabrin, Pacaps, Pain Reliever Tablets, Pamprin-IB, Panalgesic, Panodynes, Papaya, PediaProfen, Pedrazil, Pentasa, Pepto-Bismol, Percodan, Percodan Demi Tabs, Persantin, Persisin, Persistin, Pertofrane, PetoBismol, Phenaphen, Phenetron Compound, Phenylpropanilamine Pondimin (Fenfluramine), Piroxicam Capsules, Polymyxin, Ponstel Capsules, Prednisone, Presalin, Propanolol, Propulsid, Propoxyphene, Propoxyphene Compound, Propoxyphene Napsylate with Aspirin, Protamine, Prozac, Pyrroxate Q Quagesic, Quiet World Analgesic (sleeping aid), Quinine R Redux (Dexenfluramine), Relafen Tablets, Rexolate, Rhinex, Robaxin, Robasisal, Robaxisal, Roxiprin Tablets, Ru-Tuss, Rufin, S S-A-C, Sal-Sayne, Salabuff, Salatin. Saleto, Saleto 200, Saleto-400,600,800 Tablets, Salflex, Salicylamide, Salocol, Salsalate, Salsitab, Saw Palmetto, Seldane, Serzone, Sign Off Sinus Tablets, Sine Aid, Sine Off, Sinex, SK-65 Compound Capsules, Sofarin, Soltice, Soma Compound, Soma Compound with Codeine, St. John’s Wort, St. Josephs Aspirin, St. Joseph Cold Tablets (for children), Stanback Analgesic, Stanback Powder, Sudafed, Sulindac Tablets, Supac, Surmontin, Surmontil, Synalogos Capsules, Synalgos-DC Capsules T Talwin Compound, Tenol-Plus, Tenuate Dospan, Theracin, Thorazine, Ticlid, Ticlopidine, Tolectin 200,600 Tablets, Tolectin DS Capsules, Tolmetin Tablets/Capsules, Toradol Injection/Tablets, Tr-Pain Tablets, Tri-Pain, Trental, Triavil, Tricosal tablets, Trigesic, Trigestic, Trilisate, Trilisate Tablets and Liquid, Tusal U Ultrapin, Unipro, Ursinis, Ursinos Inlay Tablets V Valerian, Valesin, Valtrex, Vanquish, Verin, Vibramycin, Vicoprofen, Vioxx, Viro- Med Tablets, Visken, Vitamin-E, Vivactil, Vivarin, Voltaren W Warfarin (Coumadin), Wellbutrin, Wesprin Buffered Y Yohimbe Z Zactrin, Zoloft (Zoloft has anti-coagulant properties so just advise your anesthesiologist if you take it) Zorprin, Zyban
*Also a diet low in sodium is beneficial before and after any surgery. Plus, any other aspirin-containing medication, be it natural, prescription or over-the-counter. Alert your doctor of any medications or supplements you may be taking. Even natural supplements have their risks. Please read below.
Other Supplements, Vitamins, And Herbal Remedies Not To Ingest And Why
I know many people may take herbal supplements. Some can be very good for you, but many are contraindicated with anesthesia or surgery in general. Since these supplements are over-the-counter and generally safe to use, some patients might forget to disclose their consumption to their surgeon and anesthesiologist. Many of these are contraindicated and can severely hurt you when used in conjunction with anesthesia, other medications, or while undergoing surgery. Furthermore, just because these products are derived from plants and are considered “natural,” many medications and drugs are actually considered dangerous. Please keep this important point in mind: while you may be embarrassed to disclose your use of medications for weight loss, sexual performance, or depression, don’t be. Nothing is embarrassing when it comes to safety. This is your life – be truthful with us!
- Vitamin E is usually the #1 no-no. Vitamin E has anti-platelet properties and inhibits vital clot formation. Your surgeon may more than likely ask you to cease consuming Vitamin E in any form at least 2 to 3 weeks prior to any surgery and for 2 to 3 weeks afterward.
- Garlic (allium sativum), Ginger, Alfalfa, Cayenne, Papaya, Feverfew, Chamomile, Dong Quai root, Willow bark, Goldenseal, Guarana, Horse Chestnut and Bilberry Tablets/Supplements also have anti-platelet properties and may inhibit vital clot formation. These medications are normally taken to remedy edema (fluid retention).
- Gingko, Gingko biloba, & Selenium are powerful anti-coagulants. It is considered to be 3 times stronger than Vitamin E.
- Ginseng may cause rapid heartbeat/and or high blood pressure in some individuals as well as coagulation disruption.
- St. John’s Wort, Yohimbe, (“The natural Viagra®”) and Licorice root have a mild monoamine oxidase (MAO) inhibitory effect and may intensify the effects of anesthesia. (*note some well-known and popular anti-depressants are MAO inhibitors, disclose any and all medications you are taking – your life may depend on it)
- Melatonin decreases the amount of anesthesia needed for surgery.
- Kava Kava, Hawthorn, Lemon verbena, Muwort, Lavender and Valerian/Valerian Root: (taken to promote relaxation and sleep) have tranquilizing properties and should not be combined with other sedative agents. WARNING! Tell your anesthesiologist/surgeon if you take either one of these.
- Echinacea may have a severe impact on the liver when general anesthesia is used. Please advise your surgeon of all medications and supplements and alert him to the possible effects of herbal supplements and remedies, he may not be aware of the contraindications. It also has some coagulation disruption properties.
- Ma Huang (aka Ephedra): Used by many people for weight loss and is a major component of most weight loss supplements) has been associated with more than 800 adverse health effects including DEATH. It is an amphetamine-like compound with the potential for stimulating the central nervous system and heart.
- Gotu Kola has a stimulant effect as well.
- Ackee fruit as well as, Alfalfa, Aloe, Argimony, Barley, Bitter melon, Burdock root, Carrot oil, Chromium, Coriander, Dandelion root, Devil’s club, Eucalyptus, Fenugreek seeds, Fo-ti, Garlic, Ginseng, Grape seed, Guayusa, Gmena, Juniper, Nem seed oil, Onions, Periwinkle, Yellow root alter the blood glucose level.
- Garlic and Onions as a food: Even moderate consumption of onions and garlic can affect the body negatively when the body undergoes surgery. Try to limit your consumption for 2 weeks beforehand.
Special Medication Alerts!
If you are on anti-depressants, please advise your doctor. Some monoamine oxidase (MAO) inhibitors (also known as MAOI) intensify the effects of the anesthesia – especially general. This could be quite dangerous in the operating room if your doctor is unaware of your medication usage. If you advise your doctor or anesthesiologist, he or she can make adjustments for your anesthesia or at least will watch for the slightest decrease or increase in heart or breathing rate.
These medications may include: Isocarboxazid, Marplan, phenelzine (Nardil, Nardelzine) tranylcypromine (Parnate, Sicoton), Deprenyl, selegiline hydrochloride, 5 HTP, Amitriptyline, Prozac, Wellbutrin, Bupropion, Buropion HCL, Fluoxetin, EFFEXOR® XR, etc. They are used for the treatment of depression, obsessive-compulsive disorder, eating disorders, essential hypertension (pargyline), chronic pain syndromes, and migraine headaches. They work by inhibiting nerve transmissions in the brain that may cause depression. Tranylcypromine and phenelzine account for over 90% of all MAO inhibitors currently prescribed.
It is reported that drug interactions can occur even weeks after discontinued use of an MAOI. Therefore, in patients undergoing general anesthesia, cessation of usage is normally instructed several weeks prior to surgery to avoid possible cardiovascular effects.
If you have any questions about medications or supplements to discontinue prior to a procedure or surgery, please contact our office.