In general you should continue to take your regular medications, however there are some exceptions. These include blood thinners, diabetic medications, some blood pressure medications and fluid tablets. You should discontinue all your natural or herbal supplements at least a week before surgery.
Blood Thinners
Aspirin
If you take aspirin and you do not have a heart or other stent in place you should stop it at least seven to ten days before surgery. If you do have a stent you may still need to stop it but you should discuss this with your anaesthetist, cardiologist and surgeon.
Clopidogrel (Plavix)
This should be stopped for most surgery as with aspirin. If you have had a heart stent placed within the last six to twelve months do not stop unless you have discussed this with your anaesthetist or cardiologist.
Warfarin
This should be stopped at least 5 days before surgery. Do not stop if you have had a heart valve replacement or are at high risk of clots or stokes until you have discussed a plan with your anaesthetist, surgeon and/or cardiologist.
Dabigatran (Pradaxa)
Follow the instructions as with warfarin above.
Other blood thinners should be discussed with your anaesthetist.
Blood Pressure Medications
If you take a regular blood pressure medication then you should not take ACE inhibitor drugs on the day of surgery. Some common names for these are:
- Captopril – Capoten
- Cilazapril – Inhibace
- Enalapril – Renitec
- Lisinopril – Prinivil, Zestril
- Perindopril – Coversyl
- Benazepril – Cibacen
- Quinapril – Accupril
- Trandolapril – Gopten, Odrik
You should continue to take beta blockers if you are prescribed them. Some common beta blockers are:
- Acebutolol: ACB, Sectral
- Alprenolol: Aptin CR
- Atenolol: Ansolol, Apo-Atenolol, Loten, Tenormin
- Celiprolol: Selectol
- Labetolol: Hybloc, Trandate
- Metoprolol: Betaloc CR, Lopressor
- Nadolol: Apo-Nadolol, Corgard
- Oxprenolol: Captol, Trasicor
- Pindolol: Apo-Pindolol, Pindol, Visken, Vypen
- Propranolol: Angilol, Apo-Propranolol, Cardinol, Inderal
- Sotalol: Pacific, Sotacor
- Timolol: Apo-Timolol, Hypermol, Tilmat, Blocadre
Check the small print of the drug labels for their names. If you are unsure check with your anaesthetist or GP. If you have not been able to contact your anaesthetist or you have not been contacted by the hospital then do not take them on the day of surgery and ask the nurse at the hospital to discuss this with your anaesthetist.
Fluid Medications (Diuretics)
Some common diuretics are:
- Bendrofluazide: Neo-Naclex
- Cyclopenthiazide: Prothiazide, Navidrex
- Indapamide: Napamide, Naplin, Natrilix
- Frusemide/Furosemide: Lasix, Diurin, Urex
- Spironolactone: Spiractin
Do not take these on the day of surgery.
Diabetic Medicines
If you have diabetes, ensure that your surgeon is aware so that you can be booked as the first case on the list. In some situations this may not be possible but we will make every effort to ensure this happens.
Some general guidelines follow but these should only be followed, after discussion with your anaesthetist:
Type 2 diabetes:
If you have type 2 diabetes you will usually either be on diet control, tablets or in severe cases insulin injections. Some general guidelines follow:
Diet control:
no action necessary
Tablets:
Do not take any of your diabetic tablets on the morning of surgery.
- If you are taking DAPAGLIFLOZIN (Forxiga®), EMPAGLIFLOZIN (Jardiance®), CANAGLIFLOZIN (Invokana®, or a combination with metformin (Xigduo®, Jardiamet®) then stop these tablets 2 days before surgery.
Insulin +/- tablets:
Do not take your tablets. If you take insulin in the morning then give yourself 70% of your normal dose as long acting insulin (e.g. lantus (glargine)) in the morning when you arrive at hospital. Do not take any rapid acting insulin if you have morning surgery but if your surgery is in the afternoon then you may have a reduced amount to reflect a light breakfast only.
If you only take insulin at night then take your normal dose the night before.
If you are having major surgery (you are staying at least one night) then you should discuss your management with your anaesthetist.
Type 1 diabetes:
Minor Surgery (You are going home the same day)
Night before surgery- insulin as per normal
Day of surgery- Take 70% of your usual morning dose as long acting insulin e.g. lantus. If your surgery is in the morning, do not have breakfast and do not take your short acting insulin. If you are having surgery in the afternoon, have a light breakfast before 7 am and give yourself 70% your usual dose of insulin. Monitor your blood sugars regularly (at least every 2 hours).
If you are on an insulin pump, continue with the basal rate.
Major Surgery (You will need to stay at least one night)
Night before surgery- take your normal insulin
Day of surgery- you will probably need an insulin infusion on the day of surgery. Discuss this with your anaesthetist but if you have not been able to contact them then follow the instructions for having minor surgery.