Medicines to tell us about before surgery
The commonest cause of a cancelled operation is a medicine nobody was told about. Bring the full list – including the things you would not think of as medicines.
Do not stop anything on your own
Nothing on this page is an instruction to stop a medicine. Some are genuinely dangerous to stop suddenly. Bring the list to your appointment and we will tell you what to do with each one, and when.
Blood thinners
These matter most, because they affect bleeding during and after surgery. They include warfarin, clopidogrel, the newer agents such as apixaban and rivaroxaban, and aspirin taken for the heart.
Many are stopped for a set number of days before surgery, and some are replaced with a short-acting alternative in the meantime. That plan has to be made with the doctor who prescribed it, which is why we need to know early rather than the night before.
Painkillers and anti-inflammatories
Ibuprofen, diclofenac and similar anti-inflammatory drugs affect platelets and can increase bleeding. They are usually stopped a week or so before surgery. Paracetamol is generally fine to continue.
If you have been taking anti-inflammatories daily for months, say so. Long-term use affects the stomach and the kidneys, and both matter around an operation.
Diabetes medicines and insulin
Fasting before surgery changes what your usual dose will do. Doses are often adjusted on the morning of the operation, and some tablets are held for a day or two around it. Bring your recent blood sugar readings and your HbA1c if you have one.
Well-controlled diabetes is important here for a specific reason: high blood sugar raises the risk of wound infection, and an infection in a joint replacement is a serious complication.
Blood pressure and heart medicines
Most are continued, and some are specifically taken on the morning of surgery with a sip of water. A few – certain diuretics and some blood pressure tablets – are held on the day. We will be specific.
Steroids
If you take steroid tablets regularly, or have had a course recently, tell us. The body’s own steroid response is blunted by them, and that needs covering around surgery.
Herbal remedies and supplements
These are the ones patients leave off the list, because they do not feel like medicines. Several affect bleeding or interact with anaesthetic drugs – fish oil, vitamin E, garlic and ginkgo among them, and a number of ayurvedic preparations.
Bring the packets. It is far easier for us to read the ingredients than for you to remember them.
The simplest way to do this
Put everything you take into a bag – prescription medicines, tablets from the chemist, supplements, herbal preparations, inhalers, eye drops – and bring the bag. It takes two minutes in clinic and it removes the guesswork entirely.
Bring the bag
Everything you take, in its own packaging, to your pre-operative appointment.
