Preparing for surgery involves much more than showing up at the hospital on the scheduled day. One of the most critical steps in your pre-operative journey is reviewing your medications with your surgical team. Certain drugs that are perfectly safe in daily life can pose serious risks during surgery—increasing bleeding, interfering with anesthesia, or causing dangerous interactions with other medications.
This guide will help you understand which medications typically need to be paused before surgery, which ones you should continue, and why this decision matters for your safety.
Part I: Why Medication Adjustments Matter Before Surgery
When you undergo surgery, your body experiences significant physiological stress. Anesthesia alters how your body processes drugs, while surgical incisions create a risk of bleeding. Your regular medications may interact unpredictably in this environment .
The medications that keep you healthy at home can potentially:
- Increase bleeding risk during and after surgery
- Interact dangerously with anesthetic agents
- Affect blood pressure or heart rhythm under anesthesia
- Impact blood sugar levels during fasting
- Delay healing or increase infection risk
Stopping the wrong medications—or continuing the wrong ones—can lead to serious complications, including excessive bleeding, adverse drug reactions, or even the need to cancel your surgery .
Part II: Medications You Will Likely Need to Stop
Blood Thinners (Anticoagulants and Antiplatelets)
These medications are designed to prevent blood clots, but during surgery, they can cause dangerous bleeding .
Common blood thinners include:
Important Note: If you are taking a blood thinner for a serious condition like a mechanical heart valve, recent stent, or history of blood clots, do not stop it without explicit instructions from the prescribing physician. You may need “bridging therapy” with a shorter-acting blood thinner to protect you while the main medication is paused .
Diabetes and Weight Loss Medications (GLP-1 Agonists)
Medications like Ozempic, Wegovy, Mounjaro, and Trulicity have become very common, but they pose a specific risk during surgery. These drugs slow stomach emptying, which means food can remain in your stomach even after following fasting instructions, increasing the risk of aspiration during anesthesia .
Common GLP-1 agonists include:
- Semaglutide (Ozempic, Wegovy)
- Tirzepatide (Mounjaro, Zepbound)
- Dulaglutide (Trulicity)
- Liraglutide (Victoza, Saxenda)
- Exenatide (Byetta)
Most guidelines recommend stopping these medications 1-2 weeks before surgery to allow stomach emptying to return to normal .
Other Diabetes Medications
MAO Inhibitors (Antidepressants)
MAOIs are a class of antidepressants that can dangerously interact with anesthetic drugs, potentially causing severe high blood pressure or serotonin syndrome .
Common MAOIs include:
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Isocarboxazid (Marplan)
Because MAOIs irreversibly bind to their target enzymes, it can take 2 weeks or more for the body to recover normal function after stopping them. This decision requires careful coordination between your surgeon and psychiatrist .
Part III: Medications You Will Usually Continue
Not all medications need to be stopped. In fact, stopping some drugs can be more dangerous than continuing them through surgery.
Heart and Blood Pressure Medications
Seizure Medications
Examples: Phenytoin, carbamazepine, levetiracetam, valproate
Stopping seizure medications can trigger breakthrough seizures during surgery, which can be very dangerous. Continue these as prescribed unless your neurologist advises otherwise .
Parkinson’s Disease Medications
Examples: Levodopa/carbidopa (Sinemet), pramipexole, ropinirole
Withdrawal of Parkinson’s medications can cause severe worsening of symptoms and a life-threatening condition called neuroleptic malignant syndrome. Take these as scheduled, even on the morning of surgery .
Psychiatric Medications (Most)
Part IV: Herbal Supplements and Over-the-Counter Products
Many patients do not think of supplements as “medications,” but they can significantly affect surgery.
Supplements to stop at least 1-2 weeks before surgery:
- Garlic – increases bleeding risk
- Ginkgo biloba – increases bleeding risk
- Ginseng – can cause blood pressure instability and bleeding
- Fish oil (high doses) – may increase bleeding risk
- Vitamin E (high doses) – may increase bleeding risk
- St. John’s wort – interferes with many medications used during anesthesia
What to do: Tell your surgeon about all supplements, vitamins, and herbal products you take. Some may need to be stopped, while others are safe to continue .
Part V: Your Pre-Surgery Medication Checklist
Step 1: Create a Complete Medication List
Write down every medication, supplement, and herb you take, including:
- Prescription medications (name, dose, frequency)
- Over-the-counter drugs (pain relievers, antacids, allergy meds)
- Vitamins and supplements
- Herbal products
Step 2: Review with Your Surgical Team
At your pre-operative appointment, go through your list and ask:
- “Which of these should I stop, and when?”
- “Which should I continue?”
- “What should I do about my blood thinners?”
- “Should I take my morning medications on the day of surgery?”
Step 3: Follow Instructions Exactly
If you are told to stop a medication:
- Note the specific date and time to stop
- Ask if you need a “bridge” (alternative medication while the main one is stopped)
- Do not stop any medication without explicit instructions
Step 4: Morning of Surgery
- Take only the medications your surgeon approved
- Use only a small sip of water if you need to swallow pills
- Bring your medication list (including stopped medications) to the hospital
Part VI: What to Do If You Accidentally Take a Stopped Medication
If you realize you have taken a medication you were supposed to stop:
- Do not panic – but do not hide it either.
- Call your surgeon or anesthesia team immediately.
- Be honest about what you took and when.
- Your surgery may need to be rescheduled for your safety.
Hiding this information is dangerous. Your anesthesia team needs to know to keep you safe .
Summary Table: Medication Management Before Surgery
Conclusion: Safety Through Communication
The most important thing you can do is communicate openly with your surgical team. Give them a complete list of everything you take—prescriptions, over-the-counter drugs, vitamins, and herbs. Follow their instructions precisely. And if a mistake happens, tell them immediately.
Your surgeon and anesthesiologist want the same thing you do: a safe surgery and smooth recovery. Medication management is one of the most powerful tools they have to achieve that goal.
At Chromatic Medical Tourism, we provide comprehensive pre-operative preparation, including medication review and coordination with your surgical team. We ensure you have clear, written instructions about which medications to stop and which to continue—so you arrive at surgery fully prepared and confident.
Contact us to learn how we support you through every step of your medical journey, including medication safety before and after your procedure.
