Peri-operative Medications.

Bring a complete list

Before your procedure, write down everything you take, with the doses: prescription medicines, over-the-counter tablets, inhalers, patches, supplements and herbal remedies. Bring the list (or the boxes) on the day. The more I know, the safer your plan.

Usually keep taking...

Most regular medicines are best continued, including those for blood pressure, reflux/heartburn, thyroid, epilepsy and asthma. Don't stop anything on your own; we'll tell you if a particular tablet should be skipped.

Often patients will say “it’s okay, I'll just skip all my normal meds, I don't really need them / they're not that important / I only take them sometimes.” Doing this may result in your surgery being cancelled, if an important medication has not been taken and you have signs or symptoms when you arrive at hospital which make anaesthesia less safe. So please follow the instructions above, or those of the Anaesthetist when they contact you.

Pain patches and regular strong pain relief should also be continued as usual.

If you have surgery scheduled for the morning, please STILL have your morning medications with sips of water when you first wake up.

Must stop taking these drugs:

Some medicines need special timing: blood thinners, certain diabetes medications (including “-flozin” drugs, some insulins, and the newer weight-loss/GLP-1 injections).

Any drug ending in -flozin, including:

• Dapagliflozin (Forxiga)
• Empagliflozin (Jardiance)
• Xigduo
• Jardiamet

These must be held for 72 hours before surgery. Stop these 2-3 full days before your procedure. This is very important: if these are not stopped, you may experience a severe medical emergency, which often needs admission to the Intensive Care Unit.

Blood thinners:

We must balance the risk of stopping blood thinning medication, with the risk of excessive blood loss and post-operative bleeding complications should we continue with these medications. Each surgery and each medication combination will result in different advice being given to patients in such settings. For this reason, you must discuss the timing of stopping blood thinning medications with your surgeon and the doctor who prescribes them for you (your GP, cardiologist and so on). As a general rule of thumb:

• Aspirin: you will generally continue without cessation.
• Clopidogrel: you will generally need to cease for 7 days, and be on aspirin during that time instead, though this needs planning with your cardiologist and surgeon.
• Warfarin: timing is always individual: follow the plan your prescriber and surgeon give you. If you do not have one, please call our rooms to discuss.
• Rivaroxaban / Xarelto / Apixaban / Eliquis / other strong blood thinning agents: usually ceased 1-3 days before the procedure, and often swapped to aspirin in the lead up to surgery. Please discuss these with your surgeon.

Weight loss drugs:

The official advice regarding weight loss drugs has recently changed. The update now is to continue to take your regular weight loss medications peri-operatively with a sip of water unless told otherwise. Childhood, diabetes, reflux, pregnancy and other patient factors can result in the need for a more tailored / altered plan. Always follow the exact instructions from your hospital or from us. When they differ from this general guide, the hospital and anaesthetist's instructions take priority!

If you have taken weight loss or similar compound "peptides" eg:

• Ozempic / Wegovy (Semaglutide)
• Mounjaro (Tirzepatide)
• Trulicity (Dulaglutide)
• Victoza / Saxenda (Liraglutide)
• Retatrutide, Reta, R-10, R-20

These change your fasting guidelines completely - please tell your anaesthetist and surgeon if you have taken these in the last month or so, for instructions. If so, you can read the fasting guideline that applies to you in the Ozempic / Peptides folder on this site!

Diabetes medications:

These are planned individually, so always follow the specific instructions you're given over this general guide.

As a fallback guide you can follow in case of uncertainty, refer to the special Diabetes Medication Management Pathway we have developed for you (COMING SOON), accessed through the previous page resources by entering your surgery date & DOB. After you complete the diabetes survey, a copy will be sent to us for review and approval, and you will be given a plan for your diabetes medications!