Medications to Stop Before Surgery

When preparing for surgery, it's essential to pause certain medications to reduce risks during and after the procedure. 

These medications fall into two main categories:

1. Weight Loss and Diabetes Medications

A. GLP-1 Receptor Agonists
Examples:

• Semaglutide – Brand names: Ozempic, Wegovy
• Tirzepatide – Brand names: Mounjaro, Zepbound

When to stop:

• Weekly injections: Stop 7 days before surgery
• Daily doses: Skip the dose on the day of surgery

The reason to stop GLP-1 drugs prior to surgery is that they cause delayed emptying of the stomach.  In other words, food and stomach juices can remain in the stomach for prolonged periods with these drugs and are at risk for entering the airway during induction of general anesthesia, causing pneumonia.  Safe anesthesia requires an empty stomach whenever possible.

B. SGLT2 Inhibitors
Examples:

• Empagliflozin – Brand: Jardiance
• Canagliflozin – Brand: Invokana
• Dapagliflozin – Brand: Farxiga

When to stop:

• 4 days before surgery

C. Metformin
 When to stop:

• 2 days before surgery

D. Insulin

• If you take daily insulin injections, you’ll need a customized plan with your endocrinologist or primary care provider.

The reason to stop most of these diabetes drugs is to avoid blood sugar levels dropping too low before surgery, when patients are often fasting.

2. Blood Thinners (Anticoagulants and Antiplatelets)

A. Long-acting blood thinners: 
Examples:

• Warfarin – Brand: Coumadin
• Clopidogrel – Brand: Plavix
• Ticagrelor – Brand: Brilinta
• Aspirin

When to stop:

• 7 days before surgery
• Exceptions: If you have severe coronary artery disease, you may be instructed to continue aspirin throughout surgery.

B. Short-acting blood thinners: 
Examples:

• Apixaban – Brand: Eliquis
• Rivaroxaban – Brand: Xarelto

When to stop:

• 3 days before surgery

The reason to stop blood thinners before surgery is that surgery inevitably involves cutting small blood vessels, and we need these vessels to clot during and after surgery to prevent bleeding into the operative field during and immediately after surgery.  Of course, people are taking these blood thinners for a reason - generally out of concern for excessive clotting, for example in patients who have atrial fibrillation or other forms of heart disease.  Therefore, our goal is to restart these medications as soon as it is safe to do so after surgery.

Summary Table

When to Restart Medications After Surgery

The timing for restarting medications is highly individualized and depends on:

• The type of surgery
• The risk of bleeding after surgery
• The specific medication involved

Generally, medications are restarted gradually once the risk of postoperative bleeding has passed.

Always follow your surgeon or healthcare provider’s specific instructions. This guide serves as a general overview and not a replacement for medical advice.

Once again, I’m Dr. Michael Yeh from UCLA Health Endocrine Surgery. 

For further information, please see our related video on getting ready for surgery.  And thanks for watching.

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