This is a general guideline, so please DO NOT use this as medical advice. Before plastic surgery – or any other form of surgery- there are certain medications you should stop- they cause bleeding, gastric emptying issues, lower blood sugar (and you won’t be eating after midnight), interact with anesthetics, or increase your risk for infection. But there are medications you should take- particularly those for blood pressure and heart issues. Many blood thinners are given for a specific reason. You need to discuss exact timing with your surgeon and your managing doctor. Many of the following guidelines are recommendations from my surgery center.
General rules of thumb:
- You are NPO (nothing by mouth) after midnight the night before surgery. This means no water or morning coffee. If you need to take a medication you need to take it dry or with a TINY sip of water.
- We need your stomach empty to reduce the risk of aspiration (food going down your windpipe) which is dangerous. Many of the new weight loss medications delay gastric emptying and people have found undigested food from over a week before still in their stomach.
- If you are taking medications for blood pressure issues, heart issues, lung, seizures disorders, or gastric reflux, we frequently want you to continue those medications.
- Medications have different lengths of effect. So for some if you stop them the day before it will be gone by surgery, but for others the effects last for weeks. Common medications with long half lives are thyroid medications and antidepressants. Missing or delaying one dose will be unnoticeable.
DRUGS TO STOP 4 weeks ahead
- THC Has been found in any form to be atherosclerotic and could affect blood perfusion.
- VAPING or SMOKING anything of any kind. Will affect blood perfusion. Particularly important for flap surgeries like facelifts, breast lifts & reductions, and tummy tucks. Ideally stop this even farther ahead than 4 weeks.
- HERBALS & ALTERNATIVE MEDICATIONS. These are unregulated, may cause bleeding &other issues.
- SUPPLEMENTS Again, unregulated and may cause other effects
- COLLAGEN
- BIOTIN
DRUGS TO STOP 2 WEEKS AHEAD
- GLP-1 Agonists (Semaglutide, Ozempic, Wegovy, Trulicity, Byetta, Mounjaro). If using for diabetes, can stop 1 week ahead.
- MAO inhibitors (antidepressant Nardil, Parnate, Marplan, and Emsam) – this should be discussed with your surgeon and anesthesia 2 weeks prior to surgery
3 DAYS AHEAD STOP
- Erectile dysfunction medication
- SGLT 2 inhibitors for diabetes (end in “flozin”)
DAY BEFORE STOP
- Regular dose of vitamins, iron
DAY OF HOLD
- Diabetes medication – insulin or oral medications other than semagludite and SGLT2. You aren’t eating, and we would rather have your blood sugar be high than too low.
- Chewable antacids
- Niacin
- Premarin, estrogen
VARIABLE- need to discuss with your surgeon.
- Opioid antagonists- naltrexone (hold 4 days), naloxone (hold am of surgery), vivitrol (hold six weeks), buprenorphine (consult with anesthesia)
- BLOOD THINNERS. This advice is going to vary a lot as to type of surgery (bleeding risk) and why are you taking the blood thinner? Do you have a stent? Have Afib? This is for sure something you need to talk with your doctor about. Coumadin (generally stopped 5-7 days ahead of surgery), Plavix (7 days prior) , Aspirin, NSAIDS like Advil and Motrin (usually 2 weeks prior), Pradaxa (72 hours), Ticlid (10-14 days prior).
- AUTOIMMUNE INFUSIONS. Many of these will make you relatively more immunocompromised, so may affect infection and healing. I usually time my surgery with the infusions to minimize this.
Again, remember these are general guidelines. You should be brutally honest with your surgeon. We are here to help you have a safe, uneventful surgery.