Medication Discontinuation


In general, most common medications can be continued during the surgery except for ACE inhibitors/ARBs and Aspirin for primary prophylaxis. A more detailed look at each medication is below:


Aspirin should be discontinued 5-7 days before surgery if it is taken for primary prophylaxis (i.e. the vast majority of older patients).

In patients with vascular disease, stents, or those undergoing vascular surgery, intraoperative continuation of aspirin should be considered based on the algorithm below:

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  • Almost all should be continued.
  • Consider discontinuing ACEi and ARBs 12-24 hours before surgery because few available agents can counteract their effects intraoperatively. Refractory hypotension can be very dangerous.

Asthma Medications

  • Continued intraoperatively.
  • If patient has history of severe asthma (e.g. requiring hospitalization or intubations) give nebulized albuterol preoperatively.

Psychiatric Medications

  • Continue all psychiatric medications (including antidepressants, antianxiety, and MAOi) intraoperatively.

Autoimmune Medications

  • Continue Methotrexate if no risk for renal failure. Otherwise discontinue.
  • For all the other autoimmune medications (e.g. Etanercept, infliximab), check with prescriber.

Oral Contraceptives

  • Continue Intraoperatively.

Clopidogril (Plavix)

  • Continue in patients with stents.

COX-2 Inhibitors

  • Discontinue is surgeon is concerned about bone healing.


  • Continue Triamterene, HCTZ.
  • Disctoninue Potent Loop Diuretics.

Estrogen Compounds

  • Continue when used for Birth Control or Cancer Therapy.
  • Discontinue when used for osteoporosis or menopause symptoms.

Gastrointestinal Reflux Medications

  • Continue all, except TUMS.

Diabetes (T2) Medications

  • Discontinue: Oral hypoglycemic agent and regular insulin if blood glucose <100.
  • Continue: 1/2 NPH or combination (70/30) preparations.

Narcotics (for Pain or Addiction)

Continue all narcotics


Continue statins.

Steroids (oral or inhaled)

Continue Steroids

Thyroid Medications

Continue thyroid medications.


Discontinue Viagra and similar medications 24 hours before surgery.


Discontinue Warfarin five days before surgery.