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Home , Anagrelide, Methotrexate

PREOPERATIVE GUIDELINES FOR MEDICATIONS PRIOR TO SURGERY

Oklahoma Spine Hospital

GO STOP CAUTION

DO not Generic Brand PreOp Instruction bring MISC Washout Resume Drug Class Orencia Stop 6 weeks before surgery √ -- 6 weeks -- Immunosuppressant Should be continued until and including the day of -- -- β-Blocker Acebutolol Sectral surgery -- Humira Stop 8 weeks before surgery -- 8 wks -- Immunosuppressant Should be continued until and including the day of Anti-Depressant Amitriptyline Elavil surgery ------Should be continued until day before surgery, but DC’d Angiotensin Amlodipine/Olmesartan/Medoximil -- -- Azor on the day of surgery BMP Blockers Agrylin Should be DC’d 5 days prior to surgery -- 5 days -- Blood Thinners Apixaban Eliquis Should be DC’d 2 days prior to surgery -- 3 days -- Blood Thinners Armodafinil Nuvigil Should be DC’d 7 days prior to surgery -- 7 days -- Sleep disorders ASA Should be DC’d 5 days prior to surgery √ -- 5 days -- Blood Thinners ASA/ Aggrenox Should be DC’d 5 days prior to surgery √ -- 5 days -- Blood Thinners Aspirin Compound Anacin Should be DC’d 5 days prior to surgery √ -- 5 days -- Pain Med Aspirin Compound Aspirin Should be DC’d 5 days prior to surgery √ -- 5 days -- Pain Med Aspirin Compound Bayer Aspirin Should be DC’d 5 days prior to surgery √ -- 5 days -- Pain Med Aspirin Compound BC Powder Should be DC’d 5 days prior to surgery √ -- 5 days -- Pain Med Aspirin Compound Bufferin Should be DC’d 5 days prior to surgery √ -- 5 days -- Pain Med Aspirin Compound Ecotrin Should be DC’d 5 days prior to surgery √ -- 5 days -- Pain Med Aspirin Compound Excedrin Should be DC’d 5 days prior to surgery √ -- 5 days -- Pain Med Aspirin Compound Fiorinal Should be DC’d 5 days prior to surgery √ -- 5 days -- Pain Med Aspirin Compound Fiorinal/Codeine Should be DC’d 5 days prior to surgery √ -- 5 days -- Pain Med Aspirin Compound Pepto-Bismol Should be DC’d 5 days prior to surgery √ -- 5 days -- Nausea Aspirin Compound Percodan Should be DC’d 5 days prior to surgery √ -- 5 days -- Pain Med Aspirin Compound Synalgos DC Should be DC’d 5 days prior to surgery √ -- 5 days -- Pain Med Aspirin Compound Willowbark Should be DC’d 5 days prior to surgery √ -- 5 days -- Pain Med Should be continued until and including the day of -- -- β-Blocker Atenolol Tenormin surgery -- Should be continued until and including the day of -- -- β-Blocker Atenolol/Chlorthalidone Tenoretic surgery -- Balsalazide Colazal Should be DC’d 10 days prior to surgery -- 10 days -- Anti-Inflammatory

DO not Generic Brand PreOp Instruction bring MISC Washout Resume Drug Class Should be continued until day before surgery, but DC’d Angiotensin Converting Benazepril Lotensin on the day of surgery ------ Inhibitor Should be continued until day before surgery, but DC’d Angiotensin Converting Benazepril/HCTZ Lotensin HCT on the day of surgery BMP -- -- Should be continued until and including the day of -- -- β-Blocker Bisoprolol Zebeta surgery -- Should be continued until and including the day of -- -- β-Blocker Bisoprolol/HCTZ Ziac surgery BMP Should be continued until and including the day of √ Pain Med Buprenorphine Butrans surgery ------Should be continued until and including the day of √ Pain Meds Buprenorphine Suboxone surgery ------Should be continued until and including the day of Anti-Depressant Bupropion Wellbutrin surgery ------Should be continued until day before surgery, but DC’d Angiotensin Receptor Candesartan Atacand on the day of surgery BMP -- -- Blockers Should be continued until day before surgery, but DC’d -- -- Angiotensin Receptor Candesartan/HCTZ Atancand HCT on the day of surgery BMP Blockers Should be continued until day before surgery, but DC’d Angiotensin Converting Captopril Capoten on the day of surgery ------Enzyme Inhibitor Should be continued until day before surgery, but DC’d Angiotensin Converting Captopril/HCTZ Capozide on the day of surgery BMP -- -- Enzyme Inhibitor Should be continued until and including the day of √ Muscle Relaxer Carisoprodol Soma surgery ------Should be continued until and including the day of -- -- β-Blocker Carvedilol Coreg surgery -- CBD Oil CBD Oil Stop 10 days before surgery √ -- 10 days -- Supplement Celebrex Should be DC’d 10 days prior to surgery √ -- 10 days -- NSAIDs Pletal Should be DC’d 7 days prior to surgery -- 7 days -- Blood Thinners Should be continued until and including the day of Anti-Depressant Citalopram Celexa surgery ------ Plavix Should be DC’d 7 days prior to surgery -- 7 days -- Blood Thinners Cocaine Cocaine Should be DC’d 14 days prior to surgery √ -- 14 days -- Stimulant Should be continued until and including the day of √ Muscle Relaxer Cyclobenzaprine Flexeril surgery ------Dabigatran Pradaxa Should be DC’d 1 day prior to surgery -- 1 day -- Blood Thinners Should be continued until and including the day of Anti-Depressant Desvenlafaxine Pristiq surgery ------Dextroamphetamine Adderall Stop 3 days before surgery √ -- 7 days -- ADHD Medications Should be continued until and including the day of √ Muscle Relaxer Valium surgery ------Diclofenac Voltaren Should be DC’d 10 days prior to surgery √ -- 10 days -- NSAIDs Diclofenac/ Arthrotec Should be DC’d 10 days prior to surgery √ -- 10 days -- NSAIDs Diet Aide Diet Aide Stop 14 days before surgery √ -- 14 days -- Diet Aide Dipyridamole Persantine Should be DC’d 6 days prior to surgery -- 6 days -- Blood Thinners

DO not Generic Brand PreOp Instruction bring MISC Washout Resume Drug Class Should be continued until and including the day of Anti-Depressant Doxepin Sinequan surgery ------Should be continued until and including the day of Anti-Depressant Duloxetine Cymbalta surgery ------Edixaban Savaysa Should be DC’d 3 day prior to surgery 3 days -- Blood thinner Should be continued until day before surgery, but DC’d Angiotensin Converting Enalapril Vasotec on the day of surgery ------Enzyme Inhibitor Should be continued until day before surgery, but DC’d Angiotensin Converting Enalapril/HCTZ Vaseretic on the day of surgery BMP -- -- Enzyme Inhibitor Should be continued until day before surgery, but DC’d -- -- Angiotensin Receptor Eprosartan Teveten on the day of surgery -- Blockers Should be continued until day before surgery, but DC’d Angiotensin Receptor Eprosartan/HCTZ Teveten HCT on the day of surgery ------Blockers Should be continued until and including the day of Anti-Depressant Escitalopram Lexapro surgery ------ Enbral Stop 2 weeks before surgery √ -- 14 days -- Immunosuppressant Etodolac Lodine Should be DC’d 10 days prior to surgery √ -- 10 days -- NSAIDs Exenatide Byetta Hold day of surgery √ ------Diabetic Should be continued until day before surgery, but DC’d Angiotensin Converting Fosinopril Monopril on the day of surgery ------Enzyme Inhibitor Should be continued until day before surgery, but DC’d -- -- Angiotensin Converting Fosinopril/HCTZ Monopril HCT on the day of surgery BMP Enzyme Inhibitor Garlic Garlic Should be DC’d 10 days prior to surgery √ -- 10 days -- Supplements Ginko Baloba Ginko Baloba Should be DC’d 10 days prior to surgery √ -- 10 days -- Supplements Plaquenil Should be DC’d 10 days prior to surgery -- 10 days -- Immunosuppressive Ibuprofen Advil Should be DC’d 10 days prior to surgery √ -- 10 days -- NSAIDs Ibuprofen Motrin/Advil Should be DC’d 10 days prior to surgery √ -- 10 days -- NSAIDs Indomethacin Indocin Should be DC’d 10 days prior to surgery √ -- 10 days -- NSAIDs Remicade Stop 6 weeks before surgery √ -- 6 wks -- Immunosuppressant Insulin Insulin Give ½ of morning dose day of surgery √ ------Diabetic Insulin Pump Insulin Reduce insulin pump rate by ½ at 0600 ------Diabetic Should be continued until day before surgery, but DC’d Angiotensin Receptor Irbesartan Avapro on the day of surgery BMP -- -- Blockers Should be continued until day before surgery, but DC’d -- -- Angiotensin Receptor Irbesartan/HCTZ Avalide on the day of surgery BMP Blockers Ketoprofen Orudis Should be DC’d 10 days prior to surgery √ -- 10 days -- NSAIDs Ketorolac Toradol Should be DC’d 10 days prior to surgery √ -- 10 days -- NSAIDs Should be continued until and including the day of -- -- β-Blocker Labetalol Normodyne surgery -- Arava Should be DC’d 10 days prior to surgery -- 10 days -- Arthritis Should be continued until and including the day of √ Muscle Relaxer Lioresal Baclofen surgery ------

DO not Generic Brand PreOp Instruction bring MISC Washout Resume Drug Class Liraglutide Victoza Give ½ of morning dose day of surgery √ ------Diabetic Lisdexamfetamine Vyvanse Stop 3 days before surgery √ -- 7 days -- ADHD Medications Should be continued until day before surgery, but DC’d Angiotensin Converting Lisinopril Prinivil, Zestril on the day of surgery ------Enzyme Inhibitor Prinzide, Should be continued until day before surgery, but DC’d Angiotensin Converting Lisinopril/HCTZ BMP -- -- Zestoretic on the day of surgery Enzyme Inhibitor Should be continued until day before surgery, but DC’d Angiotensin Receptor Losartan Cozaar on the day of surgery BMP -- -- Blockers Should be continued until day before surgery, but DC’d Angiotensin Receptor Losartan/HCTZ Hyzaar on the day of surgery BMP -- -- Blockers Marijuana Marijuana Should be DC’d 1-2 weeks prior to surgery √ -- 14 days -- Illicit Drug Meloxicam Mobic Should be DC’d 10 days prior to surgery √ -- 10 days -- NSAIDs Mesalamine Pentasa Should be DC’d 10 days prior to surgery -- 10 days -- Anti-Inflammatory Should be continued until and including the day of √ Muscle Relaxer Metaxalone Skelaxin surgery ------Should be continued until and including the day of -- -- Anti-Diabetic Metformin Glucophage surgery -- Should be continued until and including the day of -- -- Anti-Diabetic Metformin/Dapagliflozin Xigduo XR surgery -- Should be continued until and including the day of -- -- Anti-Diabetic Metformin/Glipizide Metaglip surgery -- Should be continued until and including the day of -- -- Anti-Diabetic Metformin/Glyburide Glucovance surgery -- Should be continued until and including the day of -- -- Anti-Diabetic Metformin/Pioglitazone Actoplus Met surgery -- Should be continued until and including the day of -- -- Anti-Diabetic Metformin/Repaglinide PrandiMet surgery -- Should be continued until and including the day of -- -- Anti-Diabetic Metformin/Rosiglitazone Avandamet surgery -- Should be continued until and including the day of -- -- Anti-Diabetic Metformin/Sitagliptin Janumet surgery -- Should be continued until and including the day of √ Muscle Relaxer Methocarbamol Robaxin surgery ------ Methotrexate Should be DC’d 10 days prior to surgery -- 10 days -- Arthritis Methylphenidate Ritalin, Concerta Should be DC’d 7 days prior to surgery √ -- 7 days -- ADHD Medications Should be continued until and including the day of -- -- β-Blocker Metoprolol Lopressor,Toprol surgery -- Should be continued until and including the day of -- -- β-Blocker Metoprolol/HCTZ Lopressor HCT surgery BMP Should be continued until and including the day of Anti-Depressant Mirtazapine Remeron surgery ------Modafinil Provigil Should be DC’d 7 days prior to surgery -- 7 days -- Misc Should be continued until day before surgery, but DC’d Angiotensin Converting Moexipril Univasc on the day of surgery ------Enzyme Inhibitor

DO not Generic Brand PreOp Instruction bring MISC Washout Resume Drug Class Should be continued until day before surgery, but DC’d Angiotensin Converting Moexipril/HCTZ Uniretic on the day of surgery BMP -- -- Enzyme Inhibitor Nabumetone Relafen Should be DC’d 10days prior to surgery √ -- 10 days -- NSAIDs Should be continued until and including the day of -- -- β-Blocker Nadolol Corgard surgery -- Naltrexone INJ Vivitrol Should be DC’d 25 days before surgery 25 days -- Opioid Antagonist Naltrexone PO Revia Should be DC’d 3 days before surgery 3 days -- Opioid Antagonist Aleve/Naprosyn Should be DC’d 10 days prior to surgery √ -- 10 days -- NSAIDs Should be continued until and including the day of -- -- β-Blocker Nebivolol Bystolic surgery -- Should be continued until day before surgery, but DC’d Angiotensin Receptor Olmesartan Benicar on the day of surgery BMP -- -- Blockers Should be continued until day before surgery, but DC’d -- -- Angiotensin Receptor Olmesartan/Amlodipine Tribenzor on the day of surgery -- Blockers Should be continued until day before surgery, but DC’d -- -- Angiotensin Receptor Olmesartan/HCTZ Benicar HCT on the day of surgery BMP Blockers Olsalazine Dipentum Should be DC’d 10 days prior to surgery -- 10 days -- Anti-Inflammatory Should be continued until and including the day of √ Pain Meds Opiates Opiate surgery ------Should be continued until and including the day of Anti-Depressant Paroxetine Paxil surgery ------Should be continued until and including the day of Anti-Depressant Paroxetine Prozac surgery ------Pentosan Elmiron Should be DC’d 10 days prior to surgery -- 10 days -- Cystitis Trental Should be DC’d 7 days prior to surgery -- 7 days -- Blood Thinners Should be continued until day before surgery, but DC’d Angiotensin Converting Perindopril Aceon on the day of surgery ------Enzyme Inhibitor Persantine Dipyridamole Should be DC’d 7 day prior to surgery -- 7 days -- Blood Thinners Should be continued until and including the day of -- -- β-Blocker Pindolol Visken surgery -- Piroxicam Feldene Should be DC’d 10 days prior to surgery -- 10 days -- NSAIDs Effient Should be DC’d 7 days prior to surgery -- 7 days -- Blood Thinners Should be continued until and including the day of √ -- -- Supplement Probiotic Probiotic surgery -- Should be continued until and including the day of -- -- β-Blocker Propranolol Inderal surgery -- Should be continued until day before surgery, but DC’d Angiotensin Converting Quinapril Accupril on the day of surgery ------Enzyme Inhibitor Should be continued until day before surgery, but DC’d -- -- Angiotensin Converting Quinapril/HCTZ Accuretic on the day of surgery BMP Enzyme Inhibitor Should be continued until day before surgery, but DC’d Angiotensin Converting Ramipril Altace on the day of surgery ------Enzyme Inhibitor Should be continued until and including the day of Anti-Depressant Reboxetine Edronax surgery ------Ribaroxaban Xarelto Should be DC’d 3 day prior to surgery -- 3 day -- Blood Thinners

DO not Generic Brand PreOp Instruction bring MISC Washout Resume Drug Class Should be continued until and including the day of Anti-Depressant Sertraline Zoloft surgery ------ Viagra Should be DC’d 2 days prior to surgery √ -- 2 days -- ED Should be continued until and including the day of -- -- β-Blocker Sotalol Betapace surgery -- Should be continued until and including the day of Immunosuppressant Steroids Steroids surgery ------ Azulfidine Should be DC’d 10 days before surgery -- 10 days -- Anti-Inflammatory Sulindac Clinoril Should be DC’d 10 days prior to surgery √ -- 10 days -- NSAIDs Supplement Supplement Stop 10 days before surgery √ -- 10 days -- Supplements Cialis Should be DC’d 2 days prior to surgery √ -- 2 days -- ED Should be continued until day before surgery, but DC’d Angiotensin Receptor Telmisartan Micardis on the day of surgery ------Blockers Should be continued until day before surgery, but DC’d -- -- Angiotensin Receptor Telmisartan/Amlodipine Twynsta on the day of surgery -- Blockers Should be continued until day before surgery, but DC’d -- -- Angiotensin Receptor Telmisartan/HCTZ Micardis HCT on the day of surgery BMP Blockers Brilinta Should be DC’d 5 days prior to surgery -- 5 days -- Blood Thinners Ticlid Should be DC’d 7 days prior to surgery -- 7 days -- Blood Thinners Should be continued until and including the day of √ Muscle Relaxer Tizanidine Zanaflex surgery ------ Xeljanz Should be DC’d 7 days before surgery -- 7 days -- Rheumatoid Tolmetin Tolectin Should be DC’d 10 days prior to surgery -- 10 days -- NSAIDs Should be continued until day before surgery, but DC’d Angiotensin Converting Trandolapril Mavik on the day of surgery ------Enzyme Inhibitor Should be continued until day before surgery, but DC’d -- -- Angiotensin Converting Trandolapril/HCTZ Tarka on the day of surgery BMP Enzyme Inhibitor Should be continued until and including the day of Anti-Depressant Trazodone Desyrel surgery ------Should be continued until day before surgery, but DC’d Angiotensin Receptor Valsartan Diovan on the day of surgery ------Blockers Should be continued until day before surgery, but DC’d -- -- Angiotensin Receptor Valsartan/Amlodipine Exforge on the day of surgery -- Blockers Should be continued until day before surgery, but DC’d Angiotensin Receptor Valsartan/HCTZ Diovan HCT on the day of surgery BMP -- -- Blockers Should be continued until and including the day of Anti-Depressant Venlafaxine Effexor surgery ------Should be continued until and including the day of Anti-Depressant Vilazodone Viibryd surgery ------Should be continued until and including the day of Anti-Depressant Viloxazine Vivalan surgery ------Vitamin E Vitamin E Should be DC’d 10 days prior to surgery √ -- 10 days -- Supplement Should be continued until and including the day of Anti-Depressant Vortioxetine Brintellix surgery ------Warfarin Coumadin Should be DC’d 7 days prior to surgery -- 7 days -- Blood Thinners