Integrative Approaches and Surgery

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Natural Products and Surgery: What You Need to Know

Before surgery, your surgeon and anesthesiologist will want to know what drugs and supplements/natural products you’re taking. If they don’t ask about natural products or supplements, you need to tell them about any you’re taking. Reasons for this:

  • Usually you are told to stop eating and drinking at midnight before your surgery. There may be some pills you still need to take, and your doctors will tell you which ones to take with a small amount of water.
  • Some intended effects, as well as side effects and interactions of drugs and natural products, can increase the risk for complications during or shortly after surgery. Examples:1
    • Anticoagulants—drugs and supplements that “thin the blood”—can increase your risk of bleeding.
    • Drugs or supplements with sedative effects may interact with your anesthesia or sedatives and increase the time to wake up after surgery.
    • Some products might interfere with your ability to clear the anesthesia and other drugs from your system.
    • Others might suppress your immune system.

Many more interactions are possible. Follow your medical team’s directions.

Natural Products to Avoid before Surgery

Some general guidelines regarding stopping natural products before surgery:

  • Tell you surgeon and anesthesiologist about all drugs, natural products and supplements that you are taking.
  • The American Society of Anaesthesiologists advises patients to stop taking herbal medicines at least two weeks before surgery.2
  • Several integrative oncology physicians are more specific about which to stop and when. These lists are not all-inclusive, so be sure to tell you doctor of all products you are taking.

Two Weeks before Surgery

Avoid taking the following natural products or pharmaceuticals that increase your risk of bleeding:3

Natural products

Pharmaceuticals

  • Alfalfa
  • Astragalus
  • Bromelain
  • Capsicum
  • Devil’s claw
  • Dong quai (Angelica sinensis)
  • Essential fatty acids (EFAs): fish oil and other omega-3s, flax oil, evening primrose oil (EPO), borage
  • Gingko
  • Ginseng

Nonsteroidal anti-inflammatory drugs (NSAIDs):

  • Aspirin
  • Celecoxib (Celebrex)
  • Ibuprofen (Motrin, Advil)
  • Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
  • Others (MedicineNet)

Five to Ten Days before Surgery

Stop cleansing and detoxification regimens and stop taking natural products that affect your liver’s ability to clear anesthesia, sedatives, pain medications, and other surgical drugs.4

  • Garlic
  • Grapefruit juice
  • Kava
  • Methionine

Products Recommended before Surgery

Some drugs and supplements—including nutritional food supplements—might be recommended to help “build you up” before surgery as well as help your tissues heal after surgery. For recommendations of natural products to take before surgery, see the following protocols, programs and plans:

For more information on the implications of taking herbal medicines just before, during and after surgery, see The peri-operative implications of herbal medicines.5  

Written by Laura Pole, RN, MSN, OCNS; with review by Nancy Hepp, MS ; most recent update on October 15, 2019.

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