Avoid these Supplements Before Surgery

Surveys suggest that 4 out of 5 Americans use dietary supplements. Providers should always counsel patients about potential interactions with medications, but this is especially important before, during, or after surgery. Supplements that have sedative effects, increase the risk of bleeding, or affect blood sugar control should be on your radar. Here are some of the most common culprits.

Ask patients if they take any supplements for relaxation, such as valerian or kava. Both of these natural medicines have sedative effects that might cause additive CNS depression when combined with anesthesia and other medications used perioperatively. Possible liver damage is also a concern with both kava and valerian. Tell patients to stop using these and other common sedatives like cannabis and ashwagandha at least 2 weeks before a scheduled surgery.

When it comes to bleeding risk, ginkgo biloba is one to watch out for. It’s commonly used for memory and cognitive function, which is a popular supplement category for older patients. There are many cases of surgical and post-surgical complications in patients using ginkgo, particularly in the elderly population. Bleeding behind the eye during cataract surgery, excessive postoperative bleeding following hip replacement, and persistent bleeding after dental surgery have all been documented. Tell patients to stop using ginkgo at least 2 weeks before surgery.

Finally, make sure you ask about turmeric, ginger, and garlic. All three of these ingredients are popular among consumers and have the potential to both increase the risk of bleeding and interfere with blood sugar control. These effects can become dangerous, particularly when multiple ingredients with similar effects are used together.

In general, many patients still don’t realize the risks associated with dietary supplements. Ask patients directly if they’re using any natural products or supplements before a scheduled surgery – and explain why discontinuing these products is so important. Check out our monograph classes on antiplatelet, anticoagulant, hypoglycemic, and sedative agents to learn about other ingredients to watch out for.