Gastrointestinal medications

Antacids

Omit dose(s) of these medications while fasting pre-operatively.

Examples: Co-magaldrox (Maalox®, Mucogel®), Co-simalcite (Altacite Plus®), Magnesium carbonate, Magnesium trisilicate, Magnesium trisilicate with magnesium carbonate and sodium bicarbonate, Simeticone with aluminium hydroxide and magnesium hydroxide (Maalox Plus®), Sodium alginate with calcium carbonate and sodium bicarbonate (Acidex®, Gaviscon®, Peptac®), Sodium alginate with potassium bicarbonate (Acidex Advance®, Gaviscon Advance®), Kolanticon

Antispasmodics (Antimuscarinics)

Continue these medications pre-operatively.

Examples: Dicycloverine, Hyoscine butylbromide, Propantheline

Antispasmodics (Smooth Muscle Relaxants)

Continue these medications pre-operatively, except Fybogel mebeverine® (ispaghula + mebeverine).

Examples: Alverine citrate, Mebeverine, Peppermint oil

Bile Acid Sequestrants

Omit dose(s) on morning of procedure.

Examples: Colesevelam hydrochloride, Colestipol hydrochloride, Colestyramine

Histamine H2-Receptor Antagonists (H2RA)

Continue these medications pre-operatively. If patients take a H2RA ‘as required’, they should be advised to take a dose the night before/morning of procedure.

Examples: Cimetidine, Famotidine, Nizatidine, Ranitidine

Proton Pump Inhibitors (PPIs)

Continue these medications pre-operatively. If patients take a PPI ‘as required’, they should be advised to take a dose the night before/morning of procedure.

Examples: Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole

Other

Loperamide

Continue this medication pre-operatively.

Linaclotide

Continue this medication pre-operatively.

Orlistat

Omit dose(s) of these medications while fasting pre-operatively.

Pancreatin

Omit dose(s) of these medications while fasting pre-operatively.

Examples: Creon®, Nutrizym®, Pancrease HL®, Pancrex V®

Prucalopride

Continue this medication pre-operatively.

Genitourinary

5-α Reductase Inhibitors

Continue this medication pre-operatively, including combinations.

Examples: Dutasteride, Finasteride

Alpha-adrenoceptor Blockers

Continue this medication pre-operatively, including combinations.

Examples: Alfuzosin, Doxazosin, Indoramin, Prazosin, Tamsulosin, Terazosin

Antimuscarinics for Urinary Disorders

Continue as normal pre-operatively, including the following combination product: Solifenacin and tamsulosin.

Examples: Darifenacin, Fesoterodine, Flavoxate, Oxybutynin, Propiverine, Solifenacin, Tolterodine, Trospium

Combined Hormonal Contraceptives

For minor procedures, continue as normal pre-operatively if there is a low risk of prolonged immobilisation.

Otherwise it is preferable to discontinue 4 weeks before major elective surgery, surgery to the legs or surgery that involves prolonged immobilisation of a lower limb.

It is important that any patient taking these medications is warned about the intraoperative use of suggamadex if they are receiving a general anaesthetic. Suggamadex reverses the effect of certain muscle-relaxing drugs that are given when a patient is intubated. If a person receives a bolus dose of suggamadex, it is recommended that they use an alternative form of contraception in the 7 days following the operation.

Examples: Ethinylestradiol with cyproterone acetate, Ethinylestradiol with desogestrel, Ethinylestradiol with drospirenone, Ethinylestradiol with etonogestrel, Ethinylestradiol with gestodene, Ethinylestradiol with levonorgestrel, Ethinylestradiol with norelgestromin, Ethinylestradiol with norethisterone, Ethinylestradiol with norgestimate, Estradiol with dienogest, Estradiol with nomegestrol, Mestranol with norethisterone

Hormone replacement therapy (HRT)

For minor procedures, continue as normal pre-operatively if there is a low risk of prolonged immobilisation.

Preferably discontinue 4 weeks before major elective surgery, including orthopaedic and vascular leg surgery.

Examples: Conjugated Equine Oestrogen, Conjugated Equine Oestrogen with Medroxyprogesterone acetate, Conjugated Oestrogens with Bazedoxifene acetate, Estradiol, Estradiol with Dydrogesterone, Estradiol with Levonorgestrel, Estradiol with Medroxyprogesterone acetate, Estradiol with Norethisterone acetate, Estradiol with Norgestrel

Progesterone-only Contraceptives

There is a risk of contraceptive failure and pregnancy (potentially leading to cancellation of surgery) if discontinued preoperatively or if dose of progesterone-only oral contraceptive delayed by longer than 12 hours.

Continue these medications pre-operatively, except norethisterone at doses >5mg.

If taking norethisterone at doses >5mg, consider stopping 4-6 weeks before surgery where prolonged immobilisation is likely.

Examples: Desogestrel, Etonogestrel, Levonorgestrel, Medroxyprogesterone, Norethisterone, Ulipristal acetate

Other

Mirabegron

Continue this medication pre-operatively.

Raloxifene

Stop 3 days prior to surgery that will result in reduced mobility.

Tibolone

Consider stopping 4-6 weeks before surgery where prolonged immobilisation is likely (e.g. abdominal surgery or orthopaedic lower limb surgery).