Presurgery supplements to avoid. Before undergoing surgery, one important piece of info which must be disclosed to your doctor is whether you are taking herbal supplements. This is often left out by patients when doctors enquire about what medications they are taking, as often, many people do not equate medicines with supplements.

Many intensive care physicians, including anesthesiologists, will tell you of their experience with patients who take a long time to wake up after surgery, develop fits upon recovery, or bleed excessively after surgery, all due to the taking of herbals.

Forwarded to us from one of our hospitals partners: 

My doctor colleagues were quite puzzled recently when a patient, after undergoing routine surgery, took a longer time than usual to wake up after GA was completed and stopped. The patient required an overnight stay in the ICU before finally waking up 24 hours later! It was subsequently discovered that the patient had been taking supplements, in this case, St John’s Wort.

This popular supplement, EPO, needs to be stopped two weeks before surgery (see text)

Incidents like the above used to mystify many doctors previously, but the evidence is now clear that several over-the-counter supplements can interfere with the various actions of medications used during surgery.

Examples of Supplements to Avoid Prior to Surgery

Herbal supplement Possible complications
Aloe vera It may cause increased intestinal muscle movement to digest food (peristalsis), may decrease the effectiveness of water pills (diuretics) given after surgery
Bromelain It may cause bleeding or interact with antibiotics such as amoxicillin or tetracyclines
Danshen May cause bleeding
Dong quai May cause bleeding
Echinacea May interfere with immune functioning, may alter the effectiveness of immunosuppressant drugs given after transplant surgery
Ephedra It may cause abnormal heartbeat, may cause extremely high blood pressure, and coma if combined with certain antidepressants and anesthesia.
Feverfew May cause bleeding
Garlic It may cause bleeding, may interfere with normal blood clotting
Ginger May cause bleeding
Ginkgo May cause bleeding
Ginseng It may cause bleeding, may cause rapid heartbeat, may cause high blood pressure
Goldenseal May cause or worsen swelling and high blood pressure
Kava May enhance the sedative effects of anesthesia
Licorice (not including licorice candy) It may increase blood pressure
Omega-3 fatty acids May cause bleeding if taken in doses greater than 3 grams a day
Senna May cause electrolyte imbalance
St. John’s wort May increase or decrease the effects of some drugs used during and after surgery
Valerian May prolong the effects of anesthesia
Vitamin E Can increase risk of bleeding

The above list is not exhaustive. As more cases are encountered, the list gets longer! EveningPrimroseOil (EPO) is now implicated in the cause of fits or seizures following general anesthesia.

Some points to note if you are undergoing planned surgery:

  1. Remember that the list of medications that you need to reveal to your doctor includes all supplements, whether as pills or as a
  2. Some of these herbals may have to be stopped more than 2 weeks prior to planned
  3. In emergency surgery, remember to reveal to your doctor and next-of-kin what you are taking so that some preventive measures may be undertaken beforehand by the
  4. Some people believe if something is natural, it is safe. That is not necessarily true. If in doubt, show your caregiver the original container of the supplement.

Next Steps

When requesting a quote, please add any supplements you are using as well as medications so the surgeon is aware, and can give medical guidance on what to discontinue prior to surgery.  If you have any questions on this please feel to reach out or comment below. You can also read more information in our FAQ session.