Preoperative Vitamin and Supplement Management
Risk-Based Approach to Supplement Management
- The Society for Perioperative Assessment and Quality Improvement (SPAQI) recommends stopping most vitamins and supplements 2 weeks before surgery due to bleeding risk, CNS effects, or metabolic interactions, though certain supplements like fish oil/omega-3 fatty acids can be safely continued 1, 2, 3
- Supplements that affect platelet function or coagulation pathways, such as vitamin E, garlic, ginger, ginkgo biloba, and ginseng, require a 2-week discontinuation period 1, 2, 3
- Blood glucose-altering supplements, such as American ginseng, Panax ginseng, alpha-lipoic acid, and chromium, should be held 2 weeks due to unpredictable perioperative glucose effects 1
- CNS-depressant supplements, such as kava and lemon balm, pose a risk of excessive sedation with anesthetics and should be held 2 weeks 1, 4
- Cardiovascular-effecting supplements, such as caffeine supplements and kola nut preparations, should be tapered and held 2 weeks 1
Supplements With Specific Hold Periods
- Chondroitin and glucosamine can be held for 48 hours due to faster metabolism and shorter half-life 2, 3
- 5-hydroxytryptophan, L-tryptophan, and S-adenosylmethionine can be held for 24 hours due to rapid metabolism but serotonergic concerns with certain anesthetics 1
Supplements That Can Be Continued
- Fish oil/omega-3 fatty acids should be continued through surgery, as prior bleeding concerns have been disproven in prospective studies 2, 3, 4
- Anxiolytic supplements, such as German chamomile, melatonin, and passionflower, are safe to continue and may provide perioperative benefit 1
- Green tea extract can be continued, as the catechins improve cardiac function 2, 3