Related | Perioperative Medication Management Appendix (Medication Management Table)
32
Appendix A: Perioperative Medication Management
From: Perioperative Medication Management – Adult/Pediatric – Inpatient/Ambulatory
Clinical Practice Guideline
Last Reviewed 6/2019; Last Updated 8/2022
Contact information: Philip J. Trapskin, PharmD, Phone Number: (608) 263-1328,
PTrapskin@uwhealth.org
Class Medication Recommendation
Acid Suppressants
Antacids Non-soluble
Aluminum hydroxide
Calcium carbonate
Magnesium hydroxide
Magnesium oxide
Soluble
Sodium bicarbonate
Sodium citrate
Non-soluble: Recommend to hold
therapy the day of surgery
Soluble: Recommend to continue
regimen throughout the perioperative
period
H2-Receptor
Antagonists
Cimetidine
Famotidine
Nizatidine
Ranitidine
It is reasonable to continue regimen
throughout the perioperative period
Proton pump
inhibitors
Dexlansoprazole
Esomeprazole
Lansoprazole
Omeprazole
Omeprazole/sodium bicarbonate
Pantoprazole
Rabeprazole
Parathyroid surgery: Recommend
to hold 7 days prior to and day of
surgery and post-operatively until
directed to resume by surgeon.
All other surgeries: Recommend to
continue regimen throughout the
perioperative period
Allergen-specific Immunotherapy
Peanut allergen powder Recommend to coordinate
perioperative medication
management plan with surgeon and
prescribing physician
Alpha1 blockers
Alpha1 blockers Alfuzosin
Doxazosin
Phenoxybenzamine
Phentolamine
Prazosin
Silodosin
Tamsulosin
Terazosin
Cataract surgery: Recommend to
coordinate perioperative medication
management plan with surgeon
All other surgeries: Recommend to
continue regimen throughout the
perioperative period
Alpha2-adrenergic agonists
Alpha2- agonists Clonidine
Guanfacine
Lofexidine
Methyldopa
Tizanidine
Recommend to continue regimen
throughout the perioperative period
Analgesics
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33
Class Medication Recommendation
Acetaminophen It is reasonable to continue regimen
throughout the perioperative period
N-type calcium
channel blocker
Ziconotide It is reasonable to continue regimen
throughout the perioperative period.
Any interruptions in therapy (holding
or discontinuing) should be
coordinated with prescribing provider.
Nonsteroidal anti-
inflammatory drugs
(NSAIDs)
Aspirin
Celecoxib
Choline magnesium
trisalicylate Diclofenac
Diflunisal
Etodolac
Fenoprofen
Flurbiprofen
Ibuprofen
Indomethacin
Ketoprofen
Ketorolac
Magnesium salicylate
Meclofenamate
Mefenamic acid
Meloxicam
Nabumetone
Naproxen
Oxaprozin
Piroxicam
Salsalate
Sulindac
Tolmetin
For aspirin recommendations,
refer to the Anti-platelet section.
For non-aspirin NSAIDS, coordinate
with surgeon and prescribing
provider.
Opioid agonists Alfentanil
Codeine
Fentanyl
Hydrocodone
Hydromorphone
Levorphanol
Meperidine
Methadone
Morphine sulfate
Opium
Oxycodone
Oxymorphone
Paregoric
Remifentanil
Sufentanil
Tapentadol
Tramadol
Recommend to continue chronic
opioid regimen throughout the
perioperative period, unless
reduction or discontinuation is part of
the perioperative analgesic plan.
Abrupt discontinuation of opioids may
cause withdrawal symptoms and/or
increased pain
Opioid partial
agonists
Buprenorphine
Buprenorphine injection
Buprenorphine/naloxone (Suboxone®)
Butorphanol
Morphine sulfate/naltrexone
Nalbuphine
Pentazocine
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing physician
Anorexiants
Serotonin 2C
receptor agonists
Lorcaserin Recommend to hold therapy 7 days
prior to surgery and postoperatively
until directed to resume by surgeon
Sympathomimetic
anorexiants
Benzphetamine
Diethylpropion
Phendimetrazine
Phentermine
Anti-addiction Agents (see also “Opioid partial agonists” above)
Antialcoholic
agents
Acamprosate calcium
Disulfiram
Acamprosate: Recommend to
continue regimen throughout the
perioperative period
Disulfiram: Recommend to hold 7
to14 days prior to surgery
Opioid Antagonist Naltrexone Recommend to hold oral naltrexone
for 1 week prior to surgery and
intramuscular naltrexone for 4 weeks
prior to surgery
Recommend coordination of post-
operative pain management plan with
anesthesiologist, surgeon, and
primary care physician in order to
minimize use of opioids
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34
Class Medication Recommendation
Nicotine
replacement
Nicotine gum, lozenges, patches, inhalers Recommend abstinence from
smoking in the perioperative period
Recommend to coordinate nicotine
replacement perioperative
medication management plan with
surgeon. If used the day of surgery,
gum and lozenges should not be
used within 2 hours of procedure
Anti-Dementia (Alzheimer’s)Agents
Cholinesterase
inhibitors
Donepezil
Galantamine
Rivastigmine
Recommend to continue
cholinesterase inhibitors with the
knowledge that adjustments to
neuromuscular blocking drugs may
be necessary
NMDA receptor
antagonist
Memantine It is reasonable to continue regimen
throughout the perioperative period
Anti-arrhythmics
Anti-arrhythmics Amiodarone
Disopyramide
Dofetilide
Dronedarone
Flecainide
Ibutilide
Lidocaine (systemic)
Mexiletine
Procainamide
Propafenone
Quinidine
Electrophysiology
surgeries/procedures
Recommend to coordinate
perioperative medication
management plan with cardiologist
and prescribing provider
Non-electrophysiology
surgeries/procedures
Recommend to continue regimen
throughout the perioperative period
Anti-cholinergics
Anti-cholinergics Cyclizine
Dimenhydrinate
Diphenhydramine
Meclizine
Scopolamine
Trimethobenzamide
It is reasonable to continue anti-
cholinergics throughout the
perioperative period, unless a
patient-specific perioperative
management plan was provided by
the surgeon.
Anti-coagulants
Anticoagulants Antithrombin
Apixaban
Betrixaban
Argatroban
Bivalirudin
Dabigatran
Dalteparin
Desirudin
Edoxaban
Enoxaparin
Fondaparinux
Heparin
Rivaroxaban
Warfarin
Recommend to coordinate
perioperative medication
management including any plan for
neuraxial analgesia with surgeon,
anesthesiologist and prescribing
provider
Refer to Management of
Antithrombotic Therapy in the Setting
of Periprocedural, Regional
Anesthesia and/or Pain Procedures
Clinical Practice Guideline
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Anti-convulsants
Anticonvulsants Acetazolamide
Brivaracetam
Cannabidiol
(Epidiolex)
Carbamazepine
Cenobamate
Divalproex
Eslicarbazepine
Felbamate
Lacosamide
Lamotrigine
Levetiracetam
Oxcarbazepine
Perampanel
Primidone
Rufinamide
Stiripentol
Tiagabine
Topiramate
Valproic acid
Vigabatrin
Planned Neuromonitoring or
Neuromapping
Recommend to coordinate
anticonvulsant perioperative
medication management plan with
surgeon, anesthesiologist, and
prescribing provider
All other Procedures
Recommend to continue
anticonvulsant regimens throughout
the perioperative period. Anticonvulsants
(GABA analogues)
Gabapentin Pregabalin
Hydantoins Ethotoin
Fosphenytoin
Phenytoin
Potassium Channel
Openers
Ezogabine
Succinimides Ethosuximide Methsuximide
Sulfonamides Zonisamide
Anti-diabetic agents
Alpha-glucosidase
inhibitor
Acarbose
Miglitol
Refer to:
• Diabetes Medication
Adjustment: Ambulatory
Procedures
• Diabetes Medication
Adjustment: Inpatient
Procedures
Amylinomimetic Pramlintide
Biguanide Metformin
Dipeptidyl
Peptidase IV
Inhibitor
Alogliptin
Linagliptin
Saxagliptin
Sitagliptin
Glucagon-Like
Peptide-1 Receptor
Agonist
Albiglutide
Dulaglutide
Exenatide
Liraglutide
Lixisenatide
Semaglutide
Insulin Insulin Aspart
Insulin Degludec
Insulin Detemir
Insulin Glargine
Insulin Isophane
Insulin Lispro
Insulin Regular
Meglitinide Analog Nateglinide
Repaglinide
Sodium-Glucose
Cotransporter-2
Inhibitor
Canagliflozin
Dapagliflozin
Empagliflozin
Ertugliflozin
Sulfonylurea Chlorpropamide
Glimepiride
Glipizide
Glyburide
Tolazamide
Tolbutamide
Thiazolidinedione Pioglitazone Rosiglitazone
Anti-dopaminergics
Antidopaminergics Chlorpromazine
Amisulpride
Metoclopramide
Perphenazine
It is reasonable to continue regimen
in the perioperative period
Anti-emetics
5HT3 antagonists Alosetron
Dolasetron
Granisetron
Ondansetron
Palonosetron
It is reasonable to continue regimen
in the perioperative period
Phenothiazine Prochlorperazine Promethazine
Substance
P/Neurokinin 1
receptor antagonist
Aprepitant
Fosaprepitant
Fosnetupitant
Netupitant
Rolapitant
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Anti-glaucoma ophthalmics
Miotics,
Cholinesterase
Inhibitors
Acetylcholine
Carbachol
Echothiophate Iodide
Pilocarpine
Recommend to continue
cholinesterase inhibitors with the
knowledge that adjustments to
neuromuscular blocking drugs may
be necessary.
Alpha Adrenergic
Agonists
Apraclonidine Brimonidine Recommend to continue ophthalmic
alpha adrenergic agonist, beta-
adrenergic blocking agent (beta-
blockers), carbonic anhydrase
inhibitor docosanoid, synthetic, and
prostaglandin analogue regimens
throughout the perioperative period
Beta-Adrenergic
Blocking Agents
(Beta-Blockers)
Betaxolol
Carteolol
Levobunolol
Metipranolol
Timolol
Carbonic
Anhydrase
Inhibitors
Brinzolamide
Dorzolamide
Prostaglandin
Analogues
Bimatoprost
Latanoprost
Latanoprostene bunod
Tafluprost
Travoprost
Rho kinase inhibitor Netarsudil
Unoprostone
Isopropyl
Unoprostone Isopropyl
Anti-histamines
Peripherally
selective
Cetirizine
Desloratadine
Fexofenadine
Loratadine
Levocetirizine
Recommend to continue regimen
throughout the perioperative period
Nonselective Brompheniramine
Carbinoxamine
Chlorcyclizine
Chlorpheniramine
Clemastine
Cyproheptadine
Dexbrompheniramine
Dexchlorpheniramine
Diphenhydramine
Doxylamine
Hydroxyzine
Triprolidine
Anti-hyperlipidemia agents (non-statins)
Alirocumab
Bempedoic acid
Cholestyramine
Colesevelam
Colestipol
Evolocumab
Ezetimibe
Fenofibrate
Gemfibrozil
Niacin
Lomitapide
Mipomersen
Recommend to hold therapy 24
hours prior to surgery and day of
surgery to reduce risk of
rhabdomyolysis and gastrointestinal
obstruction
Statins (HMG-CoA Reductase Inhibitors)
Statins Atorvastatin
Fluvastatin
Lovastatin
Pravastatin
Rosuvastatin
Simvastatin
Recommend to continue regimen
throughout the perioperative period,
particularly in patients at high risk for
cardiovascular disease
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Anti-infectives
Amebicides Iodoquinol (Yodoxin) Active infection: Recommend to
coordinate perioperative medication
management plan with surgeon,
anesthesiologist, and prescribing
provider
Infection Prophylaxis: Recommend
to coordinate anti-infectives for
prophylaxis indications with surgeon
and prescribing provider
Aminoglycosides
(oral)
Neomycin Paromomycin
Aminoglycosides
(parenteral)
Amikacin
Gentamicin
Plazomicin
Streptomycin
Tobramycin
Anthelmintics Albendazole (Albenza)
Ivermectin
(Stromectol)
Moxidectin
Praziquantel
(Biltricide)
Pyrantel (Pin-X)
Triclabendazole
Antibiotic
Combinations
Erythromycin/Sulfisoxazole
Sulfamethoxazole/Trimethoprim
Antifungal
(Allylamine)
Terbinafine
Anidulafungin
Caspofungin
Flucytosine
Griseofulvin
Micafungin
Ketoconazole
Amphotericin B
Nystatin
Fluconazole
Isavuconazonium
Itraconazole
Posaconazole
Voriconazole
Antimalarial Chloroquine
Hydroxychloroquine
Artemether/Lumefantri
ne
Atovaquone/Proguanil
Primaquine
Quinine sulfate
Pyrimethamine
Mefloquine
Tafenoquine
Antiprotozoals Atovaquone
Miltefosine
Nitazoxanide
Pentamidine
Tinidazole
Antiretroviral
agents
Abacavir
Atazanavir
Bictegravir
Cobicistat
Darunavir
Delavirdine
Didanosine
Dolutegravir
Doravirine
Efavirenz
Elvitegravir
Emtricitabine
Enfuvirtide
Etravirine
Fosamprenavir
Ibalizumab
Indinavir
Lamivudine
Lopinavir
Maraviroc
Nefinavir
Nevirapine
Raltegravir
Rilpivirine
Ritonavir
Saquinavir
Stavudine
Tenofovir
Tipranavir
Zidovudine
Any antiretroviral
combination product
Antituberculosis
Agents
Aminosalicylic acid
Benaquiline
Capreomycin
Cycloserine
Ethambutol
Ethionamide
Isoniazid
Pretomanid
Pyrazinamide
Rifabutin
Rifampin
Rifapentine
Streptomycin
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Antiviral Agents Adefovir
Amantadine
Acyclovir
Baloxavir
Boceprevir
Cidofovir
Daclatasvir
Elbasvir/grazoprevir
Entecavir
Famciclovir
Foscarnet
Ganciclovir
Glecaprevir/pibrentasv
ir
Ledipasvir/Sofosbuvir
Letermovir
Ombitasvir/Paritaprevi
r/Ritonavir/Dasabuvir
Oseltamivir
Peramivir
Ribavirin
Rimantadine
Simeprevir
Sofosbuvir
Tecovirimat
Telaprevir
Telbivudine
Valacyclovir
Valganciclovir
Velpatasvir
Voxilaprevir
Zanamivir
Active infection: Recommend to
coordinate perioperative medication
management plan with surgeon,
anesthesiologist, and prescribing
provider
Infection Prophylaxis: Recommend
to coordinate anti-infectives for
prophylaxis indications with surgeon
and prescribing provider
Bacitracin Bacitracin
Carbapenems Doripenem
Ertapenem
Imipenem/Cilastatin
Meropenem
Meropenem/vaborbact
am
Cephalosporins Cefaclor
Cefadroxil
Cefazolin
Cefdinir
Cefditoren
Cefepime
Cefiderocol
Cefixime
Cefotaxime
Cefotetan
Cefoxitin
Cefpodoxime
Cefprozil
Ceftaroline
Ceftazidime
Ceftazidime/Avibacta
m
Ceftriaxone
Cefuroxime
Cephalexin
Chloramphenicol
Colistimethate
Fluoroquinolones Ciprofloxacin
Delafloxacin
Gemifloxacin
Levofloxacin
Moxifloxacin
Norfloxacin
Ofloxacin (drops)
Ozenoxacin
Folate Antagonists Trimethoprim
Glycylcylines Tigecycline
Ketolides Telithromycin
Leprostatics Dapsone
Lincosamides Clindamycin Lincomycin
Lipoglycopeptides Dalbavancin
Oritavancin
Telavancin
Lipopeptides Daptomycin
Macrolides Azithromycin
Clarithromycin
Erythromycin
Fidaxomicin
Methenamines Methenamine Hippurate
Methenamine Mandelate
Miscellaneous Benznidazole
Fosfomycin
Lefamulin
Metronidazole
Rifamycin
Secnidazole
Monobactams Aztreonam
Monoclonal
antibodies
Bezlotoxumab
Nitrofurans Nitrofurantoin
Oxazolidinones Linezolid Tedizolid
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Penicillins Amoxicillin
Amoxicillin/Clavulanat
e
Ampicillin
Ampicillin/sulbactam
Dicloxacillin
Nafcillin
Oxacillin
Penicillin G
Penicillin V
Piperacillin/Tazobacta
m
Ticarcillin/Clavulanate
Active infection: Recommend to
coordinate perioperative medication
management plan with surgeon,
anesthesiologist, and prescribing
provider
Infection Prophylaxis: Recommend
to coordinate anti-infectives for
prophylaxis indications with surgeon
and prescribing provider
Polymyxin B Sulfate
Rifaximin
Streptogramins Quinupristin/Dalfopristin
Sulfadiazine Sulfadiazine
Tetracyclines Demeclocycline
Doxycycline
Eravacycline
Minocycline
Omadacycline
Sarecycline
Tetracycline
Vancomycin Vancomycin
Anti-over active bladder agents
Anticholinergic Oxybutynin It is reasonable to continue regimen
throughout the perioperative period
Muscarinic receptor
antagonist
Darifenacin
Fesoterodine
Solifenacin
Tolterodine
Trospium
M3 muscarinic
agonist
Mirabegron
Phosphodiesterase
inhibitor
Flavoxate
Anti-neoplastics
Alkylating Agents Altretamine
Busulfan
Carmustine
Chlorambucil
Dacarbazine
Estramustine
Ifosfamide
Lomustine
Mechlorethamine
Melphalan
Streptozocin
Thiotepa
Recommend to coordinate
antineoplastic perioperative
medication management plan with
surgeon and prescribing provider
Anthracenedione Mitoxantrone
Antibody-Drug
Conjugates
ADO-Trastuzumab
Brentuximab Vedotin
Emtansine
Enfortumab vedotin
Fam-trastuzumab
deruxtecan
Polatuzumab vedotin
Antimetabolites Allopurinol
Capecitabine
Cladribine
Clofarabine
Cytarabine
Floxuridine
Fludarabine
Fluorouracil
Gemcitabine
Mercaptopurine
Methotrexate
Pemetrexed
Pentostatin
Pralatrexate
Rasburicase
Thioguanine
Antimitotic agents Cabazitaxel
Docetaxel
Eribulin
Ixabepilone
Paclitaxel
Vinblastine
Vincristine
Vinorelbine
Antineoplastic
Antibiotics
Bleomycin
Dactinomycin
Daunorubicin
Doxorubicin
Epirubicin
Idarubicin
Mitomycin
Valrubicin
BCL-2 Inhibitor Venetoclax
Biologic Response
Modifiers
Aldesleukin BCG live
Cytoprotective
Agents
Amifostine
Dexrazoxane
Leucovorin
Levoleucovorin
Mesna
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DNA
Demethylation
Agents
Azacitidine
Decitabine
Nelarabine
Recommend to coordinate
antineoplastic perioperative
medication management plan with
surgeon and prescribing provider
DNA
Topoisomerase
Inhibitors
Irinotecan
Topotecan
Enzymes Asparaginase
Calaspargase
Pegaspargase
Epipodophyllotoxin Etoposide Teniposide
EZH2-Inhibitor Tazemetostat
Histone
Deacetylase
Inhibitors
Belinostat
Panobinostat
Romidepsin
Vorinostat
Hormones Abiraterone
Anastrazole
Apalutamide
Bicalutamide
Buserelin
Darolutamide
Enzalutamide
Exemestane
Flutamide
Fulvestrant
Goserelin
Histelin
Letrozole
Leuprolide
Medroxyprogesterone
Megestrol
Nilutamide
Tamoxifen
Toremifene
Triptorelin
Hedgehog Pathway
Inhibitor
Glasdegib
Sonidegib
Vismodegib
Imidazotetrazine
derivatives
Temozolomide
Kinase inhibitors Abemaciclib
Acalabrutinib
Afatinib
Alectinib
Alpelisib
Axitinib
Binimetinib
Bosutinib
Brigatinib
Cabozantinib
Ceritinib
Cobimetinib
Copanlisib
Crizotinib
Dabrafenib
Dacomitinib
Dasatinib
Duvelisib
Encorafenib
Enasidenib
Entrectinib
Erdafitinib
Erlotinib
Everolimus
Gefitinib
Gilteritinib
Ibrutinib
Idelalisib
Imatinib
Ivosidenib
Lapatinib
Lenvatinib
Lorlatinib
Larotrectinib
Midostaurin
Neratinib
Nilotinib
Osimertinib
Palbociclib
Pazopanib
Pexidartinib
Ponatinib
Regorafenib
Ribociclib
Ruxolitinib
Sorafenib
Sunitinib
Temsirolimus
Trametinib
Vandetanib
Vemurafenib
Zanubrutinib
Methylhydrazine
derivatives
Procarbazine
Miscellaneous
Antineoplastics
Arsenic Trioxide
Mitotane
Porfimer
Sipuleucel-T
Sterile Talc Powder
Trabectedin
Trifluridine/tipiracil
Monoclonal
antibodies
Alemtuzumab
Atezolizumab
Avapritinib
Avelumab
Bevacizumab (and
biosimilars)
Blinatumomab
Ipilimumab
Mogamuliziumab
Moxetumomab
Necitumumab
Nivolumab
Obinutuzumab
Ofatumumab
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Brolucizumab
Cemiplimab
Cetuximab
Daratumumab
Dinutuximab
Elotuzumab
Gemtuzumab
Ibritumomab
Inotuzumab
Olaratumab
Panitumumab
Pertuzumab
Ramucirumab
Rituximab (and
biosimilars)
Tagraxofusp
Trastuzumab (and
biosimilars)
Recommend to coordinate
antineoplastic perioperative
medication management plan with
surgeon and prescribing provider
PARP Enzymes
Inhibitor
Niraparib
Olaparib
Rucaparib
Talazoparib
Platinum
Coordination
Complex
Carboplatin
Cisplatin
Oxaliplatin
Proteasome
Inhibitors
Bortezomib
Carfilzomib
Ixazomib
Protein Synthesis
Inhibitor
Omacetaxine
Radiopharmaceutic
als
Lutetium Lu-177
Radium Ra-223
Samarium Sm-153
Sodium Iodide I-131
Strontium-89 Chloride
Retinoids Tretinoin
Trifarotene
Rexinoids Bexarotene
Substituted Ureas Hydroxyurea
Vascular
Endothelial Growth
Factor
ZIV-Aflibercept
Anti-osteoporosis Agents
Bisphosphonates Alendronate
Etidronate
Ibandronate
Pamidronate
Risedronate
Tiludronate
Zolendronic Acid
Dental surgeries: Recommend to
coordinate anti-osteoporosis
perioperative medication
management plan with surgeon and
prescribing provider
All other surgeries:
Recommend to hold bisphosphonate
therapy the day of surgery and
postoperatively until directed to
resume by surgeon and to coordinate
perioperative calcitonin and
denosumab medication management
plan with surgeon and prescribing
provider
Calcitonin-salmon Calcitonin-salmon
Denosumab Denosumab
Romosozumab Romosozumab
Anti-Parkinson’s Agents
Antiparkinson
agents
Amantadine
Apomorphine
Belladonna alkaloids
Benztropine
Bromocriptine
Carbidopa
Carbidopa/Levodopa
Carbidopa/Levodopa/E
ntacapone
Istradefylline
Entacapone
Pramipexole
Rasagiline
Ropinirole
Rotigotine
Selegiline
Tolcapone
Recommend to continue regimen
throughout the perioperative period
Anti-platelets
Antiplatelet agents Anagrelide
Dipyridamole
Dipyridamole/Aspirin
Cangrelor
Cilostazol
Clopidogrel
Prasugrel
Ticagrelor
Ticlopidine
Vorapaxar
Recommend to coordinate
perioperative medication
management plan with surgeon,
anesthesiologist, and prescribing
provider (e.g. interventional
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cardiologist, neurosurgeon, vascular
surgeon)
Anti-psychotics
1st generation –
Typical
Chlorpromazine
Fluphenazine
Haloperidol
Loxapine
Perphenazine
Pimozide
Prochlorperazine
Thioridazine
Thiothixene
Trifluoperazine
Recommend to continue regimen
throughout the perioperative period
2nd generation –
Atypical
Aripiprazole
Asenapine
Brexpiprazole
Cariprazine
Clozapine
Iloperidone
Lumateperone
Lurasidone
Olanzapine
Paliperidone
Pimavanserin
Quetiapine
Risperidone
Ziprasidone
Antirheumatic Agents
Janus associated
kinase (JAK)
inhibitors
Baricitinib
Fedratinib
Ruxolitinib
Tofacitinib
Upadacitinib
Orthopedic surgery: Recommend to
hold therapy 48 hours prior to
surgery and resume 7-14 days post-
operatively if there are no signs or
symptoms of infection and incisions
are healing well
All other surgeries: Recommend to
coordinate perioperative medication
management plan with surgeon and
prescribing provider
Antimetabolites Methotrexate Orthopedic surgery: Recommend to
continue regimen throughout the
perioperative period
All other surgeries: Recommend
to coordinate perioperative
medication management plan with
surgeon and prescribing provider
Anti-TNF-alpha
agents
Adalimumab (and biosimilars)
Certolizumab
Etanercept (and biosimilars)
Golimumab
Infliximab (and biosimilars)
Orthopedic surgery: Recommend to
hold etanercept 2 weeks prior to
surgery
Orthopedic surgery: Recommend
to coordinate all other anti-TNF-alpha
agent perioperative medication
management plan with surgeon and
prescribing provider
All other surgeries: Recommend
to coordinate perioperative
medication management plan with
surgeon and prescribing provider
Gold compounds Auranofin
Gold sodium thiomalate
Orthopedic surgery: Recommend
to continue regimen throughout the
perioperative period
All other surgeries: Recommend
to coordinate perioperative
medication management plan with
surgeon and prescribing provider
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Interleukin-6
blockers
Tocilizumab Orthopedic surgery: Recommend
to
• hold subcutaneous tocilizumab 3
weeks prior to surgery
• hold intravenous tocilizumab 4
weeks prior to surgery
All other surgeries: Recommend to
coordinate perioperative medication
management plan with surgeon and
prescribing provider
Interleukin-1
blockers
Anakinra Orthopedic surgery: Recommend to
hold subcutaneous anakinra 7 days
prior to surgery
All other surgeries: Recommend
to coordinate perioperative
medication management plan with
surgeon and prescribing provider
Phosphodiesterase
-4 enzyme inhibitor
Apremilast Orthopedic surgery: Recommend
to coordinate perioperative
medication management plan with
surgeon and prescribing provider
All other surgeries: Recommend
to coordinate perioperative
medication management plan with
surgeon and prescribing provider
Pyrimidine
synthesis inhibitors
Leflunomide Orthopedic surgery: Recommend
to hold 14 days prior to surgery
All other surgeries: Recommend
to coordinate perioperative
medication management plan with
surgeon and prescribing provider
Selective T-cell
costimulation
blocker
Abatacept Orthopedic surgery: Recommend
to hold subcutaneous abatacept 2
weeks prior to surgery and
intravenous abatacept 4 weeks prior
to surgery
All other surgeries: Recommend
to coordinate perioperative
medication management plan with
surgeon and prescribing provider
Beta-blockers
Beta-Adrenergic
Blocking Agents
(Beta-Blockers)
Acebutolol
Atenolol
Betaxolol
Bisoprolol
Esmolol
Metoprolol
Nadolol
Nebivolol
Penbutolol
Pindolol
Propranolol
Sotalol
Timolol
Recommend to continue beta-blocker
regimens throughout the
perioperative period unless
contraindicated by hemodynamic
instability or profound bronchospasm
Alpha/Beta-
Adrenergic
Blocking Agents
Carvedilol
Labetalol
Benzodiazepines
Benzodiazepines Alprazolam
Chlordiazepoxide
Clobazam
Clonazepam
Clorazepate
Diazepam
Lorazepam
Oxazepam
Recommend to continue regimen
throughout the perioperative period
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Calcium Channel Blockers
Calcium channel
blockers
Amlodipine
Clevidipine
Diltiazem
Felodipine
Isradipine
Nicardipine
Nifedipine
Nimodipine
Nisoldipine
Verapamil
Recommend to continue regimen
throughout the perioperative period
Cardiovascular Agents – Miscellaneous
Alpha1-Agonist Midodrine Recommend to continue regimen
throughout the perioperative period
Cardiac Glycoside Digoxin Recommend to continue regimen
throughout the perioperative period
Central
Monoamine-
Depleting Agent
Deutetrabenazine
Reserpine
Tetrabenazine
Valbenazine
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon and
prescribing provider
Cyclic nucleotide-
gated (HCN)
channels (f-
channels)
Ivabradine Recommend to continue regimen
throughout the perioperative period
Dopamine Agonist Fenoldopam Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon and
prescribing provider
Ganglionic Blocker Mecamylamine Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon and
prescribing provider
Inotropics Inamrinone
Milrinone
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon and
prescribing provider
Inward sodium
channel inhibitor
Ranolazine Recommend to continue regimen
throughout the perioperative period
Potassium
removing resins
Patiromer
Sodium polystyrene sulfonate
Sodium zirconium cyclosilicate
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon and
prescribing provider
Transthyretin
stabilizer
Tafamidis Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon and
prescribing provider
Central Nervous System – Miscellaneous
Antianxiety agent Buspirone
Meprobamate
Recommend to continue regimen
throughout the perioperative period
Antidepressants Bupropion
Nefazodone hydrochloride
Trazodone
Vortioxetine
Recommend coordination of
perioperative medication
management plan with surgeon,
anesthesiologist, and prescribing
provider
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Anticholinesterase
muscle stimulants
Edrophonium
Neostigmine
Pyridostigmine
Recommend coordination of
perioperative medication
management plan with surgeon,
anesthesiologist, and prescribing
provider
Antioxidants Edaravone Recommend coordination of
perioperative medication
management plan with surgeon,
anesthesiologist, and prescribing
provider
Antisense
Oligonucleotide
Eteplirsen
Golodirsen
Inotersen
Nusinersin
Recommend to coordinate antisense
oligonucleotide management plan
with anesthesiologist, surgeon, and
prescribing provider
Cholinergic muscle
stimulant
Guanidine Recommend coordination of
perioperative medication
management plan with surgeon,
anesthesiologist, and prescribing
provider
CNS stimulants Amphetamine
Armodafinil
Caffeine
Dexmethylphenidate
Dextroamphetamine
Doxapram
Lisdexamfetamine
Methamphetamine
Methylphenidate
Modafinil
Armodafinil, Modafinil:
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider
All other CNS stimulants:
Recommend to continue regimen
throughout the perioperative period
Dopamine and
Norepinephrine
Reuptake Inhibitor
Solriamfetol Recommend to coordinate
perioperative management plan with
anesthesiologist, surgeon, and
prescribing provider
Glutamate Inhibitor Riluzole Recommend to continue regimen
throughout the perioperative period
Lithium Lithium Recommend to continue regimen
throughout the perioperative period
Miscellaneous
psychotherapeutic
agents
Atomoxetine
Sodium oxybate
Atomoxetine: Recommend to
continue regimen throughout the
perioperative period
Pitolisant, Sodium oxybate:
Recommend to coordinate
perioperative management plan with
anesthesiologist, surgeon, and
prescribing provider
Mixed 5HT1A
agonist/5HT2A
antagonist
Flibanserin Recommend to coordinate
perioperative management plan with
anesthesiologist, surgeon, and
prescribing provider
NMDA Antagonist Esketamine Recommend to coordinate
perioperative management plan with
anesthesiologist, surgeon, and
prescribing provider
Partial neuronal α4
β2 nicotinic
receptor agonist
Varenicline Recommend to hold therapy the day
of surgery and post-operatively until
directed to resume by surgeon
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Potassium Channel
Blocker
Amifampridine
Dalfampridine
Recommend to continue regimen
throughout the perioperative period
Tripeptidyl
peptidase-1 (TPP-
1) analog
Cerliponase alfa Recommend to coordinate
perioperative management plan with
anesthesiologist, surgeon, and
prescribing provider
Corticosteroid
Corticosteroid Betamethasone
Budesonide
Cortisone
Cosyntropin
Deflazacort
Dexamethasone
Hydrocortisone
Fludrocortisone
Methylprednisolone
Prednisolone
Prednisone
Triamcinolone
Recommend to continue regimen
throughout the perioperative period
Diuretics
Carbonic
anhydrase
inhibitors
Acetazolamide
Methazolamide
Heart failure of volume overload
indication:
Recommend to coordinate diuretic
perioperative management plan with
anesthesiologist, surgeon, and
prescribing provider
Hypertension indication:
Recommend to hold diuretic the day
of surgery
Diuretic
Combinations
Amiloride/Hydrochlorothiazide
Spironolactone/ Hydrochlorothiazide
Triamterene/ Hydrochlorothiazide
Loop Diuretics Bumetanide
Ethacrynic Acid
Furosemide
Torsemide
Osmotic Mannitol
Potassium Sparing Amiloride
Spironolactone
Triamterene
Thiazides Chlorothiazide
Chlorthalidone
Hydrochlorothiazide
Indapamide
Methyclothiazide
Metolazone
Estrogens and Progestins – Miscellaneous
Estrogen Conjugated Estrogens
Ethinyl Estradiol
Estradiol valerate
Esterified Estrogens
Estradiol
Estradiol Cypionate
Estropipate
Recommend to coordinate
perioperative management plan with
surgeon, and prescribing provider
Progestins Desogestrel
Drospirenone
Etonogestrel
Ethynodiol Diacetate
Hydroxyprogesterone
caproate
Levonorgestrel
Medroxyprogesterone
acetate
Megestrol Acetate
Norelgestromin
Norgestimate
Norgestrel
Norethindrone Acetate
Progesterone
Segesterone
Ulipristal
Selective Estrogen
Receptor Modulator
Bazedoxifene
Clomiphene Citrate
Ospemifene
Raloxifene
Endocrine and Metabolic Agents – Miscellaneous
4-
Hydroxyphenylpyru
vate dioxygenase
inhibitor
Nitisinone It is reasonable continue regimen
throughout the perioperative period.
5-Alpha Reductase
Inhibitor
Dutasteride
Finasteride
Anabolic Steroid Oxymetholone
Androgens Danazol
Oxandrolone
Fluoxymesterone
Methyltestosterone
Testosterone
Anti-androgen Cyproterone Dienogest
Antithyroid Agents Methimazole
Propylthiouracil
Sodium Iodide
Betaine Anhydrous Betaine Anhydrous
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Bile Acids Cholic Acid
Bromocriptine
Mesylate
Bromocriptine Mesylate
Cabergoline Cabergoline
Calcimimetics Cinacalcet Etelcalcetide
Carglumic acid Carglumic acid
Chelating Agent Deferasirox
Deferiprone
Deferoxamine
Cysteamine Cysteamine
Cystic fibrosis
transmembrane
conductance
regulator
potentiator
Elexacaftor
Ivacaftor
Lumacaftor
Tezacaftor
Detoxification
agents
Dimercaprol
Edetate Calcium
Disodium
Pentetate Calcium
Trisodium
Pentetate Zinc
Trisodium
Prussian Blue (Ferric
Hexacyanoferrate)
Succimer (DMSA)
Trientine
Hydrochloride
Enzyme
replacement
Asfotase
Agalsidase Beta
Alglucosidase alfa
Elosulfase alfa
Galsulfase
Idursulfase
Imiglucerase
Laronidase
Sebelipase
Taliglucerase Alfa
Velaglucerase alfa
Farnesoid X
receptor agonist
Obeticholic acid
Glucosylceramide
Synthase Inhibitor
Eliglustat
Miglustat
Glycerol
Phenylbutyrate
Glycerol Phenylbutyrate
Gonadotropin
Releasing Hormone
Agonist
Nafarelin
Gonadotropin
Releasing Hormone
Antagonist
Cetrorelix
Degarelix
Elagolix
Ganirelix
Growth Hormone Somatropin
Growth Hormone
Agonists
Macimorelin
Insulin-like growth
factor
Mecasermin
Lipodystrophy
agents
Metreleptin
Tesamorelin
Lipolytic Deoxycholic acid
Ovulation
Stimulator
Choriogonadotropin
Alfa
Chorionic
Gonadotropin
Follitropin alfa
Follitropin beta
Lutropin Alpha
Menotropins
Urofollitropin
Melanocortin
receptor agonist
Bremelanotide
Parathyroid
hormone analogues
Abaloparatide
Parathyroid
Teriparatide
Pegvisomant Pegvisomant
Pharmacologic
Chaperone
Migalastat
Phenylketonuria
agents
Sapropterin Dichloride
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Phosphate Binders Lanthanum Sevelamer
Posterior Pituitary
Hormones
Desmopressin
Vasopressin
Selective Estrogen
Receptor Modulator
Bazedoxifene
Clomiphene Citrate
Ospemifene
Raloxifene
Sodium Benzoate
and Sodium
Phenylacetate
Sodium Benzoate and Sodium Phenylacetate
Sodium
Phenylbutyrate
Sodium Phenylbutyrate
Somatostatin
Analogs
Lanreotide
Octreotide
Pasireotide
Thyroid Drugs Potassium Iodide
Levothyroxine Sodium
Liothyronine Sodium
Liotrix
Thyroid Desiccated
Tryptophan
hydroxylase
inhibitors
Telotristat
Uridine Triacetate
Uterine Active
Agents
Carboprost
Dinoprostone
Methylergonovine
Maleate
Mifepristone
Oxytocin
Vasopressin
Receptor
Antagonists
Conivaptan Hydrochloride
Tolvaptan
Gastrointestinal Agents – Laxatives
Bowel evacuants Polyethylene glycol (PEG)
PEG-electrolyte combination
Sodium phosphate
Sodium phosphate/magnesium oxide/citric acid
Recommend to coordinate
perioperative medication
management plan with surgeon and
prescribing provider
Bulk-producing
laxatives
Calcium polycarbophil
Methylcellulose
Psyllium
Emollients Mineral oil
Surfactants Docusate calcium Docusate sodium
Hyperosmotic
agents
Glycerin
Lactilol
Lactulose
Sorbitol
Stimulants Bisacodyl
Cascara sagrada
Sennosides
Gastrointestinal Agents – Miscellaneous
5-Aminosalicylic
Acid Derivative
Balsalazide
Mesalamine
Olsalazine
Sulfasalazine
Recommend to continue regimen
throughout the perioperative period
Antidiarrheals Bismuth subsalicylate
Crofelemer
Difenoxin/atropine
Diphenoxylate/atropine
Loperamide
Loperamide/simethicone
Bismuth subsalicylate:
Recommend to hold bismuth
subsalicylate the day of surgery due
to the potential to cause black stools
All other medications: It is
reasonable to continue other
antidiarrheals throughout the
perioperative period
Antiflatulents Alpha-d-galactosidase Simethicone Sucralfate: Recommend to hold
sucralfate the day of surgery
Antispasmodics Dicyclomine
Belladonna
alkaloids
Atropine sulfate
Hyoscyamine sulfate
Scopolamine
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Cholinergic Agonist Cevimeline Pilocarpine All other medications:
Recommend to continue regimen
throughout the perioperative period
Chloride Channel
Activator
Lubiprostone
Digestive Enzymes Pancreatic Enzymes Pancrelipase
GI Anticholinergic
Combinations
Atropine/scopolamine/hyoscyamine/phenobarbit
al
Clidinium/chlordiazepoxide
GI Quaternary
Anticholinergics
Glycopyrrolate
Mepenzolate
Methscopolamine
Propantheline
GI stimulants Dexpanthenol
Metoclopramide
Prucalopride
Tegaserod
GLP-2 analogs Teduglutide
Glutamine L-glutamine
Guanylate cyclase-
C agonist
Linaclotide
Plecanatidecalci
Miscellaneous Eluxadoline
Sucralfate
Chenodiol
Ursodiol
Alvimopan
Methylnaltrexone
Naloxegol
Tenapanor
Systemic
Deodorizers
Bismuth subgallate
Chlorophyll derivatives
Chlorophyllin
Genitourinary and Renal Agents – Miscellaneous
Cystine depleting
agents
Cysteamine bitartrate
Penicillamine
Tiopronin It is reasonable to continue regimen
throughout the perioperative period
Interstitial cystitis
agents
Dimethyl sulfoxide
Pentosan polysulfate
sodium
Phenazopyridine
Phenazopyridine/buta
barbital/hyoscyamine
Urinary acidifiers Ascorbic acid
Urinary cholinergics Bethanechol
Urinary alkalinizers Potassium citrate
Sodium bicarbonate
Sodium bicarbonate/citric acid (Shohl’s solution)
Miscellaneous Acetohydroxamic acid
Cellulose sodium phosphate
Gout Agents
β-tubulin
polymerization
inhibitor
Colchicine Recommend to coordinate
perioperative medication
management plan with surgeon and
prescribing provider
Uric acid
transporter-1
(URAT-1) inhibitor
Lesinurad It is reasonable to continue regimen
throughout the perioperative period
Xanthine Oxidase
Inhibitor
Allopurinol
Febuxostat
It is reasonable to continue regimen
throughout the perioperative period
Recombinant urate-
oxidase
Pegloticase It is reasonable to continue regimen
throughout the perioperative period
Uricosurics Probenecid Recommend to hold therapy the day
of surgery and postoperatively until
directed to resume by surgeon
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Hematological Agents – Miscellaneous
For additional information, see Management of Antithrombotic Therapy in the Setting of Periprocedural, Regional
Anesthesia and/or Pain Procedures Clinical Practice Guideline
Antihemophilic
agents
Anti-inhibitor coagulant complex
Antihemophilic Factor VIII
Coagulation Factor XIIIa
Factor IX
Factor VIIa
Factor XIII
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider
Antihemophilic
Factor
Combinations
Antihemophilic factor/von Willebrand Factor
Complex
Anti-von Willebrand
Factor
Caplacizumab Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider
Antisickling agents Hydroxyurea
Voxelotor
Recommend to continue regimen in
the perioperative period
Bradykinin
inhibitors
Icatibant It is reasonable to continue regimen
in the perioperative period
Coagulants Protamine Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider
Erythropoiesis-
stimulating agents
Darbepoetin and biosimilars
Epoetin Alfa and biosimilars
Epoetin Beta and biosimilars
Methoxy Polyethylene Glycol-Beta
It is reasonable to continue regimen
in the perioperative period
Hematopoietic stem
cell mobilizer
Plerixafor Recommend to coordinate
perioperative medication
management plan with surgeon and
prescribing provider
Granulocyte-colony
stimulating factors
Filgrastim (and biosimilars)
Pegfilgrastim (and biosimilars)
Recommend to coordinate
perioperative medication
management plan with surgeon and
prescribing provider
Granulocyte
macrophage
colony-stimulating
factor
Sargramostim Recommend to coordinate
perioperative medication
management plan with surgeon and
prescribing provider
Thrombopoietic
agents
Avatrombopag
Eltrombopag
Lusutrombopag
Oprelvekin
Romiplostim
Recommend to coordinate
perioperative medication
management plan with surgeon and
prescribing provider
Porphyria Agents Hemin
Givosiran
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider
Hemorrheologic
agents
Pentoxifylline Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider
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Hemostatics Absorbable Gelatin
Aminocaproic Acid
Ferric subsulfate
Fibrinogen
Concentrate
Microfibrillar Collagen
Hemostat
Oxidized Cellulose
Prothrombin Complex
Concentrate
Thrombin
Tranexamic Acid
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider
Kallikrein Inhibitor Ecallantide
Lanadelumab
It is reasonable to continue regimen
in the perioperative period
Plasma expanders Albumin Human
Dextran 40
Hetastarch
Plasma Protein
Fraction
Tetrastarch
It is reasonable to continue regimen
in the perioperative period
Protein C1
inhibitors
C1 Inhibitor (Cinryze) Recommend to continue regimen in
the perioperative period
Thrombolytic
agents
Alteplase
Defibrotide
Protein C Concentrate
Reteplase
Tenecteplase
Urokinase
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider
Monoclonal
Antibodies
Crizanlizumab Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider
Herbals and Supplements
Amino Acids Levocarnitine
L-Lysine
Methionine
Threonine
Inborn errors of metabolism
Recommend to coordinate use of
supplements and perioperative
medication management plan with
anesthesiologist, surgeon, and
prescribing provider
All other patients
Recommend to hold herbals and
supplements 7 days prior to surgery.
Cannabidiol CBD oil, OTC or supplement; not including
Epidiolex prescription for seizure management)
Electrolytes Potassium Sodium Chloride
Fish Oils Omega-3 Fatty Acids
Lipotropics Choline Inositol
Minerals Calcium
Magnesium
Phosphorus
Systemic
Alkalinizers
Citric Acid
Citrate
Tromethamine
Trace Elements Chromium
Copper
Fluoride
Ferric Maltol
Iron
Manganese
Selenium
Zinc
Vitamins Beta-Carotene
Phytonadione (Vitamin
K)
Vitamin A
Calcitriol
Cholecalciferol
Doxercalciferol
Ergocalciferol
Paricalcitol
Vitamin E
Aminobenzoate
potassium
Bioflavonoids
Biotin
Hydroxycobalamin
Cobalamin (B12)
Folic Acid
Niacin (B3)
Niacinamide
Pantothenic Acid (B5)
Pyridoxine (B6)
Riboflavin (B2)
Thiamine (B1)
Ascorbic acid (Vitamin
C)
Calcium Ascorbate
Sodium Ascorbate
Miscellaneous Coenzyme Q10
Edavarone
Lactase
Sacrosidase
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Immunologic Agents
Immunomodulators Abatacept
Adalimumab (and
biosimilars)
Anakinra
Apremilast
Brodalumab
Canakinumab
Certolizumab
Daclizumab
Dimethyl Fumarate
Diroximel Fumarate
Etanercept (and
biosimilars)
Fingolimod
Golimumab
Guselkumab
Infliximab (and
biosimilars)
Interferons
Ixekizumab
Lenalidomide
Mitoxantrone
Natalizumab
Pembrolizumab
Pomalidomide
Rilonacept
Secukinumab
Selinexor
Siponimod
Risankizumab
Teriflunomide
Thalidomide
Tildrakizumab
Tocilizumab
Ustekinumab
Vedolizumab
Recommend to coordinate
perioperative medication
management plan with surgeon and
prescribing provider
Immunostimulants Elapegdemase Pegademase Bovine
Immunosuppressiv
es
Alefacept
Azathioprine
Basiliximab
Belatacept
Cyclosporine
Dupilumab
Durvalumab
Glatiramer
Mycophenolate
Ocrelizumab
Sirolimus
Tacrolimus
Keratinocyte
Growth Factors
Palifermin
Miscellaneous
Monoclonal
Antibodies
Belimumab
Burosumab
Denosumab
Eculizumab
Palivizumab
Ravulizumab
Raxibacumab
Sarilumab
Siltuximab
Teprotumumab
Intranasal anti-allergy
Antihistamines Azelastine Olopatadine It is reasonable to continue regimen
in the perioperative period
Mast cell stabilizers Cromolyn
Steroids Beclomethasone
Budesonide
Ciclesonide
Flunisolide
Fluticasone
Mometasone
Triamcinolone
Migraine Agents
Sympathomimetic Isometheptene Recommend to hold therapy the day
of surgery, although may be
approved with coordination of
anesthesiologist
Serotonin 5HT1B,1D
Agonist (triptans)
Almotriptan
Eletriptan Frovatriptan
Naratriptan
Rizatriptan,
Sumatriptan,
Zolmitriptan
Serotonin 5HT1F
Agonist
Lasmiditan
Ergot Derivatives Dihydroergotamine mesylate
Ergotamine tartrate
Calcitonin Gene-
related Peptide
Receptor
Antagonist
Eptinezumab
Erenumbe
Fremanezumab
Galcanezumab
Rimegepant
Ubrogepant
Monoamine Oxidase Inhibitors
Monoamine
Oxidase Inhibitors
(MAOI)
Isocarboxazid
Phenelzine
Tranylcypromine
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider
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53
Ophthalmic Agents – Miscellaneous
Cycloplegic
Mydriatics
Atropine Sulfate
Cyclopentolate HCl
Homatropine HBr
Scopolamine HBr
Tropicamide
Cyclopentolate/Phenyl
ephrine
Hydroxyamphetamine
Hydrobromide/Tropica
mide
Recommend to continue regimen
throughout the perioperative period
Antibiotics Azithromycin
Bacitracin
Besifloxacin
Ciprofloxacin HCl
Erythromycin
Gatifloxacin
Gentamicin
Levofloxacin
Moxifloxacin
Ofloxacin
Sulfacetamide
Tobramycin
Antihistamines Alcaftadine
Azelastine HCl
Emedastine
difumarate
Epinastine HCl
Ketotifen
Olopatadine HCl
Corticosteroids Dexamethasone
Difluprednate
Fluocinolone
acetonide
Fluorometholone
acetate
Loteprednol etabonate
Prednisolone
Rimexolone
Triamcinolone
acetonide
Decongestants Naphazoline HCl
Oxymetazoline HCl
Phenylephrine HCl
Tetrahydrozoline HCl
Decongestant/
Antihistamine
Naphazoline/Pheniramine
Immunologic Cyclosporine
Mast Cell Stabilizer Bepotastine besilate
Cromolyn Na
Lodoxamide
tromethamine
Nedocromil Na
Nonsteroidal Anti-
Inflammatory
Bromfenac
Diclofenac
Flurbiprofen
Ketorolac
Nepafenac
Otic Preparations
Misc.
Antipyrine/Benzocaine
Ciprofloxacin
Ofloxacin
Fluocinolone acetonide
Ciprofloxacin HCl/Hydrocortisone
Ciprofloxacin/Dexamethasone
Neomycin/Polymyxin B/Hydrocortisone
Recombinant
Human Nerve
Growth Factor
Cenegermin
Selective VEGF
Antagonist
Aflibercept
Pegaptanib Na
Ranibizumab
Steroid/ Antibiotic Bacitracin/Neomycin/Polymyxin
B/Hydrocortisone
Dexamethasone/Tobramycin
Loteprednol/Tobramycin
Neomycin/Polymyxin B/Dexamethasone
Neomycin/Polymyxin B/Hydrocortisone
Sulfacetamide/Prednisolone
Phosphodiesterase-5 enzyme inhibitors
Phosphodiesterase
-5 enzyme
inhibitors
Avanafil
Sildenafil
Tadalafil
Vardenafil
Taking for Pulmonary Arterial
Hypertension (PAH) indication:
Recommend to continue regimen
throughout the perioperative period
Taking for BPH
Recommend to coordinate
perioperative management plan with
anesthesiologist, surgeon, and
prescribing provider
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54
Taking for other indications:
Recommend to hold therapy five
days prior to and the day of surgery
in all patients
Pheochromocytoma Agents
Tyrosine
Hydroxylase
Inhibitor
Metyrosine Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider
Alpha1-Blocker Phenoxybenzamine HCL
Phentolamine Mesylate
Renin Angiotensin System Antagonists
Angiotensin
Converting Enzyme
(ACE) Inhibitors
Benazepril
Captopril
Cilazapril
Enalapril Enalaprilat
Fosinopril
Lisinopril
Moexipril
Perindopril
Quinapril
Ramipril
Trandolapril
Significant Heart Failure (American
College of Cardiology
Foundation/American Heart
Association (ACCF/AHA) heart
failure staging system Stage D, or
New York Heart Association (NYHA)
Functional Classification III or IV) or
History of High Blood Pressure
(systolic ≥180 mmHg or diastolic
≥120 mmHg):
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, prescribing
provider
For all other indications:
Hold for 24 hours prior to surgery
and the day of surgery
Angiotensin II
receptor blockers
Candesartan
Losartan
Olmesartan
Valsartan
Direct renin
inhibitors
Aliskiren
Neprilysin inhibitor Sacubitril Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, prescribing
provider
Selective
Aldosterone
Receptor
Antagonists
Eplerenone It is reasonable to continue regimen
throughout the perioperative period
Respiratory Agents
Antifibrotic agents Pirfenidone Recommend to coordinate
perioperative medication
management plan with surgeon and
prescribing provider
Arylalkylamine
decongestants
Phenylephrine
Pseudoephedrine
Recommend to hold therapy the day
of surgery
Inhaled
anticholinergics
Aclidinium
Ipratropium
Revefenacin
Tiotropium
Umeclidinium
Recommend to continue regimen
throughout the perioperative period
and to administer on the morning of
surgery
Expectorants Guaifenesin
Potassium iodide
It is reasonable to continue regimen
throughout the perioperative period
Inhaled
corticosteroids
Beclomethasone
Budesonide
Ciclesonide
Flunisolide
Fluticasone
Mometasone
Recommend to continue regimen
throughout the perioperative period
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Inhaled
sympathomimetics
Albuterol
Arformoterol
Ephedrine
Epinephrine
Formoterol
Indacaterol
Isoproterenol
Levalbuterol
Metaproterenol
Olodaterol
Pirbuterol
Salmeterol
Terbutaline
Vilanterol
Recommend to continue regimen
throughout the perioperative period
and to administer on the morning of
surgery
Interleukin-5
receptor
antagonists
Mepolizumab
Reslizumab
Recommend to continue regimen
throughout the perioperative period
Leukotriene
modifiers
Montelukast
Zafirlukast
Zileuton Recommend to continue regimen
throughout the perioperative period
and administer on the morning of
surgery
Lung surfactants Beractant
Calfactant
Lucinactant
Poractant
It is reasonable to continue regimen
throughout the perioperative period
Monoclonal
antibodies (IgE
inhibitor)
Omalizumab Recommend to continue regimen
throughout the perioperative period
Mucolytics Acetylcysteine Dornase alfa Recommend to continue regimen
throughout the perioperative period
Non-narcotic
antitussives
Benzonatate
Dextromethorphan
It is reasonable to continue regimen
throughout the perioperative period
PDE-4 inhibitor Roflumilast Recommend to continue regimen
throughout the perioperative period
Respiratory
enzymes
Aplha1-proteinase inhibitor Recommend to continue regimen
throughout the perioperative period
Tyrosine kinase
inhibitor
Fostamatinib
Nintedanib
Recommend to continue regimen
throughout the perioperative period
Xanthine
derivatives
Aminophylline
Dyphylline
Theophylline Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider
Sedatives and Hypnotics
Sedatives and
hypnotics
Amobarbital
Butabarbital
Pentobarbital
Phenobarbital
Secobarbital
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, and prescribing
provider
Nonbarbiturate
sedatives and
hypnotics
Chloral hydrate
Dexmedetomidine
Eszopiclone
Lemborexant
Ramelteon
Suvorexant
Tasimelteon
Zaleplon
Zolpidem
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56
Selective Serotonin Reuptake Inhibitors (SSRIs) & Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
SSRI Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Vilazodone
Recommend to coordinate
perioperative medication
management plan with surgeon,
anesthesiologist, and prescribing
provider
SNRI Desvenlafaxine
Duloxetine
Levomilnacipran
Milnacipran
Venlafaxine
Skeletal Muscle Relaxants
Direct acting Dantrolene Recommend to continue regimen
throughout the perioperative period
Centrally acting Baclofen
Carisoprodol
Chlorzoxazone
Cyclobenzaprine
Diazepam
Metaxalone
Methocarbamol
Orphenadrine
Tizanidine
It is reasonable to continue regimen
throughout the perioperative period
Tetra-cyclic antidepressants
Tetra-cyclic
antidepressants
Maprotiline
Mirtazapine
It is reasonable to continue regimen
throughout the perioperative period
Toxins
Botulinum toxins:
Type A
AbobotulinumtoxinA
IncobotulinumtoxinA
OnabotulinumtoxinA
PrabotulinumtoxinA
It is reasonable to hold 48 hours
prior to surgery and not resume until
approved by surgeon
Type B toxin Rimabotulinum toxin B
Tri-cyclic antidepressants
Tricyclic
antidepressants
Amitriptyline
Amoxapine
Clomipramine
Desipramine
Doxepin
Imipramine
Nortriptyline
Protriptyline
Trimipramine
It is reasonable to continue regimen
throughout the perioperative period
Vasodilators
Endothelin
Receptor
Antagonist
Ambrisentan
Bosentan
Macitentan
Recommend to continue regimen
throughout the perioperative period
Human B-Type
Natriuretic Peptide
Nesiritide Recommend to continue regimen
throughout the perioperative period
Nitrates Amyl Nitrate
Isosorbide Dinitrate
Isosorbide Mononitrate
Nitroglycerin
Recommend to continue regimen
throughout the perioperative period
Peripheral
Vasodilators
Hydralazine
Isoxsuprine
Minoxidil
Papaverine
Recommend to coordinate
perioperative medication
management plan with surgeon,
anesthesiologist and prescribing
provider
Prostanoids Epoprostenol
Iloprost
Selexipag
Treprostinil
Recommend to coordinate
perioperative medication
management plan with surgeon,
anesthesiologist and prescribing
provider
Soluble Guanylate
Cyclase Stimulator
Riociguat Recommend to coordinate
perioperative medication
management plan with surgeon,
anesthesiologist and prescribing
provider
Effective 8/10/2022. Contact CCKM@uwhealth.org for previous versions
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57
Vasopressors Angiotensin II
Dobutamine
Dopamine
Droxidopa
Ephedrine
Epinephrine
Isoproterenol
Norepinephrine
Phenylephrine
Recommend to coordinate
perioperative medication
management plan with surgeon,
anesthesiologist and prescribing
provider
Effective 8/10/2022. Contact CCKM@uwhealth.org for previous versions
Copyright © 2022 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: CCKM@uwhealth.org Last Revised: 08/2022
Appendix A: Perioperative Medication Management