Herbal Supplements to Avoid Before Surgery

What Nutritional Supplements Cause Problems During Surgery?

herbal supplement pills on table
What herbal supplements do you need to avoid before surgery?. Andrew Brookes/Cultura/Getty Images

Herbal Supplements and Surgery - Can They Be Dangerous?

Did you know that taking some herbal supplements in the two weeks before or after having surgery can be dangerous? In fact, these nutritional supplements can be as dangerous as taking aspirin or Advil (ibuprofen) before surgery.

Most people know they should tell their doctors about any prescription or over-the-counter drugs they are taking, especially when they are planning to have surgery.

But not everyone stops to think about the possible risks their herbal supplements could pose to the success and safety of their surgery.

Why Herbal Supplements Get Missed in the Pre-Surgery Checklist

Many people assume that just because a product is labeled as "natural", it is harmless. The truth is that many powerful drugs (and poisons) are based on natural substances, so it's clear that many natural substances can have a potent effect on the body. If this seems surprising, hemlock is "natural" and "plant-based" and can even be grown organically, but it didn't do much for Romeo an Juliet's relationship.

We understand why people may be reluctant to report their used of alternative therapies such as herbal supplements to their surgeon. Medical doctors, in general, are not very familiar with nutritional supplements, and may disapprove or even lecture a person about using these treatments. Yet people who withhold this information can pay a hefty price.

Another problem with reporting supplements is that people fear their surgery will be postponed if they admit they are using a supplement, and this can certainly occur. It's often not enough to just skip a supplement on the day of surgery. Some of these supplements have to be stopped at least two weeks prior to surgery for surgery to be safe.

Potential Risks of Supplements Prior to Surgery

Below is a general list of herbal supplements that may affect surgical outcome and safety.  Keep in mind that some herbal supplements have a combination of compounds. In addition, some of these supplements go by more than one name. Your best bet is to bring any supplements with you to your pre-operative appointment and have your surgeon read through the ingredients.

In addition to the potential problems with surgery noted below, many herbal supplements can interact with commonly prescribed medications. This could include medications used for anesthesia, so the potential interaction may not be obvious to you. To emphasize the potential problem of interactions, take a look at this list of herbal supplements which interact with the medication warfarin. (Warfarin is a medication which has been used for people who develop blood clots after surgery.)

In general, it is recommended that you cease taking any of these supplements at least two weeks prior to your surgery date (and don't resume taking them until you have your doctor's OK).

Some Specific Surgical Risks Related to Herbal Supplements

Below we list some of the known problems which herbal supplements may cause in surgery. This list is not exhaustive. Again, as noted above, some supplements may contain a combination of herbal remedies and each of these may have more than one name on a label. If you are looking through your dietary supplements and wondering what they are, here is a list of the most common dietary supplements.

Supplements that can cause bleeding problems:

  • Gingko Biloba
  • Garlic
  • Ginseng
  • Fish oils (omega-3 fatty acids)
  • Green tea
  • Dong Quai
  • Feverfew
  • Saw palmetto

Supplements that can have cardiovascular effects:

Supplements that can cause drug interactions:

  • Echinacea
  • Goldenseal
  • Licorice
  • St John's Wort
  • Kava
  • Valerian

Supplements that can have anesthetic effects:

  • Valerian
  • St John's Wort
  • Kava

Supplements known to cause other types adverse events:

A Shared Responsibility

The American Society for Aesthetic Plastic Surgery encourages doctors to give detailed lists of these supplements to their patients. One of the best things you can do is to tell your doctor about anything that you take daily. If you think about it is this way, you will remember to disclose all the vitamins, supplements, and medications you take regularly. 

If you use herbal supplements, make sure to learn about herbal supplements which may be contaminated or toxic.

Sources:

Levy, I., Attias, S., Ben-Arye, E. et al. Perioperative Risks of Dietary and Herbal Supplements. World Journal of Surgery. 2016 Nov 22. (Epub ahead of print).

Singh, V., Mohammad, S., and N. Singh. Herbs and Surgery. National Journal of Maxillofacial Surgery. 2012. 3(1):101-106.

Wang, C., Moss, J., and C. Yuan. Commonly Used Dietary Supplements on Coagulation Function During Surgery. Medicines. 2015. 2(3):157-185.

Wong, A., and S. Townley. Herbal Medicines and Anaesthesia. Continuing Education in Critical Care and Pain. 2011. 11(1):14-17.

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