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Perioperative Medication Management- Medication Management Table

Perioperative Medication Management- Medication Management Table - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Medications, Related


Appendix B: Perioperative Medication Management
From: Perioperative Medication Management – Adult/Pediatric – Inpatient/Ambulatory
Clinical Practice Guideline
Last Reviewed 12/2016; Last Updated 1/2018
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
H
2
-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
Alpha
1
blockers
Alpha
1
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
Alpha
2
adrenergic agonists
Alpha
2
- agonists Clonidine
Guanfacine
Methyldopa
Tizanidine
Recommend to continue regimen throughout
the perioperative period
Analgesics
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

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
Hydromorpho
ne
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
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Class Medication Recommendation
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

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
Procainamid
e
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

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Class Medication Recommendation
Anti-convulsants
Anticonvulsants Acetazolamide
Brivaracetam
Carbamazepine
Divalproex
Eslicarbazepine
Felbamate
Lacosamide
Lamotrigine
Levetiracetam
Oxcarbazepi
ne
Perampanel
Primidone
Rufinamide
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
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Class Medication Recommendation
Anti-dopaminergics
Antidopaminergics
Chlorpromazine
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
Netupitant
Rolapitant

Class Medication Recommendation
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
Dexbrompheniramine
Dexchlorpheniramine
Diphenhydramine
Doxylamine
Hydroxyzine
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Class Medication Recommendation
Cyproheptadine Triprolidine
Anti-hyperlipidemia agents (non-statins)
Alirocumab
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


Class Medication Recommendation
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
Streptomycin
Tobramycin
Anthelmintics Albendazole (Albenza)
Ivermectin (Stromectol)
Praziquantel (Biltricide)
Pyrantel (Pin-X)
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
Hydroxychloroquin
e
Artemether/Lumef
antrine
Atovaquone/Progu
anil
Primaquine
Quinine sulfate
Pyrimethamine
Mefloquine
Antiprotozoals Atovaquone
Miltefosine
Nitazoxanide
Pentamidine
Tinidazole
Antiretroviral
agents
Abacavir
Atazanavir
Cobicistat
Darunavir
Delavirdine
Didanosine
Lamivudine
Lopinavir
Maraviroc
Nefinavir
Nevirapine
Raltegravir
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Dolutegravir
Efavirenz
Elvitegravir
Emtricitabine
Enfuvirtide
Etravirine
Fosamprenavir
Indinavir
Rilpivirine
Ritonavir
Saquinavir
Stavudine
Tenofovir
Tipranavir
Zidovudine
Antituberculosis
Agents
Aminosalicylic
acid
Benaquiline
Capreomycin
Cycloserine
Ethambutol
Ethionamide
Isoniazid
Pyrazinamide
Rifabutin
Rifampin
Rifapentine
Streptomycin
Antiviral Agents Adefovir
Amantadine
Acyclovir
Boceprevir
Cidofovir
Daclatasvir
Elbasvir/grazoprev
ir
Entecavir
Famciclovir
Foscarnet
Ganciclovir
Glecaprevir/pibren
tasvir
Ledipasvir/Sofosb
uvir
Letermovir
Ombitasvir/Paritaprev
ir/Ritonavir/Dasabuvir
Oseltamivir
Peramivir
Ribavirin
Rimantadine
Simeprevir
Sofosbuvir
Telaprevir
Telbivudine
Valacyclovir
Valganciclovir
Velpatasvir
Voxilaprevir
Zanamivir
Bacitracin Bacitracin
Carbapenems Doripenem
Ertapenem
Imipenem/Cilastatin
Meropenem
Meropenem/vaborbac
tam
Cephalosporins Cefaclor
Cefadroxil
Cefazolin
Cefdinir
Cefditoren
Cefepime
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
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org


Lipoglycopeptide
s
Dalbavancin
Oritavancin
Telavancin
Lipopeptides Daptomycin
Macrolides Azithromycin
Clarithromycin
Erythromycin
Fidaxomicin
Methenamines Methenamine Hippurate
Methenamine Mandelate
Miscellaneous Benznidazole
Fosfomycin
Metronidazole
Secnidazole
Monobactams Aztreonam
Monoclonal
antibodies
Bezlotoxumab
Nitrofurans Nitrofurantoin
Oxazolidinones Linezolid Tedizolid
Penicillins Amoxicillin
Amoxicillin/Clavulanate
Ampicillin
Ampicillin/sulbactam
Dicloxacillin
Nafcillin
Oxacillin
Penicillin G
Penicillin V
Piperacillin/Tazobactam
Ticarcillin/Clavulanate
Polymyxin B Sulfate
Rifaximin
Streptogramins Quinupristin/Dalfopristin
Sulfadiazine Sulfadiazine
Tetracyclines Demeclocycline
Doxycycline
Minocycline
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
Phosphodiestera
se inhibitor
Flavoxate

Anti-neoplastics
Alkylating Agents Altretamine
Busulfan
Carmustine
Chlorambucil
Dacarbazine
Estramustine
Ifosfamide
Lomustine
Mechlorethamin
e
Melphalan
Streptozocin
Thiotepa
Recommend to coordinate
antineoplastic perioperative
medication management plan
with surgeon and prescribing
provider





Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Anthracenedione Mitoxantrone











































Recommend to coordinate
antineoplastic perioperative
medication management plan
with surgeon and prescribing
provider






































































Antibody-Drug
Conjugates
ADO-Trastuzumab Emtansine
Brentuximab 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
DNA Demethylation
Agents
Azacitidine
Decitabine
Nelarabine
DNA
Topoisomerase
Inhibitors
Irinotecan
Topotecan
Enzymes Asparaginase
Pegaspargase
Epipodophyllotoxins Etoposide
Teniposide
Histone
Deacetylase
Inhibitors
Belinostat
Panobinostat
Romidepsin
Vorinostat
Hormones Abiraterone
Anastrazole
Bicalutamide
Buserelin
Enzalutamide
Exemestane
Flutamide
Fulvestrant
Goserelin
Histrelin
Letrozole
Leuprolide
Medroxyprogest
erone
Megestrol
Nilutamide
Tamoxifen
Toremifene
Triptorelin
Hedgehog Pathway
Inhibitor
Sonidegib
Vismodegib
Imidazotetrazine
derivatives
Temozolomide
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Kinase inhibitors Abemaciclib
Acalabrutinib
Afatinib
Alectinib
Axitinib
Bosutinib
Brigatinib
Cabozantinib
Ceritinib
Cobimetinib
Copanlisib
Crizotinib
Dabrafenib
Dasatinib
Enasidenib
Erlotinib
Everolimus
Gefitinib
Ibrutinib
Idelalisib
Imatinib

Lapatinib
Lenvatinib
Midostaurin
Neratinib
Nilotinib
Osimertinib
Palbociclib
Pazopanib
Ponatinib
Regorafenib
Ribociclib
Ruxolitinib
Sorafenib
Sunitinib
Temsirolimus
Trametinib
Vandetanib
Vemurafenib


















Recommend to coordinate
antineoplastic perioperative
medication management plan
with surgeon and prescribing
provider










































Methylhydrazine
derivatives
Procarbazine
Miscellaneous
Antineoplastics
Arsenic Trioxide
Mitotane
Porfimer
Sipuleucel-T
Sterile Talc Powder
Trabectedin
Trifluridine/tipiracil
Monoclonal
antibodies
Alemtuzumab
Atezolizumab
Avelumab
Bevacizumab and
biosimilars
Blinatumomab
Cetuximab
Daratumumab
Dinutuximab
Elotuzumab
Gemtuzumab
Ibritumomab
Inotuzumab
Ipilimumab
Necitumumab
Nivolumab
Obinutuzumab
Ofatumumab
Olaratumab
Panitumumab
Pertuzumab
Ramucirumab
Rituximab
Trastuzumab
(and
biosimilars)
PARP Enzymes
Inhibitor
Olaparib
Rucaparib
Platinum
Coordination
Complex
Carboplatin
Cisplatin
Oxaliplatin
Proteasome
Inhibitors
Bortezomib
Carfilzomib
Ixazomib
Protein Synthesis
Inhibitor
Omacetaxine
Radiopharmaceutic
als
Radium RA 223
Samarium SM 153
Sodium Iodide I 131
Strontium-89 Chloride
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Retinoids Tretinoin
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
Anti-Parkinson’s Agents
Antiparkinson
agents
Amantadine
Apomorphine
Belladonna alkaloids
Benztropine
Bromocriptine
Carbidopa
Carbidopa/Levodopa
Carbidopa/Levodopa/
Entacapone
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
cardiologist, neurosurgeon,
vascular surgeon)

Anti-psychotics
1
st
generation –
Typical
Chlorpromazine
Fluphenazine
Haloperidol
Loxapine
Perphenazine
Pimozide
Prochlorperazin
e
Thioridazine
Thiothixene
Trifluoperazine
Recommend to continue regimen
throughout the perioperative
period

2
nd
generation –
Atypical

Aripiprazole
Asenapine
Brexpiprazole
Cariprazine
Clozapine
Olanzapine
Paliperidone
Pimavanserin
Quetiapine
Risperidone
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org


Iloperidone
Lurasidone
Ziprasidone
Antirheumatic Agents
Janus associated
kinase (JAK)
inhibitors
Tofacitinib 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
Certolizumab
Etanercept
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

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

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
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Benzodiazepines
Benzodiazepines Alprazolam
Chlordiazepoxide
Clobazam
Clonazepam
Clorazepate
Diazepam
Lorazepam
Oxazepam
Recommend to continue regimen
throughout the perioperative
period

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
Alpha
1
-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

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

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org


Antidepressants Bupropion
Nefazodone hydrochloride
Trazodone
Vortioxetine
Recommend coordination of
perioperative medication
management plan with surgeon,
anesthesiologist, and prescribing
provider

Anticholinesteras
e 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
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

Glutamate
Inhibitor
Riluzole Recommend to continue regimen
throughout the perioperative
period

Lithium Lithium Recommend to continue regimen
throughout the perioperative
period

Miscellaneous
psychotherapeuti
c agents
Atomoxetine
Sodium oxybate
Atomoxetine: Recommend to
continue regimen throughout the
perioperative period

Sodium oxybate: Recommend
to coordinate sodium oxybate
perioperative management plan
with anesthesiologist, surgeon,
and prescribing provider

Mixed 5HT
1A

agonist/5HT
2A

antagonist
Flibanserin Recommend to coordinate
perioperative management plan
with anesthesiologist, surgeon,
and prescribing provider

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org


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

Potassium
Channel Blocker
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
Ulipristal
Selective
Estrogen
Receptor
Modulator
Bazedoxifene
Clomiphene Citrate
Ospemifene
Raloxifene
Endocrine and Metabolic Agents – Miscellaneous
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

4-
Hydroxyphenylpy
ruvate
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
Bile Acids Cholic Acid
Bromocriptine
Mesylate
Bromocriptine Mesylate
Cabergoline Cabergoline
Calcimimetics Cinacalcet
Etelcalcetide
Carglumic acid Carglumic acid
Chelating Agent Deferasirox
Deferiprone
Deferoxamine
Cysteamine Cysteamine
Detoxification
agents
Dimercaprol
Edetate Calcium
Disodium
Pentetate Calcium
Trisodium
Pentetate Zinc
Trisodium
Prussian Blue
(Ferric
Hexacyanoferra
te)
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
Glucosylceramid
e Synthase
Inhibitor
Eliglustat
Miglustat
Glycerol
Phenylbutyrate
Glycerol Phenylbutyrate
Gonadotropin
Releasing
Hormone Agonist
Nafarelin
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Gonadotropin
Releasing
Hormone
Antagonist
Cetrorelix
Degarelix
Ganirelix

Growth Hormone Somatropin
Growth Hormone
Agonists
Macimorelin
Insulin-like
growth factor
Mecasermin
Ivacaftor Ivacaftor
Lipodystrophy
agents
Metreleptin
Tesamorelin
Lipolytic Deoxycholic acid
Ovulation
Stimulator
Choriogonadotropin Alfa
Chorionic Gonadotropin
Follitropin alfa
Follitropin beta
Lutropin Alpha
Menotropins
Urofollitropin

Parathyroid
hormone
analogues
Abaloparatide
Parathyroid
Teriparatide
Pegvisomant Pegvisomant
Phenylketonuria
agents
Sapropterin Dichloride
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
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org


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
Lactulose
Sorbitol
Stimulants Bisacodyl
Cascara sagrada
Sennosides
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org


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





All other medications:
Recommend to continue regimen
throughout the perioperative
period




Antispasmodics Dicyclomine
Belladonna
alkaloids
Atropine sulfate
Hyoscyamine sulfate
Scopolamine
Cholinergic
Agonist
Cevimeline
Pilocarpine
Chloride Channel
Activator
Lubiprostone
Digestive
Enzymes
Pancreatic Enzymes
Pancrelipase
GI Anticholinergic
Combinations
Atropine/scopolamine/hyoscyamine/pheno
barbital
Clidinium/chlordiazepoxide
GI Quaternary
Anticholinergics
Glycopyrrolate
Mepenzolate
Methscopolamine
Propantheline
GI stimulants Dexpanthenol
Metoclopramide
GLP-2 analogs Teduglutide
Glutamine L-glutamine
Guanylate
cyclase-C agonist
Linaclotide
Plecanatidecalci
Miscellaneous Eluxadoline
Sucralfate
Chenodiol
Ursodiol
Alvimopan
Methylnaltrexone
Naloxegol
Systemic
Deodorizers
Bismuth subgallate
Chlorophyll
derivatives
Chlorophyllin
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

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/butabarbital/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

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
Antisickling
agents
Hydroxyurea Recommend to continue regimen in
the perioperative period

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

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
Epoetin Alfa
Epoetin Beta
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
Pegfilgrastim

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
Eltrombopag
Oprelvekin
Romiplostim

Recommend to coordinate
perioperative medication
management plan with surgeon and
prescribing provider

Hemin Hemin 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

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 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

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org



Thrombolytic
agents
Alteplase
Defibrotide
Protein C Concentrate
Reteplase
Tenecteplase
Urokinase
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.







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
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
Immunologic Agents
Immunomodulato
rs
Abatacept
Adalimumab
Anakinra
Apremilast
Brodalumab
Canakinumab
Certolizumab
Daclizumab
Dimethyl Fumarate
Etanercept
Fingolimod
Golimumab
Interferons
Ixekizumab
Lenalidomide
Mitoxantrone
Natalizumab
Pembrolizumab
Pomalidomide
Rilonacept
Secukinumab
Teriflunomide
Thalidomide
Tocilizumab
Recommend to coordinate
perioperative medication
management plan with surgeon and
prescribing provider

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org


Guselkumab
Infliximab (and
biosimilars)
Ustekinumab
Vedolizumab
Immunostimulant
s
Pegademase Bovine
Immunosuppressi
ves
Alefacept
Azathioprine
Basiliximab
Belatacept
Cyclosporine
Dupilumab
Durvalumab
Glatiramer
Mycophenolate
Ocrelizumab
Sirolimus
Tacrolimus
Keratinocyte
Growth Factors
Palifermin
Miscellaneous
Monoclonal
Antibodies
Belimumab
Denosumab
Eculizumab
Palivizumab
Raxibacumab
Sarilumab
Siltuximab
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
Sympathomimeti
c
Isometheptene Recommend to hold therapy the day
of surgery, although may be
approved with coordination of
anesthesiologist

Serotonin
5HT
1B,1D
Agonist
(triptans)
Almotriptan
Eletriptan Frovatriptan
Naratriptan
Rizatriptan,
Sumatriptan,
Zolmitriptan
Ergot Derivatives Dihydroergotamine mesylate
Ergotamine tartrate
Monoamine Oxidase Inhibitors
Monoamine
Oxidase
Inhibitors (MAOI)
Isocarboxazid
Phenelzine
Tranylcypromine
Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider

Ophthalmic Agents – Miscellaneous
Cycloplegic
Mydriatics
Atropine Sulfate
Cyclopentolate HCl
Homatropine HBr
Scopolamine HBr
Tropicamide
Cyclopentolate/Phenylephrine
Hydroxyamphetamine
Hydrobromide/Tropicamide
Recommend to continue regimen
throughout the perioperative period

Antibiotics Azithromycin
Bacitracin
Besifloxacin
Ciprofloxacin HCl
Erythromycin
Gatifloxacin
Gentamicin
Levofloxacin
Moxifloxacin
Ofloxacin
Sulfacetamide
Tobramycin
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

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
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
Phosphodiestera
se-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

Taking for other indications:
Recommend to hold therapy five days
prior to and the day of surgery in all
patients

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Pheochromocytoma Agents
Tyrosine
Hydroxylase
Inhibitor
Metyrosine

Recommend to coordinate
perioperative medication
management plan with
anesthesiologist, surgeon, and
prescribing provider

Alpha
1
-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
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

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org

Inhaled
sympathomimetic
s
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
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
Ramelteon
Suvorexant
Tasimelteon
Zaleplon
Zolpidem
Selective Serotonin Reuptake Inhibitors (SSRIs) & Serotonin Norepinephrine Reuptake
Inhibitors (SNRIs)
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org


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
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

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org


Soluble
Guanylate
Cyclase
Stimulator
Riociguat Recommend to coordinate
perioperative medication management
plan with surgeon, anesthesiologist
and prescribing provider

Vasopressors Dobutamine
Dopamine
Droxidopa
Ephedrine
Epinephrine
Isoproterenol
Norepinephrine
Phenylephrine

Recommend to coordinate
perioperative medication management
plan with surgeon, anesthesiologist
and prescribing provider

Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
01/2018CCKM@uwhealth.org