Preparing for Orthopaedic Surgery: What Medications Should You Stop? by Dr. Kashyap Solanki

If you’re scheduled for an orthopaedic procedure such as a Total Knee Replacement, Total Hip Replacement, ACL Reconstruction, or Tendon Repair, preparation begins well before the day of surgery.

One of the most important steps is reviewing your regular medications. Some drugs can affect bleeding, anesthesia, wound healing, or infection risk, and may need to be paused or adjusted for a safe and smooth surgery.

In this article, we’ll walk you through the key categories of medications, why they matter, and general timelines for stopping or modifying them — while reminding you to always follow your surgeon’s and anesthetist’s specific instructions.

Why It’s Important to Review Your Medications

Certain medicines — including commonly used painkillers and herbal supplements — can influence how your body reacts during and after surgery. Some increase bleeding, others may interact with anaesthesia, while some can affect your immune response.

That’s why every patient at Dr Kashyap Solanki’s Orthopaedic Clinic, Andheri (Mumbai), undergoes a thorough pre-anaesthesia check-up (PAC) to minimise risks and ensure a seamless experience.

1. Blood Thinners (Anticoagulants & Antiplatelets)

These medications reduce clotting risk but can cause excessive bleeding during surgery if not managed correctly.

Medication	When to Stop Before Surgery
Aspirin, Clopidogrel (Plavix)	5–7 days before
Warfarin (Coumadin)	5 days before (with INR monitoring)
Rivaroxaban (Xarelto), Apixaban (Eliquis)	2–3 days before
Dabigatran (Pradaxa)	2–5 days before
Heparin (UFH/LMWH)	6–12 hours before

👉 Some patients may require “bridging” therapy with alternative medications. This will be decided in coordination with your physician.

2. NSAIDs (Painkillers)

Non-Steroidal Anti-Inflammatory Drugs can increase bleeding risk and affect kidney function during surgery.

Examples	When to Stop
Ibuprofen, Diclofenac, Naproxen	2–5 days before
Etoricoxib (Arcoxia)	1–2 days before

✅ Paracetamol is generally safe and can usually be continued.

3. Herbal & Homeopathic Supplements

Even “natural” supplements can have unpredictable effects on bleeding and anaesthesia.

Common Supplements	Stop How Early?
Garlic, Ginkgo, Ginseng	7 days before
St. John’s Wort	5–7 days before
Ayurvedic/Homoeopathic remedies	5–7 days before

📝 Always inform your surgeon about all supplements you are taking.

4. Diabetes Medications

Good blood sugar control is crucial for wound healing and infection prevention. Some diabetic medicines may need to be paused or adjusted.

Medication	Guidance
Metformin	Stop 24–48 hours before surgery.
SGLT2 inhibitors (e.g., Dapagliflozin, Empagliflozin)	Stop 3 days before
Insulin	Usually adjusted on the day of surgery.

📈 Your surgeon and diabetologist will provide individualised instructions.

5. Steroids

If you’re on long-term steroids (e.g., Prednisolone), do not stop suddenly. You may require a “stress dose” before and after surgery to prevent adrenal complications. Your care team will coordinate this.

6. DMARDs (Disease-Modifying Anti-Rheumatic Drugs)

For patients with autoimmune conditions such as rheumatoid arthritis, DMARDs may impact healing and infection risk.

🔸 Conventional DMARDs

Drug	Stop or Continue?
Methotrexate	Usually continued
Leflunomide (Arava)	May need to stop 1–2 weeks before
Sulfasalazine, Hydroxychloroquine	Generally safe to continue

🔸 Biologic DMARDs

Drug	When to Stop
Etanercept (Enbrel), Adalimumab (Humira)	1–2 weeks before
Infliximab	Schedule surgery just before the next dose
Rituximab	Surgery at least 4 weeks after the last infusion

🔸 Targeted Synthetic DMARDs

Drug	When to Stop
Tofacitinib, Baricitinib, Upadacitinib	3–5 days before surgery

⚠️ Always discuss changes with your rheumatologist.

Medications Usually Safe to Continue

• Thyroid medications

• Most anti-hypertensives (some may be held on the day of surgery)

• Statins

• Inhalers for asthma or COPD

• Paracetamol

Final Pre-Surgery Medication Checklist

✔️ Share your complete medication list (including supplements) with your surgeon

✔️ Don’t stop or change any medication without medical advice

✔️ Attend your pre-anaesthesia check-up (PAC) well in advance

✔️ Clarify when to restart each medication after surgery

Expert Orthopaedic Care in Mumbai

At Dr Kashyap Solanki’s Orthopaedic Clinic in Andheri (Mumbai), we ensure that every patient is well prepared before surgery. Our team works closely with your physicians to optimise your medications and minimise risks — ensuring a safe, smooth, and speedy recovery.

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About Dr Kashyap Prabhu Solanki & Dr Prabhu Solanki

Orthopaedic Surgeon – Andheri, Mumbai

Dr Kashyap Solanki specialises in hip and knee replacement, robotic-assisted knee surgery, and joint preservation procedures like HTO, arthroscopy, and ligament reconstruction. He is also known for performing complex revision joint replacements and managing challenging upper and lower limb fractures. With a focus on precision and patient-centred care, Dr Solanki helps restore mobility and improve quality of life through advanced orthopaedic solutions.

With over four decades of distinguished orthopaedic practice, Dr Prabhu Solanki stands as one of Mumbai’s most experienced and respected orthopaedic surgeons. Having treated more than 40,000 patients and performed over 10,000 surgeries, his clinical outcomes and dedication have earned him widespread recognition — not just in Mumbai, but across India and abroad.

Dr Solanki’s reputation for precision, ethical care, and long-term results has brought him patients from all over India, as well as international patients seeking high-quality orthopaedic treatment and surgical expertise in Mumbai.

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