Dr. Denis Grillo, Ear, Nose & Throat, 6/17/14

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OTC medications and supplements could pose surgery risk

By Dr. Denis Grillo

Years ago, patients were taking medications only if the doctor recommended and/or directed it. Nowadays, patients are fairly savvy and use the Internet, sources such as Wikipedia, and go to health food stores and get advice from questionably trained individuals about the benefits of over-the-counter medications, herbal supplements, etc. 

For the most part, the information out there is fairly accurate, but I would always recommend reviewing anything you take, whether it is prescription or over-the-counter, with your primary care doctor. 

The new concern is that some of these medications could interfere with surgery and could affect intraoperative outcomes, create complications and even affect and delay healing. Studies by doctors and scientists suggest upwards of about half of the patient population is taking some over-the-counter and/or herbal supplements. 

The danger that we as surgeons concern ourselves with is that over-the-counter medications and supplements could increase bleeding during and after the surgery. Also, supplements can affect heart and blood pressure issues, which in combination with general anesthetic could potentially harm the patient. Things that are known to increase the risk of bleeding include aspirin, nonsteroidal anti-inflammatories commonly used for arthritis, bilberry, bromelain, fish oil, flaxseed oil, garlic, selenium, vitamin E and a product called MSM, which is short for methylsulfonylmethane. 

Another interesting fact is that there seems to be more women than men taking these supplements. I believe this to be the case because women, generally speaking, are more health- and beauty-oriented than male patients.

Other common supplements include echinacea, ephedra, ma huang, gingko, ginseng, kava, St. John’s Wort, valerian, feverfew and ginger. These supplements taken regularly probably pose no risk and questionably provide some health benefits, but in risky situations where surgery and anesthesia are involved it probably is best to terminate them two or three weeks before the surgery to make sure they do not interfere with medications given during the surgery and to not interfere and cause excessive bleeding during and after the surgery. 

The best thing to do is have an open discussion with your primary care doctor as well as the surgeon and get their advice and you will likely be able to resume these medications and supplements after the healing process. 

Denis Grillo, D.O., FOCOO, is an ear, nose and throat specialist in Crystal River. Call him at 352-795-0011 or visit CrystalCommunityENT.com.