Vitamins & OTC supplements

Question 1

Vitamin E (a-tocopherol)

Answer 1

STOP 14 days preop
Risks: bleeding (Anti-platelet effect)
Elim: Hepatic
Half-life: 44h

Question 2

Garlic

Answer 2

Stop > 7 (14) days

Risks: bleeding (Decreased platelet aggregation)

Question 3

Gingko

Answer 3

Stop > 36h, ideally 14 days preop

Risks: bleeding (Anti-platelet effect)

Question 4

Echinacea

Answer 4

Stop >14 d preop
Variable effect on immune function depending on the preparation method
Hepatotoxicity has been described

Question 5

St John’s Wort

Licorice root

Answer 5

Stop >5 days before sx
Mild MAO-I effect (Increases endogenous amines)
Amplifies sedative effect

Question 6

Valerian

Answer 6

Delayed emergence

Withdrawal syndrome is like BZD withdrawal, tx with benzos

Question 7

Melatonin

Answer 7

Delayed emergence, sedative

Question 8

Ma Huang (Ephedra)

Answer 8

STOP >24h before sx

SNS stimulation

Question 9

Ginger

Answer 9

Stop > 14 days
Antiplatelet effect
Hypoglycemic agent

Question 10

Ginseng

Answer 10

Stop > 7 days, ideally 14 days preop

Platelet inhibition

Question 11

Kava

Answer 11

Stop > 24h before surgery

Risks: delayed emergence, hepatotoxicity