Herbal Supplements to Avoid Before Surgery

Did you know that taking some herbal supplements in the month 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 healthcare providers 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, consider that hemlock is "natural" and "plant-based" and can even be grown organically—but it didn't do much for Romeo and Juliet's relationship.

We understand why people may be reluctant to report their use of alternative therapies such as herbal supplements to their surgeon. Some medical healthcare providers are not very familiar with nutritional supplements and may disapprove or even lecture a person about using these treatments. Yet patients 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 to four weeks prior to surgery for surgery to be safe.

Potential Risks of Supplements Prior to Surgery

Below, you'll find 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.

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

Some Specific Surgical Risks Related to Herbal Supplements

Below we list some of the known problems 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.

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

• Ephedra (causes hypertension, palpitations, and tachycardia)
• Garlic (can cause hypotension)
• Ginseng
• Kava

Supplements That Can Cause Drug Interactions

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

Supplements That Can Have Anesthetic Effects

• Valerian
• St. John's Wort
• Kava

Supplements Known to Cause Other Types of Adverse Events

• St. John's Wort (can cause photosensitivity, especially after laser or chemical peels)
• Ginseng (can cause hypoglycemia)

Shared Responsibility

The American Society for Aesthetic Plastic Surgery encourages healthcare providers to give detailed lists of these supplements to their patients. On your part, the best thing you can do is tell your practitioner 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 that may be contaminated or toxic.