68 Days To Scheduled Surgery
In preparation for my upcoming Periacetabular Osteotomy, I noticed several sites and forums discussing the need to quit certain medications in the weeks prior to the procedure. Being on a large regimen of prescription medications myself, this became an immediate concern. After discussing with my psychiatrist, I decided to call and leave a message for my surgeon's physician's assistant. As I await her response, here is the research I have performed on the essential question:
Which, if any, of my currently prescribed medications will I need to quit taking prior to my surgery date?
Lexapro (escitalopram)
As an SSRI (Selective Serotonin Reuptake Inhibitors), Lexapro is used to treat anxiety and major depression in adults over the age of 12. Diagnosed at age 14 with Panic Disorder and Moderate Anxiety, I have been on a fairly large dose of SSRIs for the past 10 years. Websites like PDRhealth.com (Physicians' Desk Resource) note that Lexapro "may increase your risk of bleeding. Do not take Lexapro with aspirin, nonsteroidal anti-inflammatory drugs, or blood-thinners (such as warfarin)." With blood loss as one of the primary risks for this specific surgery, the Lexapro dosage can become a concern.
The other issue is the interaction between Lexapro and Morphine during surgical recovery. Drug.com notes that when these two medications are combined, there is a moderate potential of central nervous system and respiratory system depression. A study posted to eHealthMe.com regarding patients' experience with mixing these two drugs noted that possibly side effects include vomiting, pain, nausea, and headaches.
Interactions between Lexapro and Anesthesia seem to be of little concern to physicians and surgeons blogging on the web.
Bottom Line: I am awaiting a response from the Physician's Assistant, but should it be recommended that I ween off the Lexapro, my psychiatrist has recommended a system that lowers my dose 5mg per week until I am completely off of my 20mg dose.
Yasmin (Ethinyl Estradiol with Drosperinone)
The birth control pill Yasmin is commonly prescribed to make periods less heavy and more predictable, and prevent pregnancy. Due to extremely heavy and irregular periods, I have been on birth control pills since my Freshman year of High School. Like Lexapro, Yasmin does cause concern in a surgery like this one. It has been argued that this form of birth control acts as an anticoagulant, increasing the risk for blood clots. NetDoctor.co.uk notes that "the risk of blood clots forming in the veins (venous thromboembolism) while taking the pill may be temporarily increased if you are immobile for prolonged periods of time, for example if you have a major accident or major surgery. For this reason, your doctor will usually recommend that you stop taking this pill for a period of time (usually four to six weeks) prior to any planned surgery, particularly abdominal surgery or orthopaedic surgery on the lower limbs."
Bottom Line: Again, I am waiting to hear from the Physician's Assistant, but as I do not currently need pregnancy protection, I will most likely finish my current pill pack and then stop taking them.
Phentermine
The drug nicknamed "Phen" is used as an appetite suppressant in weight-loss management. I have been visiting the Medi Clinic for 3 months and taking a low dose of Phentermine every morning to aid in the weight-loss program. When mixed with a high-protein, low-carb, low-calorie diet, I have been able to shed 20 lbs, which will undoubtedly help in the surgical recovery. However, Phentermine is one drug that cannot be mixed with anesthesia.
Phentermine can alter the chemical balance in the brain's two neurotransmitters, serotonin and dopamine, which can result in hypertension under general anesthesia. Should an anesthesiologist be unaware of a patient being on Phentermine, potentially fatal results have occurred.
Bottom Line: I have notified my surgeon that I am currently taking the Phentermine and am awaiting a response from the Physician's Assistant as to when I should stop taking the meds. Internet sources have generally recommended stopping doses at least 2 weeks prior to surgery.
Xanax (alprazolam)
Xanax is a benzodiazepine that is used to treat panic and anxiety disorders, especially panic attacks. Since I was nervous about the withdrawal affects of potentially weening off my Lexapro, I was glad to know that my trusty Xanax would be allowed all the way up until the date of my surgery. Hospitals will often use a fellow benzodiazepine, Valium, to calm nerves before surgery.
Bottom Line: No need to worry about taking Xanax in the weeks before surgery.
