What medications you must stop before neurosurgery

Blood thinners are the most important category. Aspirin, clopidogrel (Plavix), warfarin and the newer oral anticoagulants (rivaroxaban, apixaban, dabigatran) all need to be stopped or bridged in a specific way, usually five to seven days before surgery. Do not stop them on your own — some carry their own risk when discontinued.

Non-steroidal anti-inflammatories (ibuprofen, diclofenac, naproxen) increase bleeding risk and are usually stopped one week before surgery. Paracetamol is safe.

Several supplements act as mild blood thinners and should be stopped: fish oil, vitamin E, garlic tablets, ginkgo, ginseng and turmeric supplements. Stop these one week before.

Diabetes medications are adjusted, not always stopped. Metformin is often held on the day of surgery. Insulin doses are usually reduced during the fasting period. Newer diabetes drugs (GLP-1 agonists, SGLT-2 inhibitors) have specific fasting rules — tell us if you take these.

You will receive a written medication plan with your surgery date. If anything is unclear, phone the rooms rather than guess. Never stop or change a medication without checking.