Failing to prevent the consequences of interrupting drug treatment before
surgery might be as serious as the consequences of medication errors, experts
say.
In an editorial in the British Medical Journal (2000;321:719), Dr David Noble
(consultant in anaesthesia and intensive care medicine, Grampian university
hospitals, Aberdeen) and Professor Henrik Kehlet (professor of surgery, Hvidovre
university hospital, Denmark) say that abrupt interruptions of drug treatment
may lead to a loss of effect, rebound exacerbation of disease and an increased
risk of postoperative complications. While reducing or abstaining from recreational
drugs and a small number of therapeutic drugs (eg, oral anticoagulants) may
be desirable before surgery, “the abrupt discontinuation of most drugs
is unlikely to be of any benefit,” they say.
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| Abruptly stopping drugs before surgery might be dangerous, experts say |
The authors suggest that patients should continue their drugs until the day
of surgery, when possible, and that drugs are then administered by a non-oral
route (or that alternative drugs are used if no non-oral preparations are available).
In addition, they suggest normalising patients’ gastrointestinal transit
times as soon as possible after surgery to overcome the problem of reduced drug
absorption caused by delayed gastric emptying, a particular problem following
major abdominal surgery.
Problems with abrupt discontinuation of drugs are not sufficiently recognised
by the pharmaceutical industry, they say. Guidance on parenteral alternatives
should be included in drug information leaflets and national drug formularies,
they suggest. Hospital pharmacists could play an important role in providing
information on symptoms, signs and potential sequelae of abrupt drug withdrawal
as well as strategies to avoid these problems, they add.
The authors note that studies have found particular problems with the withdrawal
of antihypertensives, l-Dopa, benzodiazepines and antidepressants.