Herbal remedies position statement

There is limited information regarding the use of herbal medicines and the risks during surgery and anaesthesia. Patients often consider herbal medicines to be ‘safe’ and their use is not always disclosed to healthcare staff. However, there are a number of adverse effects and potential interactions that need to be considered and patients should be specifically asked about any herbal medicines they may be taking. Since the number of herbal medicines and their pharmacological effects is vast and varied, the recommendation for elective surgery is to stop all herbal medicines one or two weeks pre-operatively.

For patients undergoing emergency surgery, consider the potential side effects and interactions and use caution where necessary.

For example:

• garlic, ginger, ginkgo and ginseng can affect coagulation

• valerian can cause central nervous system depression

• echinacea can cause poor wound healing

• St John’s Wort can increase the metabolism (and thus decrease the pharmacological effect) of many medications by inducing cytochrome P450 enzymes.

Herbal medicines should be withheld throughout the patient’s hospital stay and only recommenced once adequate recovery (including wound healing) has taken place.

References

UKMI Medicines Q&A. How should herbal medicines be managed in patients undergoing surgery? Accessed via www.sps.nhs.uk 29/08/2019. Date prepared: 30th August 2017.