32 Appendix A: Perioperative Medication Management From: Perioperative Medication Management – Adult/Pediatric – Inpatient/Ambulatory Clinical Practice Guideline Last Reviewed 6/2019; Last Updated 8/2022 Contact information: Philip J. Trapskin, PharmD, Phone Number: (608) 263-1328, PTrapskin@uwhealth.org Class Medication Recommendation Acid Suppressants Antacids Non-soluble Aluminum hydroxide Calcium carbonate Magnesium hydroxide Magnesium oxide Soluble Sodium bicarbonate Sodium citrate Non-soluble: Recommend to hold therapy the day of surgery Soluble: Recommend to continue regimen throughout the perioperative period H2-Receptor Antagonists Cimetidine Famotidine Nizatidine Ranitidine It is reasonable to continue regimen throughout the perioperative period Proton pump inhibitors Dexlansoprazole Esomeprazole Lansoprazole Omeprazole Omeprazole/sodium bicarbonate Pantoprazole Rabeprazole Parathyroid surgery: Recommend to hold 7 days prior to and day of surgery and post-operatively until directed to resume by surgeon. All other surgeries: Recommend to continue regimen throughout the perioperative period Allergen-specific Immunotherapy Peanut allergen powder Recommend to coordinate perioperative medication management plan with surgeon and prescribing physician Alpha1 blockers Alpha1 blockers Alfuzosin Doxazosin Phenoxybenzamine Phentolamine Prazosin Silodosin Tamsulosin Terazosin Cataract surgery: Recommend to coordinate perioperative medication management plan with surgeon All other surgeries: Recommend to continue regimen throughout the perioperative period Alpha2-adrenergic agonists Alpha2- agonists Clonidine Guanfacine Lofexidine Methyldopa Tizanidine Recommend to continue regimen throughout the perioperative period Analgesics Effective 8/10/2022. Contact CCKM@uwhealth.org for previous versions Copyright © 2022 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 08/2022 33 Class Medication Recommendation Acetaminophen It is reasonable to continue regimen throughout the perioperative period N-type calcium channel blocker Ziconotide It is reasonable to continue regimen throughout the perioperative period. Any interruptions in therapy (holding or discontinuing) should be coordinated with prescribing provider. Nonsteroidal anti- inflammatory drugs (NSAIDs) Aspirin Celecoxib Choline magnesium trisalicylate Diclofenac Diflunisal Etodolac Fenoprofen Flurbiprofen Ibuprofen Indomethacin Ketoprofen Ketorolac Magnesium salicylate Meclofenamate Mefenamic acid Meloxicam Nabumetone Naproxen Oxaprozin Piroxicam Salsalate Sulindac Tolmetin For aspirin recommendations, refer to the Anti-platelet section. For non-aspirin NSAIDS, coordinate with surgeon and prescribing provider. Opioid agonists Alfentanil Codeine Fentanyl Hydrocodone Hydromorphone Levorphanol Meperidine Methadone Morphine sulfate Opium Oxycodone Oxymorphone Paregoric Remifentanil Sufentanil Tapentadol Tramadol Recommend to continue chronic opioid regimen throughout the perioperative period, unless reduction or discontinuation is part of the perioperative analgesic plan. Abrupt discontinuation of opioids may cause withdrawal symptoms and/or increased pain Opioid partial agonists Buprenorphine Buprenorphine injection Buprenorphine/naloxone (Suboxone®) Butorphanol Morphine sulfate/naltrexone Nalbuphine Pentazocine Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing physician Anorexiants Serotonin 2C receptor agonists Lorcaserin Recommend to hold therapy 7 days prior to surgery and postoperatively until directed to resume by surgeon Sympathomimetic anorexiants Benzphetamine Diethylpropion Phendimetrazine Phentermine Anti-addiction Agents (see also “Opioid partial agonists” above) Antialcoholic agents Acamprosate calcium Disulfiram Acamprosate: Recommend to continue regimen throughout the perioperative period Disulfiram: Recommend to hold 7 to14 days prior to surgery Opioid Antagonist Naltrexone Recommend to hold oral naltrexone for 1 week prior to surgery and intramuscular naltrexone for 4 weeks prior to surgery Recommend coordination of post- operative pain management plan with anesthesiologist, surgeon, and primary care physician in order to minimize use of opioids Effective 8/10/2022. Contact CCKM@uwhealth.org for previous versions Copyright © 2022 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 08/2022 34 Class Medication Recommendation Nicotine replacement Nicotine gum, lozenges, patches, inhalers Recommend abstinence from smoking in the perioperative period Recommend to coordinate nicotine replacement perioperative medication management plan with surgeon. If used the day of surgery, gum and lozenges should not be used within 2 hours of procedure Anti-Dementia (Alzheimer’s)Agents Cholinesterase inhibitors Donepezil Galantamine Rivastigmine Recommend to continue cholinesterase inhibitors with the knowledge that adjustments to neuromuscular blocking drugs may be necessary NMDA receptor antagonist Memantine It is reasonable to continue regimen throughout the perioperative period Anti-arrhythmics Anti-arrhythmics Amiodarone Disopyramide Dofetilide Dronedarone Flecainide Ibutilide Lidocaine (systemic) Mexiletine Procainamide Propafenone Quinidine Electrophysiology surgeries/procedures Recommend to coordinate perioperative medication management plan with cardiologist and prescribing provider Non-electrophysiology surgeries/procedures Recommend to continue regimen throughout the perioperative period Anti-cholinergics Anti-cholinergics Cyclizine Dimenhydrinate Diphenhydramine Meclizine Scopolamine Trimethobenzamide It is reasonable to continue anti- cholinergics throughout the perioperative period, unless a patient-specific perioperative management plan was provided by the surgeon. Anti-coagulants Anticoagulants Antithrombin Apixaban Betrixaban Argatroban Bivalirudin Dabigatran Dalteparin Desirudin Edoxaban Enoxaparin Fondaparinux Heparin Rivaroxaban Warfarin Recommend to coordinate perioperative medication management including any plan for neuraxial analgesia with surgeon, anesthesiologist and prescribing provider Refer to Management of Antithrombotic Therapy in the Setting of Periprocedural, Regional Anesthesia and/or Pain Procedures Clinical Practice Guideline Effective 8/10/2022. Contact CCKM@uwhealth.org for previous versions Copyright © 2022 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 08/2022 35 Anti-convulsants Anticonvulsants Acetazolamide Brivaracetam Cannabidiol (Epidiolex) Carbamazepine Cenobamate Divalproex Eslicarbazepine Felbamate Lacosamide Lamotrigine Levetiracetam Oxcarbazepine Perampanel Primidone Rufinamide Stiripentol Tiagabine Topiramate Valproic acid Vigabatrin Planned Neuromonitoring or Neuromapping Recommend to coordinate anticonvulsant perioperative medication management plan with surgeon, anesthesiologist, and prescribing provider All other Procedures Recommend to continue anticonvulsant regimens throughout the perioperative period. Anticonvulsants (GABA analogues) Gabapentin Pregabalin Hydantoins Ethotoin Fosphenytoin Phenytoin Potassium Channel Openers Ezogabine Succinimides Ethosuximide Methsuximide Sulfonamides Zonisamide Anti-diabetic agents Alpha-glucosidase inhibitor Acarbose Miglitol Refer to: • Diabetes Medication Adjustment: Ambulatory Procedures • Diabetes Medication Adjustment: Inpatient Procedures Amylinomimetic Pramlintide Biguanide Metformin Dipeptidyl Peptidase IV Inhibitor Alogliptin Linagliptin Saxagliptin Sitagliptin Glucagon-Like Peptide-1 Receptor Agonist Albiglutide Dulaglutide Exenatide Liraglutide Lixisenatide Semaglutide Insulin Insulin Aspart Insulin Degludec Insulin Detemir Insulin Glargine Insulin Isophane Insulin Lispro Insulin Regular Meglitinide Analog Nateglinide Repaglinide Sodium-Glucose Cotransporter-2 Inhibitor Canagliflozin Dapagliflozin Empagliflozin Ertugliflozin Sulfonylurea Chlorpropamide Glimepiride Glipizide Glyburide Tolazamide Tolbutamide Thiazolidinedione Pioglitazone Rosiglitazone Anti-dopaminergics Antidopaminergics Chlorpromazine Amisulpride Metoclopramide Perphenazine It is reasonable to continue regimen in the perioperative period Anti-emetics 5HT3 antagonists Alosetron Dolasetron Granisetron Ondansetron Palonosetron It is reasonable to continue regimen in the perioperative period Phenothiazine Prochlorperazine Promethazine Substance P/Neurokinin 1 receptor antagonist Aprepitant Fosaprepitant Fosnetupitant Netupitant Rolapitant Effective 8/10/2022. Contact CCKM@uwhealth.org for previous versions Copyright © 2022 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 08/2022 36 Anti-glaucoma ophthalmics Miotics, Cholinesterase Inhibitors Acetylcholine Carbachol Echothiophate Iodide Pilocarpine Recommend to continue cholinesterase inhibitors with the knowledge that adjustments to neuromuscular blocking drugs may be necessary. Alpha Adrenergic Agonists Apraclonidine Brimonidine Recommend to continue ophthalmic alpha adrenergic agonist, beta- adrenergic blocking agent (beta- blockers), carbonic anhydrase inhibitor docosanoid, synthetic, and prostaglandin analogue regimens throughout the perioperative period Beta-Adrenergic Blocking Agents (Beta-Blockers) Betaxolol Carteolol Levobunolol Metipranolol Timolol Carbonic Anhydrase Inhibitors Brinzolamide Dorzolamide Prostaglandin Analogues Bimatoprost Latanoprost Latanoprostene bunod Tafluprost Travoprost Rho kinase inhibitor Netarsudil Unoprostone Isopropyl Unoprostone Isopropyl Anti-histamines Peripherally selective Cetirizine Desloratadine Fexofenadine Loratadine Levocetirizine Recommend to continue regimen throughout the perioperative period Nonselective Brompheniramine Carbinoxamine Chlorcyclizine Chlorpheniramine Clemastine Cyproheptadine Dexbrompheniramine Dexchlorpheniramine Diphenhydramine Doxylamine Hydroxyzine Triprolidine Anti-hyperlipidemia agents (non-statins) Alirocumab Bempedoic acid Cholestyramine Colesevelam Colestipol Evolocumab Ezetimibe Fenofibrate Gemfibrozil Niacin Lomitapide Mipomersen Recommend to hold therapy 24 hours prior to surgery and day of surgery to reduce risk of rhabdomyolysis and gastrointestinal obstruction Statins (HMG-CoA Reductase Inhibitors) Statins Atorvastatin Fluvastatin Lovastatin Pravastatin Rosuvastatin Simvastatin Recommend to continue regimen throughout the perioperative period, particularly in patients at high risk for cardiovascular disease Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 37 Anti-infectives Amebicides Iodoquinol (Yodoxin) Active infection: Recommend to coordinate perioperative medication management plan with surgeon, anesthesiologist, and prescribing provider Infection Prophylaxis: Recommend to coordinate anti-infectives for prophylaxis indications with surgeon and prescribing provider Aminoglycosides (oral) Neomycin Paromomycin Aminoglycosides (parenteral) Amikacin Gentamicin Plazomicin Streptomycin Tobramycin Anthelmintics Albendazole (Albenza) Ivermectin (Stromectol) Moxidectin Praziquantel (Biltricide) Pyrantel (Pin-X) Triclabendazole Antibiotic Combinations Erythromycin/Sulfisoxazole Sulfamethoxazole/Trimethoprim Antifungal (Allylamine) Terbinafine Anidulafungin Caspofungin Flucytosine Griseofulvin Micafungin Ketoconazole Amphotericin B Nystatin Fluconazole Isavuconazonium Itraconazole Posaconazole Voriconazole Antimalarial Chloroquine Hydroxychloroquine Artemether/Lumefantri ne Atovaquone/Proguanil Primaquine Quinine sulfate Pyrimethamine Mefloquine Tafenoquine Antiprotozoals Atovaquone Miltefosine Nitazoxanide Pentamidine Tinidazole Antiretroviral agents Abacavir Atazanavir Bictegravir Cobicistat Darunavir Delavirdine Didanosine Dolutegravir Doravirine Efavirenz Elvitegravir Emtricitabine Enfuvirtide Etravirine Fosamprenavir Ibalizumab Indinavir Lamivudine Lopinavir Maraviroc Nefinavir Nevirapine Raltegravir Rilpivirine Ritonavir Saquinavir Stavudine Tenofovir Tipranavir Zidovudine Any antiretroviral combination product Antituberculosis Agents Aminosalicylic acid Benaquiline Capreomycin Cycloserine Ethambutol Ethionamide Isoniazid Pretomanid Pyrazinamide Rifabutin Rifampin Rifapentine Streptomycin Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 38 Antiviral Agents Adefovir Amantadine Acyclovir Baloxavir Boceprevir Cidofovir Daclatasvir Elbasvir/grazoprevir Entecavir Famciclovir Foscarnet Ganciclovir Glecaprevir/pibrentasv ir Ledipasvir/Sofosbuvir Letermovir Ombitasvir/Paritaprevi r/Ritonavir/Dasabuvir Oseltamivir Peramivir Ribavirin Rimantadine Simeprevir Sofosbuvir Tecovirimat Telaprevir Telbivudine Valacyclovir Valganciclovir Velpatasvir Voxilaprevir Zanamivir Active infection: Recommend to coordinate perioperative medication management plan with surgeon, anesthesiologist, and prescribing provider Infection Prophylaxis: Recommend to coordinate anti-infectives for prophylaxis indications with surgeon and prescribing provider Bacitracin Bacitracin Carbapenems Doripenem Ertapenem Imipenem/Cilastatin Meropenem Meropenem/vaborbact am Cephalosporins Cefaclor Cefadroxil Cefazolin Cefdinir Cefditoren Cefepime Cefiderocol Cefixime Cefotaxime Cefotetan Cefoxitin Cefpodoxime Cefprozil Ceftaroline Ceftazidime Ceftazidime/Avibacta m Ceftriaxone Cefuroxime Cephalexin Chloramphenicol Colistimethate Fluoroquinolones Ciprofloxacin Delafloxacin Gemifloxacin Levofloxacin Moxifloxacin Norfloxacin Ofloxacin (drops) Ozenoxacin Folate Antagonists Trimethoprim Glycylcylines Tigecycline Ketolides Telithromycin Leprostatics Dapsone Lincosamides Clindamycin Lincomycin Lipoglycopeptides Dalbavancin Oritavancin Telavancin Lipopeptides Daptomycin Macrolides Azithromycin Clarithromycin Erythromycin Fidaxomicin Methenamines Methenamine Hippurate Methenamine Mandelate Miscellaneous Benznidazole Fosfomycin Lefamulin Metronidazole Rifamycin Secnidazole Monobactams Aztreonam Monoclonal antibodies Bezlotoxumab Nitrofurans Nitrofurantoin Oxazolidinones Linezolid Tedizolid Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 39 Penicillins Amoxicillin Amoxicillin/Clavulanat e Ampicillin Ampicillin/sulbactam Dicloxacillin Nafcillin Oxacillin Penicillin G Penicillin V Piperacillin/Tazobacta m Ticarcillin/Clavulanate Active infection: Recommend to coordinate perioperative medication management plan with surgeon, anesthesiologist, and prescribing provider Infection Prophylaxis: Recommend to coordinate anti-infectives for prophylaxis indications with surgeon and prescribing provider Polymyxin B Sulfate Rifaximin Streptogramins Quinupristin/Dalfopristin Sulfadiazine Sulfadiazine Tetracyclines Demeclocycline Doxycycline Eravacycline Minocycline Omadacycline Sarecycline Tetracycline Vancomycin Vancomycin Anti-over active bladder agents Anticholinergic Oxybutynin It is reasonable to continue regimen throughout the perioperative period Muscarinic receptor antagonist Darifenacin Fesoterodine Solifenacin Tolterodine Trospium M3 muscarinic agonist Mirabegron Phosphodiesterase inhibitor Flavoxate Anti-neoplastics Alkylating Agents Altretamine Busulfan Carmustine Chlorambucil Dacarbazine Estramustine Ifosfamide Lomustine Mechlorethamine Melphalan Streptozocin Thiotepa Recommend to coordinate antineoplastic perioperative medication management plan with surgeon and prescribing provider Anthracenedione Mitoxantrone Antibody-Drug Conjugates ADO-Trastuzumab Brentuximab Vedotin Emtansine Enfortumab vedotin Fam-trastuzumab deruxtecan Polatuzumab vedotin Antimetabolites Allopurinol Capecitabine Cladribine Clofarabine Cytarabine Floxuridine Fludarabine Fluorouracil Gemcitabine Mercaptopurine Methotrexate Pemetrexed Pentostatin Pralatrexate Rasburicase Thioguanine Antimitotic agents Cabazitaxel Docetaxel Eribulin Ixabepilone Paclitaxel Vinblastine Vincristine Vinorelbine Antineoplastic Antibiotics Bleomycin Dactinomycin Daunorubicin Doxorubicin Epirubicin Idarubicin Mitomycin Valrubicin BCL-2 Inhibitor Venetoclax Biologic Response Modifiers Aldesleukin BCG live Cytoprotective Agents Amifostine Dexrazoxane Leucovorin Levoleucovorin Mesna Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 40 DNA Demethylation Agents Azacitidine Decitabine Nelarabine Recommend to coordinate antineoplastic perioperative medication management plan with surgeon and prescribing provider DNA Topoisomerase Inhibitors Irinotecan Topotecan Enzymes Asparaginase Calaspargase Pegaspargase Epipodophyllotoxin Etoposide Teniposide EZH2-Inhibitor Tazemetostat Histone Deacetylase Inhibitors Belinostat Panobinostat Romidepsin Vorinostat Hormones Abiraterone Anastrazole Apalutamide Bicalutamide Buserelin Darolutamide Enzalutamide Exemestane Flutamide Fulvestrant Goserelin Histelin Letrozole Leuprolide Medroxyprogesterone Megestrol Nilutamide Tamoxifen Toremifene Triptorelin Hedgehog Pathway Inhibitor Glasdegib Sonidegib Vismodegib Imidazotetrazine derivatives Temozolomide Kinase inhibitors Abemaciclib Acalabrutinib Afatinib Alectinib Alpelisib Axitinib Binimetinib Bosutinib Brigatinib Cabozantinib Ceritinib Cobimetinib Copanlisib Crizotinib Dabrafenib Dacomitinib Dasatinib Duvelisib Encorafenib Enasidenib Entrectinib Erdafitinib Erlotinib Everolimus Gefitinib Gilteritinib Ibrutinib Idelalisib Imatinib Ivosidenib Lapatinib Lenvatinib Lorlatinib Larotrectinib Midostaurin Neratinib Nilotinib Osimertinib Palbociclib Pazopanib Pexidartinib Ponatinib Regorafenib Ribociclib Ruxolitinib Sorafenib Sunitinib Temsirolimus Trametinib Vandetanib Vemurafenib Zanubrutinib Methylhydrazine derivatives Procarbazine Miscellaneous Antineoplastics Arsenic Trioxide Mitotane Porfimer Sipuleucel-T Sterile Talc Powder Trabectedin Trifluridine/tipiracil Monoclonal antibodies Alemtuzumab Atezolizumab Avapritinib Avelumab Bevacizumab (and biosimilars) Blinatumomab Ipilimumab Mogamuliziumab Moxetumomab Necitumumab Nivolumab Obinutuzumab Ofatumumab Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 41 Brolucizumab Cemiplimab Cetuximab Daratumumab Dinutuximab Elotuzumab Gemtuzumab Ibritumomab Inotuzumab Olaratumab Panitumumab Pertuzumab Ramucirumab Rituximab (and biosimilars) Tagraxofusp Trastuzumab (and biosimilars) Recommend to coordinate antineoplastic perioperative medication management plan with surgeon and prescribing provider PARP Enzymes Inhibitor Niraparib Olaparib Rucaparib Talazoparib Platinum Coordination Complex Carboplatin Cisplatin Oxaliplatin Proteasome Inhibitors Bortezomib Carfilzomib Ixazomib Protein Synthesis Inhibitor Omacetaxine Radiopharmaceutic als Lutetium Lu-177 Radium Ra-223 Samarium Sm-153 Sodium Iodide I-131 Strontium-89 Chloride Retinoids Tretinoin Trifarotene Rexinoids Bexarotene Substituted Ureas Hydroxyurea Vascular Endothelial Growth Factor ZIV-Aflibercept Anti-osteoporosis Agents Bisphosphonates Alendronate Etidronate Ibandronate Pamidronate Risedronate Tiludronate Zolendronic Acid Dental surgeries: Recommend to coordinate anti-osteoporosis perioperative medication management plan with surgeon and prescribing provider All other surgeries: Recommend to hold bisphosphonate therapy the day of surgery and postoperatively until directed to resume by surgeon and to coordinate perioperative calcitonin and denosumab medication management plan with surgeon and prescribing provider Calcitonin-salmon Calcitonin-salmon Denosumab Denosumab Romosozumab Romosozumab Anti-Parkinson’s Agents Antiparkinson agents Amantadine Apomorphine Belladonna alkaloids Benztropine Bromocriptine Carbidopa Carbidopa/Levodopa Carbidopa/Levodopa/E ntacapone Istradefylline Entacapone Pramipexole Rasagiline Ropinirole Rotigotine Selegiline Tolcapone Recommend to continue regimen throughout the perioperative period Anti-platelets Antiplatelet agents Anagrelide Dipyridamole Dipyridamole/Aspirin Cangrelor Cilostazol Clopidogrel Prasugrel Ticagrelor Ticlopidine Vorapaxar Recommend to coordinate perioperative medication management plan with surgeon, anesthesiologist, and prescribing provider (e.g. interventional Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 42 cardiologist, neurosurgeon, vascular surgeon) Anti-psychotics 1st generation – Typical Chlorpromazine Fluphenazine Haloperidol Loxapine Perphenazine Pimozide Prochlorperazine Thioridazine Thiothixene Trifluoperazine Recommend to continue regimen throughout the perioperative period 2nd generation – Atypical Aripiprazole Asenapine Brexpiprazole Cariprazine Clozapine Iloperidone Lumateperone Lurasidone Olanzapine Paliperidone Pimavanserin Quetiapine Risperidone Ziprasidone Antirheumatic Agents Janus associated kinase (JAK) inhibitors Baricitinib Fedratinib Ruxolitinib Tofacitinib Upadacitinib Orthopedic surgery: Recommend to hold therapy 48 hours prior to surgery and resume 7-14 days post- operatively if there are no signs or symptoms of infection and incisions are healing well All other surgeries: Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Antimetabolites Methotrexate Orthopedic surgery: Recommend to continue regimen throughout the perioperative period All other surgeries: Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Anti-TNF-alpha agents Adalimumab (and biosimilars) Certolizumab Etanercept (and biosimilars) Golimumab Infliximab (and biosimilars) Orthopedic surgery: Recommend to hold etanercept 2 weeks prior to surgery Orthopedic surgery: Recommend to coordinate all other anti-TNF-alpha agent perioperative medication management plan with surgeon and prescribing provider All other surgeries: Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Gold compounds Auranofin Gold sodium thiomalate Orthopedic surgery: Recommend to continue regimen throughout the perioperative period All other surgeries: Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 43 Interleukin-6 blockers Tocilizumab Orthopedic surgery: Recommend to • hold subcutaneous tocilizumab 3 weeks prior to surgery • hold intravenous tocilizumab 4 weeks prior to surgery All other surgeries: Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Interleukin-1 blockers Anakinra Orthopedic surgery: Recommend to hold subcutaneous anakinra 7 days prior to surgery All other surgeries: Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Phosphodiesterase -4 enzyme inhibitor Apremilast Orthopedic surgery: Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider All other surgeries: Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Pyrimidine synthesis inhibitors Leflunomide Orthopedic surgery: Recommend to hold 14 days prior to surgery All other surgeries: Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Selective T-cell costimulation blocker Abatacept Orthopedic surgery: Recommend to hold subcutaneous abatacept 2 weeks prior to surgery and intravenous abatacept 4 weeks prior to surgery All other surgeries: Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Beta-blockers Beta-Adrenergic Blocking Agents (Beta-Blockers) Acebutolol Atenolol Betaxolol Bisoprolol Esmolol Metoprolol Nadolol Nebivolol Penbutolol Pindolol Propranolol Sotalol Timolol Recommend to continue beta-blocker regimens throughout the perioperative period unless contraindicated by hemodynamic instability or profound bronchospasm Alpha/Beta- Adrenergic Blocking Agents Carvedilol Labetalol Benzodiazepines Benzodiazepines Alprazolam Chlordiazepoxide Clobazam Clonazepam Clorazepate Diazepam Lorazepam Oxazepam Recommend to continue regimen throughout the perioperative period Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 44 Calcium Channel Blockers Calcium channel blockers Amlodipine Clevidipine Diltiazem Felodipine Isradipine Nicardipine Nifedipine Nimodipine Nisoldipine Verapamil Recommend to continue regimen throughout the perioperative period Cardiovascular Agents – Miscellaneous Alpha1-Agonist Midodrine Recommend to continue regimen throughout the perioperative period Cardiac Glycoside Digoxin Recommend to continue regimen throughout the perioperative period Central Monoamine- Depleting Agent Deutetrabenazine Reserpine Tetrabenazine Valbenazine Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon and prescribing provider Cyclic nucleotide- gated (HCN) channels (f- channels) Ivabradine Recommend to continue regimen throughout the perioperative period Dopamine Agonist Fenoldopam Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon and prescribing provider Ganglionic Blocker Mecamylamine Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon and prescribing provider Inotropics Inamrinone Milrinone Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon and prescribing provider Inward sodium channel inhibitor Ranolazine Recommend to continue regimen throughout the perioperative period Potassium removing resins Patiromer Sodium polystyrene sulfonate Sodium zirconium cyclosilicate Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon and prescribing provider Transthyretin stabilizer Tafamidis Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon and prescribing provider Central Nervous System – Miscellaneous Antianxiety agent Buspirone Meprobamate Recommend to continue regimen throughout the perioperative period Antidepressants Bupropion Nefazodone hydrochloride Trazodone Vortioxetine Recommend coordination of perioperative medication management plan with surgeon, anesthesiologist, and prescribing provider Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 45 Anticholinesterase muscle stimulants Edrophonium Neostigmine Pyridostigmine Recommend coordination of perioperative medication management plan with surgeon, anesthesiologist, and prescribing provider Antioxidants Edaravone Recommend coordination of perioperative medication management plan with surgeon, anesthesiologist, and prescribing provider Antisense Oligonucleotide Eteplirsen Golodirsen Inotersen Nusinersin Recommend to coordinate antisense oligonucleotide management plan with anesthesiologist, surgeon, and prescribing provider Cholinergic muscle stimulant Guanidine Recommend coordination of perioperative medication management plan with surgeon, anesthesiologist, and prescribing provider CNS stimulants Amphetamine Armodafinil Caffeine Dexmethylphenidate Dextroamphetamine Doxapram Lisdexamfetamine Methamphetamine Methylphenidate Modafinil Armodafinil, Modafinil: Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider All other CNS stimulants: Recommend to continue regimen throughout the perioperative period Dopamine and Norepinephrine Reuptake Inhibitor Solriamfetol Recommend to coordinate perioperative management plan with anesthesiologist, surgeon, and prescribing provider Glutamate Inhibitor Riluzole Recommend to continue regimen throughout the perioperative period Lithium Lithium Recommend to continue regimen throughout the perioperative period Miscellaneous psychotherapeutic agents Atomoxetine Sodium oxybate Atomoxetine: Recommend to continue regimen throughout the perioperative period Pitolisant, Sodium oxybate: Recommend to coordinate perioperative management plan with anesthesiologist, surgeon, and prescribing provider Mixed 5HT1A agonist/5HT2A antagonist Flibanserin Recommend to coordinate perioperative management plan with anesthesiologist, surgeon, and prescribing provider NMDA Antagonist Esketamine Recommend to coordinate perioperative management plan with anesthesiologist, surgeon, and prescribing provider Partial neuronal α4 β2 nicotinic receptor agonist Varenicline Recommend to hold therapy the day of surgery and post-operatively until directed to resume by surgeon Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 46 Potassium Channel Blocker Amifampridine Dalfampridine Recommend to continue regimen throughout the perioperative period Tripeptidyl peptidase-1 (TPP- 1) analog Cerliponase alfa Recommend to coordinate perioperative management plan with anesthesiologist, surgeon, and prescribing provider Corticosteroid Corticosteroid Betamethasone Budesonide Cortisone Cosyntropin Deflazacort Dexamethasone Hydrocortisone Fludrocortisone Methylprednisolone Prednisolone Prednisone Triamcinolone Recommend to continue regimen throughout the perioperative period Diuretics Carbonic anhydrase inhibitors Acetazolamide Methazolamide Heart failure of volume overload indication: Recommend to coordinate diuretic perioperative management plan with anesthesiologist, surgeon, and prescribing provider Hypertension indication: Recommend to hold diuretic the day of surgery Diuretic Combinations Amiloride/Hydrochlorothiazide Spironolactone/ Hydrochlorothiazide Triamterene/ Hydrochlorothiazide Loop Diuretics Bumetanide Ethacrynic Acid Furosemide Torsemide Osmotic Mannitol Potassium Sparing Amiloride Spironolactone Triamterene Thiazides Chlorothiazide Chlorthalidone Hydrochlorothiazide Indapamide Methyclothiazide Metolazone Estrogens and Progestins – Miscellaneous Estrogen Conjugated Estrogens Ethinyl Estradiol Estradiol valerate Esterified Estrogens Estradiol Estradiol Cypionate Estropipate Recommend to coordinate perioperative management plan with surgeon, and prescribing provider Progestins Desogestrel Drospirenone Etonogestrel Ethynodiol Diacetate Hydroxyprogesterone caproate Levonorgestrel Medroxyprogesterone acetate Megestrol Acetate Norelgestromin Norgestimate Norgestrel Norethindrone Acetate Progesterone Segesterone Ulipristal Selective Estrogen Receptor Modulator Bazedoxifene Clomiphene Citrate Ospemifene Raloxifene Endocrine and Metabolic Agents – Miscellaneous 4- Hydroxyphenylpyru vate dioxygenase inhibitor Nitisinone It is reasonable continue regimen throughout the perioperative period. 5-Alpha Reductase Inhibitor Dutasteride Finasteride Anabolic Steroid Oxymetholone Androgens Danazol Oxandrolone Fluoxymesterone Methyltestosterone Testosterone Anti-androgen Cyproterone Dienogest Antithyroid Agents Methimazole Propylthiouracil Sodium Iodide Betaine Anhydrous Betaine Anhydrous Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 47 Bile Acids Cholic Acid Bromocriptine Mesylate Bromocriptine Mesylate Cabergoline Cabergoline Calcimimetics Cinacalcet Etelcalcetide Carglumic acid Carglumic acid Chelating Agent Deferasirox Deferiprone Deferoxamine Cysteamine Cysteamine Cystic fibrosis transmembrane conductance regulator potentiator Elexacaftor Ivacaftor Lumacaftor Tezacaftor Detoxification agents Dimercaprol Edetate Calcium Disodium Pentetate Calcium Trisodium Pentetate Zinc Trisodium Prussian Blue (Ferric Hexacyanoferrate) Succimer (DMSA) Trientine Hydrochloride Enzyme replacement Asfotase Agalsidase Beta Alglucosidase alfa Elosulfase alfa Galsulfase Idursulfase Imiglucerase Laronidase Sebelipase Taliglucerase Alfa Velaglucerase alfa Farnesoid X receptor agonist Obeticholic acid Glucosylceramide Synthase Inhibitor Eliglustat Miglustat Glycerol Phenylbutyrate Glycerol Phenylbutyrate Gonadotropin Releasing Hormone Agonist Nafarelin Gonadotropin Releasing Hormone Antagonist Cetrorelix Degarelix Elagolix Ganirelix Growth Hormone Somatropin Growth Hormone Agonists Macimorelin Insulin-like growth factor Mecasermin Lipodystrophy agents Metreleptin Tesamorelin Lipolytic Deoxycholic acid Ovulation Stimulator Choriogonadotropin Alfa Chorionic Gonadotropin Follitropin alfa Follitropin beta Lutropin Alpha Menotropins Urofollitropin Melanocortin receptor agonist Bremelanotide Parathyroid hormone analogues Abaloparatide Parathyroid Teriparatide Pegvisomant Pegvisomant Pharmacologic Chaperone Migalastat Phenylketonuria agents Sapropterin Dichloride Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 48 Phosphate Binders Lanthanum Sevelamer Posterior Pituitary Hormones Desmopressin Vasopressin Selective Estrogen Receptor Modulator Bazedoxifene Clomiphene Citrate Ospemifene Raloxifene Sodium Benzoate and Sodium Phenylacetate Sodium Benzoate and Sodium Phenylacetate Sodium Phenylbutyrate Sodium Phenylbutyrate Somatostatin Analogs Lanreotide Octreotide Pasireotide Thyroid Drugs Potassium Iodide Levothyroxine Sodium Liothyronine Sodium Liotrix Thyroid Desiccated Tryptophan hydroxylase inhibitors Telotristat Uridine Triacetate Uterine Active Agents Carboprost Dinoprostone Methylergonovine Maleate Mifepristone Oxytocin Vasopressin Receptor Antagonists Conivaptan Hydrochloride Tolvaptan Gastrointestinal Agents – Laxatives Bowel evacuants Polyethylene glycol (PEG) PEG-electrolyte combination Sodium phosphate Sodium phosphate/magnesium oxide/citric acid Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Bulk-producing laxatives Calcium polycarbophil Methylcellulose Psyllium Emollients Mineral oil Surfactants Docusate calcium Docusate sodium Hyperosmotic agents Glycerin Lactilol Lactulose Sorbitol Stimulants Bisacodyl Cascara sagrada Sennosides Gastrointestinal Agents – Miscellaneous 5-Aminosalicylic Acid Derivative Balsalazide Mesalamine Olsalazine Sulfasalazine Recommend to continue regimen throughout the perioperative period Antidiarrheals Bismuth subsalicylate Crofelemer Difenoxin/atropine Diphenoxylate/atropine Loperamide Loperamide/simethicone Bismuth subsalicylate: Recommend to hold bismuth subsalicylate the day of surgery due to the potential to cause black stools All other medications: It is reasonable to continue other antidiarrheals throughout the perioperative period Antiflatulents Alpha-d-galactosidase Simethicone Sucralfate: Recommend to hold sucralfate the day of surgery Antispasmodics Dicyclomine Belladonna alkaloids Atropine sulfate Hyoscyamine sulfate Scopolamine Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 49 Cholinergic Agonist Cevimeline Pilocarpine All other medications: Recommend to continue regimen throughout the perioperative period Chloride Channel Activator Lubiprostone Digestive Enzymes Pancreatic Enzymes Pancrelipase GI Anticholinergic Combinations Atropine/scopolamine/hyoscyamine/phenobarbit al Clidinium/chlordiazepoxide GI Quaternary Anticholinergics Glycopyrrolate Mepenzolate Methscopolamine Propantheline GI stimulants Dexpanthenol Metoclopramide Prucalopride Tegaserod GLP-2 analogs Teduglutide Glutamine L-glutamine Guanylate cyclase- C agonist Linaclotide Plecanatidecalci Miscellaneous Eluxadoline Sucralfate Chenodiol Ursodiol Alvimopan Methylnaltrexone Naloxegol Tenapanor Systemic Deodorizers Bismuth subgallate Chlorophyll derivatives Chlorophyllin Genitourinary and Renal Agents – Miscellaneous Cystine depleting agents Cysteamine bitartrate Penicillamine Tiopronin It is reasonable to continue regimen throughout the perioperative period Interstitial cystitis agents Dimethyl sulfoxide Pentosan polysulfate sodium Phenazopyridine Phenazopyridine/buta barbital/hyoscyamine Urinary acidifiers Ascorbic acid Urinary cholinergics Bethanechol Urinary alkalinizers Potassium citrate Sodium bicarbonate Sodium bicarbonate/citric acid (Shohl’s solution) Miscellaneous Acetohydroxamic acid Cellulose sodium phosphate Gout Agents β-tubulin polymerization inhibitor Colchicine Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Uric acid transporter-1 (URAT-1) inhibitor Lesinurad It is reasonable to continue regimen throughout the perioperative period Xanthine Oxidase Inhibitor Allopurinol Febuxostat It is reasonable to continue regimen throughout the perioperative period Recombinant urate- oxidase Pegloticase It is reasonable to continue regimen throughout the perioperative period Uricosurics Probenecid Recommend to hold therapy the day of surgery and postoperatively until directed to resume by surgeon Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 50 Hematological Agents – Miscellaneous For additional information, see Management of Antithrombotic Therapy in the Setting of Periprocedural, Regional Anesthesia and/or Pain Procedures Clinical Practice Guideline Antihemophilic agents Anti-inhibitor coagulant complex Antihemophilic Factor VIII Coagulation Factor XIIIa Factor IX Factor VIIa Factor XIII Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider Antihemophilic Factor Combinations Antihemophilic factor/von Willebrand Factor Complex Anti-von Willebrand Factor Caplacizumab Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider Antisickling agents Hydroxyurea Voxelotor Recommend to continue regimen in the perioperative period Bradykinin inhibitors Icatibant It is reasonable to continue regimen in the perioperative period Coagulants Protamine Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider Erythropoiesis- stimulating agents Darbepoetin and biosimilars Epoetin Alfa and biosimilars Epoetin Beta and biosimilars Methoxy Polyethylene Glycol-Beta It is reasonable to continue regimen in the perioperative period Hematopoietic stem cell mobilizer Plerixafor Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Granulocyte-colony stimulating factors Filgrastim (and biosimilars) Pegfilgrastim (and biosimilars) Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Granulocyte macrophage colony-stimulating factor Sargramostim Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Thrombopoietic agents Avatrombopag Eltrombopag Lusutrombopag Oprelvekin Romiplostim Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Porphyria Agents Hemin Givosiran Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider Hemorrheologic agents Pentoxifylline Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 51 Hemostatics Absorbable Gelatin Aminocaproic Acid Ferric subsulfate Fibrinogen Concentrate Microfibrillar Collagen Hemostat Oxidized Cellulose Prothrombin Complex Concentrate Thrombin Tranexamic Acid Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider Kallikrein Inhibitor Ecallantide Lanadelumab It is reasonable to continue regimen in the perioperative period Plasma expanders Albumin Human Dextran 40 Hetastarch Plasma Protein Fraction Tetrastarch It is reasonable to continue regimen in the perioperative period Protein C1 inhibitors C1 Inhibitor (Cinryze) Recommend to continue regimen in the perioperative period Thrombolytic agents Alteplase Defibrotide Protein C Concentrate Reteplase Tenecteplase Urokinase Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider Monoclonal Antibodies Crizanlizumab Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider Herbals and Supplements Amino Acids Levocarnitine L-Lysine Methionine Threonine Inborn errors of metabolism Recommend to coordinate use of supplements and perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider All other patients Recommend to hold herbals and supplements 7 days prior to surgery. Cannabidiol CBD oil, OTC or supplement; not including Epidiolex prescription for seizure management) Electrolytes Potassium Sodium Chloride Fish Oils Omega-3 Fatty Acids Lipotropics Choline Inositol Minerals Calcium Magnesium Phosphorus Systemic Alkalinizers Citric Acid Citrate Tromethamine Trace Elements Chromium Copper Fluoride Ferric Maltol Iron Manganese Selenium Zinc Vitamins Beta-Carotene Phytonadione (Vitamin K) Vitamin A Calcitriol Cholecalciferol Doxercalciferol Ergocalciferol Paricalcitol Vitamin E Aminobenzoate potassium Bioflavonoids Biotin Hydroxycobalamin Cobalamin (B12) Folic Acid Niacin (B3) Niacinamide Pantothenic Acid (B5) Pyridoxine (B6) Riboflavin (B2) Thiamine (B1) Ascorbic acid (Vitamin C) Calcium Ascorbate Sodium Ascorbate Miscellaneous Coenzyme Q10 Edavarone Lactase Sacrosidase Effective 8/10/2022. Contact CCKM@uwhealth.org for previous versions Copyright © 2022 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 52 Immunologic Agents Immunomodulators Abatacept Adalimumab (and biosimilars) Anakinra Apremilast Brodalumab Canakinumab Certolizumab Daclizumab Dimethyl Fumarate Diroximel Fumarate Etanercept (and biosimilars) Fingolimod Golimumab Guselkumab Infliximab (and biosimilars) Interferons Ixekizumab Lenalidomide Mitoxantrone Natalizumab Pembrolizumab Pomalidomide Rilonacept Secukinumab Selinexor Siponimod Risankizumab Teriflunomide Thalidomide Tildrakizumab Tocilizumab Ustekinumab Vedolizumab Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Immunostimulants Elapegdemase Pegademase Bovine Immunosuppressiv es Alefacept Azathioprine Basiliximab Belatacept Cyclosporine Dupilumab Durvalumab Glatiramer Mycophenolate Ocrelizumab Sirolimus Tacrolimus Keratinocyte Growth Factors Palifermin Miscellaneous Monoclonal Antibodies Belimumab Burosumab Denosumab Eculizumab Palivizumab Ravulizumab Raxibacumab Sarilumab Siltuximab Teprotumumab Intranasal anti-allergy Antihistamines Azelastine Olopatadine It is reasonable to continue regimen in the perioperative period Mast cell stabilizers Cromolyn Steroids Beclomethasone Budesonide Ciclesonide Flunisolide Fluticasone Mometasone Triamcinolone Migraine Agents Sympathomimetic Isometheptene Recommend to hold therapy the day of surgery, although may be approved with coordination of anesthesiologist Serotonin 5HT1B,1D Agonist (triptans) Almotriptan Eletriptan Frovatriptan Naratriptan Rizatriptan, Sumatriptan, Zolmitriptan Serotonin 5HT1F Agonist Lasmiditan Ergot Derivatives Dihydroergotamine mesylate Ergotamine tartrate Calcitonin Gene- related Peptide Receptor Antagonist Eptinezumab Erenumbe Fremanezumab Galcanezumab Rimegepant Ubrogepant Monoamine Oxidase Inhibitors Monoamine Oxidase Inhibitors (MAOI) Isocarboxazid Phenelzine Tranylcypromine Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 53 Ophthalmic Agents – Miscellaneous Cycloplegic Mydriatics Atropine Sulfate Cyclopentolate HCl Homatropine HBr Scopolamine HBr Tropicamide Cyclopentolate/Phenyl ephrine Hydroxyamphetamine Hydrobromide/Tropica mide Recommend to continue regimen throughout the perioperative period Antibiotics Azithromycin Bacitracin Besifloxacin Ciprofloxacin HCl Erythromycin Gatifloxacin Gentamicin Levofloxacin Moxifloxacin Ofloxacin Sulfacetamide Tobramycin Antihistamines Alcaftadine Azelastine HCl Emedastine difumarate Epinastine HCl Ketotifen Olopatadine HCl Corticosteroids Dexamethasone Difluprednate Fluocinolone acetonide Fluorometholone acetate Loteprednol etabonate Prednisolone Rimexolone Triamcinolone acetonide Decongestants Naphazoline HCl Oxymetazoline HCl Phenylephrine HCl Tetrahydrozoline HCl Decongestant/ Antihistamine Naphazoline/Pheniramine Immunologic Cyclosporine Mast Cell Stabilizer Bepotastine besilate Cromolyn Na Lodoxamide tromethamine Nedocromil Na Nonsteroidal Anti- Inflammatory Bromfenac Diclofenac Flurbiprofen Ketorolac Nepafenac Otic Preparations Misc. Antipyrine/Benzocaine Ciprofloxacin Ofloxacin Fluocinolone acetonide Ciprofloxacin HCl/Hydrocortisone Ciprofloxacin/Dexamethasone Neomycin/Polymyxin B/Hydrocortisone Recombinant Human Nerve Growth Factor Cenegermin Selective VEGF Antagonist Aflibercept Pegaptanib Na Ranibizumab Steroid/ Antibiotic Bacitracin/Neomycin/Polymyxin B/Hydrocortisone Dexamethasone/Tobramycin Loteprednol/Tobramycin Neomycin/Polymyxin B/Dexamethasone Neomycin/Polymyxin B/Hydrocortisone Sulfacetamide/Prednisolone Phosphodiesterase-5 enzyme inhibitors Phosphodiesterase -5 enzyme inhibitors Avanafil Sildenafil Tadalafil Vardenafil Taking for Pulmonary Arterial Hypertension (PAH) indication: Recommend to continue regimen throughout the perioperative period Taking for BPH Recommend to coordinate perioperative management plan with anesthesiologist, surgeon, and prescribing provider Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 54 Taking for other indications: Recommend to hold therapy five days prior to and the day of surgery in all patients Pheochromocytoma Agents Tyrosine Hydroxylase Inhibitor Metyrosine Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider Alpha1-Blocker Phenoxybenzamine HCL Phentolamine Mesylate Renin Angiotensin System Antagonists Angiotensin Converting Enzyme (ACE) Inhibitors Benazepril Captopril Cilazapril Enalapril Enalaprilat Fosinopril Lisinopril Moexipril Perindopril Quinapril Ramipril Trandolapril Significant Heart Failure (American College of Cardiology Foundation/American Heart Association (ACCF/AHA) heart failure staging system Stage D, or New York Heart Association (NYHA) Functional Classification III or IV) or History of High Blood Pressure (systolic ≥180 mmHg or diastolic ≥120 mmHg): Recommend to coordinate perioperative medication management plan with anesthesiologist, prescribing provider For all other indications: Hold for 24 hours prior to surgery and the day of surgery Angiotensin II receptor blockers Candesartan Losartan Olmesartan Valsartan Direct renin inhibitors Aliskiren Neprilysin inhibitor Sacubitril Recommend to coordinate perioperative medication management plan with anesthesiologist, prescribing provider Selective Aldosterone Receptor Antagonists Eplerenone It is reasonable to continue regimen throughout the perioperative period Respiratory Agents Antifibrotic agents Pirfenidone Recommend to coordinate perioperative medication management plan with surgeon and prescribing provider Arylalkylamine decongestants Phenylephrine Pseudoephedrine Recommend to hold therapy the day of surgery Inhaled anticholinergics Aclidinium Ipratropium Revefenacin Tiotropium Umeclidinium Recommend to continue regimen throughout the perioperative period and to administer on the morning of surgery Expectorants Guaifenesin Potassium iodide It is reasonable to continue regimen throughout the perioperative period Inhaled corticosteroids Beclomethasone Budesonide Ciclesonide Flunisolide Fluticasone Mometasone Recommend to continue regimen throughout the perioperative period Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 55 Inhaled sympathomimetics Albuterol Arformoterol Ephedrine Epinephrine Formoterol Indacaterol Isoproterenol Levalbuterol Metaproterenol Olodaterol Pirbuterol Salmeterol Terbutaline Vilanterol Recommend to continue regimen throughout the perioperative period and to administer on the morning of surgery Interleukin-5 receptor antagonists Mepolizumab Reslizumab Recommend to continue regimen throughout the perioperative period Leukotriene modifiers Montelukast Zafirlukast Zileuton Recommend to continue regimen throughout the perioperative period and administer on the morning of surgery Lung surfactants Beractant Calfactant Lucinactant Poractant It is reasonable to continue regimen throughout the perioperative period Monoclonal antibodies (IgE inhibitor) Omalizumab Recommend to continue regimen throughout the perioperative period Mucolytics Acetylcysteine Dornase alfa Recommend to continue regimen throughout the perioperative period Non-narcotic antitussives Benzonatate Dextromethorphan It is reasonable to continue regimen throughout the perioperative period PDE-4 inhibitor Roflumilast Recommend to continue regimen throughout the perioperative period Respiratory enzymes Aplha1-proteinase inhibitor Recommend to continue regimen throughout the perioperative period Tyrosine kinase inhibitor Fostamatinib Nintedanib Recommend to continue regimen throughout the perioperative period Xanthine derivatives Aminophylline Dyphylline Theophylline Recommend to coordinate perioperative medication management plan with anesthesiologist, surgeon, and prescribing provider Sedatives and Hypnotics Sedatives and hypnotics Amobarbital Butabarbital Pentobarbital Phenobarbital Secobarbital Recommend to coordinate perioperative medication management plan with anesthesiologist, and prescribing provider Nonbarbiturate sedatives and hypnotics Chloral hydrate Dexmedetomidine Eszopiclone Lemborexant Ramelteon Suvorexant Tasimelteon Zaleplon Zolpidem Effective 8/10/2022. 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Contact: CCKM@uwhealth.org Last Revised: 08/2022 56 Selective Serotonin Reuptake Inhibitors (SSRIs) & Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) SSRI Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline Vilazodone Recommend to coordinate perioperative medication management plan with surgeon, anesthesiologist, and prescribing provider SNRI Desvenlafaxine Duloxetine Levomilnacipran Milnacipran Venlafaxine Skeletal Muscle Relaxants Direct acting Dantrolene Recommend to continue regimen throughout the perioperative period Centrally acting Baclofen Carisoprodol Chlorzoxazone Cyclobenzaprine Diazepam Metaxalone Methocarbamol Orphenadrine Tizanidine It is reasonable to continue regimen throughout the perioperative period Tetra-cyclic antidepressants Tetra-cyclic antidepressants Maprotiline Mirtazapine It is reasonable to continue regimen throughout the perioperative period Toxins Botulinum toxins: Type A AbobotulinumtoxinA IncobotulinumtoxinA OnabotulinumtoxinA PrabotulinumtoxinA It is reasonable to hold 48 hours prior to surgery and not resume until approved by surgeon Type B toxin Rimabotulinum toxin B Tri-cyclic antidepressants Tricyclic antidepressants Amitriptyline Amoxapine Clomipramine Desipramine Doxepin Imipramine Nortriptyline Protriptyline Trimipramine It is reasonable to continue regimen throughout the perioperative period Vasodilators Endothelin Receptor Antagonist Ambrisentan Bosentan Macitentan Recommend to continue regimen throughout the perioperative period Human B-Type Natriuretic Peptide Nesiritide Recommend to continue regimen throughout the perioperative period Nitrates Amyl Nitrate Isosorbide Dinitrate Isosorbide Mononitrate Nitroglycerin Recommend to continue regimen throughout the perioperative period Peripheral Vasodilators Hydralazine Isoxsuprine Minoxidil Papaverine Recommend to coordinate perioperative medication management plan with surgeon, anesthesiologist and prescribing provider Prostanoids Epoprostenol Iloprost Selexipag Treprostinil Recommend to coordinate perioperative medication management plan with surgeon, anesthesiologist and prescribing provider Soluble Guanylate Cyclase Stimulator Riociguat Recommend to coordinate perioperative medication management plan with surgeon, anesthesiologist and prescribing provider Effective 8/10/2022. Contact CCKM@uwhealth.org for previous versions Copyright © 2022 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 08/2022 57 Vasopressors Angiotensin II Dobutamine Dopamine Droxidopa Ephedrine Epinephrine Isoproterenol Norepinephrine Phenylephrine Recommend to coordinate perioperative medication management plan with surgeon, anesthesiologist and prescribing provider Effective 8/10/2022. Contact CCKM@uwhealth.org for previous versions Copyright © 2022 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 08/2022 Appendix A: Perioperative Medication Management