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CLINICIAN REFERENCE

Dietary supplements / herbal products

Medication reconciliation includes supplements and herbal products, their ingredients and doses. Ayurvedic, bodybuilding and weight-loss products, as well as vitamins, are relevant to this review.

Why this matters

Supplement use is common and frequently not volunteered, because patients may not consider these products to be medicines. Multi-ingredient products require particular attention because their contents may be uncertain. Product quality and labelling can vary.

Mechanisms to consider

Potential effects on bleeding, haemodynamics, sedation, glucose control and prescribed medicines inform assessment. The SPAQI consensus considers 83 supplements individually. Its recommendations distinguish products that may be continued from those for which interruption is advised. An early preoperative review allows time to clarify ingredients and agree a plan; a two-week review window is not a universal two-week stopping rule.

  • Bleeding or platelet effects have been discussed for products such as garlic supplements, ginkgo and high-dose vitamin E, but the strength of evidence and clinical relevance vary by product, dose and concurrent medicines.
  • Enzyme induction and drug interactions: St John’s wort
  • Sedation or interaction with anaesthetic agents: kava, valerian
  • Glucose lowering: ginseng and some traditional glucose-lowering preparations
  • Sympathomimetic effects: ephedra-containing and some pre-workout or weight-loss products

These examples identify questions for review rather than proving that every listed product causes a perioperative complication. Fish oil is not grouped here as an established reason to interrupt treatment: in the OPERA cardiac-surgery trial, fish oil did not increase perioperative bleeding. That finding applies to the studied products and population and does not replace assessment of other ingredients or concurrent antithrombotics.

Practical application

  • Direct questions about Ayurvedic, Siddha, Unani, homeopathic, bodybuilding and weight-loss products can identify use that might otherwise be missed.
  • Packaging or a photograph of the ingredients label may help identify the product.
  • Useful records include the product name, known ingredients, dose and duration of use.
  • Pharmacist input may be useful for unfamiliar or multi-ingredient products.
  • For products prescribed for a medical condition, discussion with the usual practitioner can help assess the consequences of interruption.
  • In urgent surgery, recording recent exposure can inform assessment of possible bleeding, regional-anaesthesia and drug-interaction concerns.

Decisions about interruption depend on product-specific evidence and local guidance. There is no single evidence-based stop interval that can safely be applied to every supplement. The SPAQI table gives the agent-specific recommendation where one exists.

Sources