How to hold meds before a colonoscopy?

Which meds need to be held before colonoscopy.

Most meds can be taken with a sip of water about 3 hours before the procedure…including low-dose aspirin or NSAIDs.

For others, work with your pharmacist or doctor and consider some rules of thumb.

Anticoagulants. In general, suggest holding warfarin 5 days before the procedure…or direct oral anticoagulants (DOACs), such as Pradaxa (dabigatran), one to 2 days before in patients with normal renal function.

Most warfarin patients don’t need to be “bridged” with low-molecular-weight heparin (enoxaparin, etc) unless their clot risk is high.

Antiplatelets. Suggest holding clopidogrel or Effient (prasugrel) at least 5 to 7 days before…or Brilinta (ticagrelor) 3 to 5 days before. Platelets recover more quickly after stopping Brilinta.

Anticoagulants OR antiplatelets can usually be restarted right away if polyps are NOT removed. (After polypectomy, consider restarting DOACs 48 to 72 hrs afterward, and warfarin about 12 hrs after (if bleeding not ongoing), weighing thromboembolism vs bleeding risk. Consider restarting anticoagulants right after procedure if polyps are not removed and patient not at high risk of bleeding.)

If polyps are removed, suggest resuming warfarin about 12 hrs after the procedure…antiplatelets 24 hrs after…and DOACs 48 to 72 hrs after.

Diabetes meds. Consider glucose control, dietary intake, and whether the patient has type 1 or type 2 diabetes. Keep in mind, patients will be on a clear liquid diet the day before the colonoscopy procedure.

On the day PRIOR to the colonoscopy, suggest holding sulfonylureas.

Consider taking half of premixed insulin doses the day prior colonoscopy. And suggest taking usual basal insulin doses…or halving the PM dose.

All other diabetes meds can be continued as usual the day prior.

On the morning of the procedure, generally suggest holding diabetes meds. But suggest continuing some basal insulin…especially in patients with type 1 diabetes.

If you are counting count carbs, take mealtime insulin as usual the day before. Otherwise, take giving half the normal dose.

Stop oral iron (due to constipating effect and stool discoloration) and supplements (e.g., fish oil, ginkgo, garlic, and herbals due to bleeding risk, interactions with anesthesia, or unknown risks) five to seven days prior to colonoscopy.