Understanding What Meds Should You Not Take Before Cataract Surgery?

October 7, 2025 •

4 min read

As a significant portion of the population undergoes cataract surgery annually, understanding pre-operative medication management is critical for safety and a successful outcome. Knowing what meds should you not take before cataract surgery can help prevent serious complications, such as excessive bleeding or complications related to anesthesia.

Quick Summary

A guide on medications to temporarily suspend before cataract surgery, including blood thinners, certain alpha-blockers for prostate issues, and herbal supplements, due to risks like bleeding, floppy iris syndrome, and drug interactions.

Key Points

Report all medications: Provide your ophthalmologist with a complete list of all medications, over-the-counter drugs, and supplements you take before your consultation.
Blood thinners require coordination: Stopping blood thinners like aspirin or warfarin depends on your overall health and the type of surgery, and requires coordination between your eye surgeon and prescribing doctor.
Alpha-blockers can cause IFIS: Inform your surgeon if you take or have taken alpha-blocker medications like Flomax, as they can cause Intraoperative Floppy Iris Syndrome (IFIS) during surgery, though stopping them is often not necessary.
Adjust diabetes meds due to fasting: Expect to adjust or skip your diabetes medication on the morning of surgery due to fasting requirements to prevent low blood sugar.
Avoid certain supplements: Discontinue supplements with blood-thinning properties, such as fish oil, Vitamin E, and ginkgo biloba, 7-10 days before surgery.

Navigating Pre-Operative Medication Protocols

Before undergoing cataract surgery, your eye surgeon and other physicians will provide specific instructions on which medications to stop, continue, or modify. This is crucial to minimize risks, ensure the procedure goes smoothly, and support a speedy recovery. While cataract surgery is generally a low-risk procedure, certain medications can increase the potential for complications like bleeding or complications related to anesthesia.

Blood Thinners and Antiplatelet Medications

For many patients, especially older individuals with pre-existing health conditions, managing blood-thinning medications before surgery is a major concern. These medications work by preventing blood clots, but they can also increase the risk of bleeding during surgery.

Aspirin and NSAIDs: Most ophthalmologists advise stopping nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve) for 7 to 10 days before surgery. However, some surgeons may permit low-dose aspirin to continue for certain high-risk patients, a decision made in consultation with the patient's cardiologist or primary care physician.
Prescription Anticoagulants: Medications like warfarin (Coumadin) and newer direct oral anticoagulants (DOACs) such as apixaban (Eliquis) and rivaroxaban (Xarelto) must be managed carefully. Your eye surgeon will collaborate with the prescribing doctor to determine if and when these need to be stopped. For most routine cataract surgeries, continuing these medications is often considered safe, but this is a decision made on a case-by-case basis.
Clopidogrel (Plavix): Similar to other antiplatelets, the decision to stop Plavix should be made in close consultation with your eye surgeon and cardiologist, as the risk of bleeding must be weighed against the risk of a blood clot.

Alpha-Blockers and Intraoperative Floppy Iris Syndrome (IFIS)

Alpha-blocker medications, commonly prescribed for benign prostatic hyperplasia (BPH) and high blood pressure, pose a unique challenge during cataract surgery.

What is IFIS? These drugs can cause a condition called Intraoperative Floppy Iris Syndrome (IFIS), characterized by poor pupil dilation, a billowing iris, and the pupil constricting during the procedure. IFIS can make surgery more difficult and increase the risk of complications.
Key Medications: Tamsulosin (Flomax) is most commonly associated with IFIS, but other alpha-blockers like alfuzosin (Uroxatral), terazosin (Hytrin), and doxazosin (Cardura) are also implicated.
What to do: It is important to inform your ophthalmologist if you are currently taking or have ever taken any alpha-blocker medication, as the effects can be long-lasting. The medication often does not need to be stopped, but knowing about it allows the surgeon to adapt their surgical technique to prevent or manage IFIS.

Diabetes Medications and Blood Sugar Management

Properly managing diabetes medications is essential to avoid hypoglycemia (low blood sugar) due to pre-operative fasting.

Oral Medications: Many oral diabetic medications should be withheld on the morning of surgery because you will be fasting and not eating. Taking them on an empty stomach can cause blood sugar levels to drop dangerously low.
Insulin: Depending on the type and timing of your surgery, insulin doses need to be carefully adjusted. Your doctor might instruct you to take only half of your long-acting insulin dose the morning of surgery and to skip any short-acting insulin. Your surgical team will monitor your blood sugar and administer insulin intravenously if needed during the procedure.

Herbal Supplements, Vitamins, and Over-the-Counter Products

Many seemingly harmless over-the-counter and herbal products can interfere with surgery.

Blood-Thinning Supplements: Fish oil (omega-3 fatty acids), vitamin E, garlic, ginger, and ginkgo biloba all have blood-thinning properties and should be discontinued 7-10 days before surgery.
Herbal Supplements: Other products like St. John's Wort and ginseng can interact with anesthesia.
Multi-Vitamins: It is often recommended to stop taking multivitamins in the week leading up to surgery, as they can contain ingredients that affect blood clotting.

Comparison Table: Key Medications Before Cataract Surgery


Medication Type	Examples	Reason for Concern	Typical Pre-Op Guidance
Blood Thinners / Antiplatelets	Warfarin (Coumadin), Clopidogrel (Plavix), Apixaban (Eliquis), Aspirin, NSAIDs (Ibuprofen)	Increased risk of bleeding, although rare in modern cataract surgery. For combined glaucoma procedures, the risk is higher.	For aspirin/NSAIDs, often stopped 7-10 days prior. For prescription blood thinners, continuation is often possible, but requires consultation with the prescribing physician.
Alpha-Blockers	Tamsulosin (Flomax), Alfuzosin (Uroxatral), Terazosin (Hytrin)	Can cause Intraoperative Floppy Iris Syndrome (IFIS), making surgery more complex.	Do not stop without consulting your ophthalmologist. Inform them about current or past use so they can adapt the surgical technique.
Diabetes Medications	Oral agents, Short-acting Insulin	Risk of hypoglycemia (low blood sugar) due to fasting requirements.	Hold oral medications and fast-acting insulin on the morning of surgery. Long-acting insulin may be adjusted.
Herbal Supplements / Vitamins	Fish Oil, Vitamin E, Garlic, Ginseng, Gingko Biloba	Potential blood-thinning effects and interaction with anesthesia.	Stop 7-10 days before surgery.

Communicating with Your Medical Team

Always have a complete list of your medications, including prescription drugs, over-the-counter products, and supplements, to discuss with your eye surgeon and primary care physician. Do not make any changes to your medication regimen without explicit instruction from a medical professional. Your surgical team will provide a personalized plan based on your overall health and specific medication needs. For more details on preparation, check the general instructions available on many clinic websites, such as this guide from Kaiser Permanente.

Conclusion: Planning for a Successful Surgery

In preparation for cataract surgery, discontinuing certain medications is a critical step to ensure a complication-free procedure and recovery. By understanding which medications to avoid—specifically blood thinners, certain alpha-blockers, and selected supplements—and discussing these with your healthcare team, you can manage the risks effectively. A coordinated approach between your ophthalmologist, primary care doctor, and other specialists is the best way to safeguard your health and achieve the best possible visual outcome.

Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider regarding your personal health and treatment plan.

Frequently Asked Questions

Yes, in many cases. Your surgeon will likely instruct you to stop taking aspirin, along with other nonsteroidal anti-inflammatory drugs (NSAIDs), for week or two before the procedure to minimize bleeding risk. However, this depends on your personal health risks, and the decision should be made in consultation with your doctor.

For most routine cataract surgeries using modern techniques, continuing oral anticoagulants like Eliquis or Xarelto may be possible with your doctor's approval. For complex cases or combined procedures (like glaucoma surgery), you may need to temporarily stop. The decision is made by your eye surgeon and prescribing physician.

You should not stop taking Flomax or other alpha-blockers without consulting your ophthalmologist. These medications can cause Intraoperative Floppy Iris Syndrome (IFIS) but informing your surgeon is more important than stopping the medication, as the effects can be permanent. The surgeon can then use modified techniques.

You will likely be told to skip any oral diabetes medication and fast-acting insulin on the morning of surgery. For long-acting insulin, the dose may be reduced. These adjustments are necessary to prevent low blood sugar (hypoglycemia) due to pre-operative fasting.

Yes. Herbal and vitamin supplements that have blood-thinning properties should be stopped 7 to 10 days before surgery. Common examples include fish oil, vitamin E, garlic, ginseng, and ginkgo biloba.

Medications can cause issues for several reasons. Blood thinners increase the risk of bleeding. Alpha-blockers interfere with the muscles controlling the iris, causing it to become floppy and constrict during the procedure (IFIS). Some supplements can thin the blood or interact negatively with anesthesia.

Most patients are advised to continue taking their blood pressure and cholesterol medications as usual, even on the morning of surgery, with a small sip of water. However, always follow your doctor's specific instructions.