From the Guidelines
You should not stop Abilify and Zoloft without consulting your surgeon and psychiatrist before knee replacement surgery, as abruptly stopping these medications can lead to withdrawal symptoms or worsening of the underlying mental health condition. When considering the management of psychiatric medications like Abilify (aripiprazole) and Zoloft (sertraline) in the context of surgery, it's crucial to weigh the risks of discontinuation against the potential benefits 1.
Medication Considerations
- Zoloft, an SSRI, may have a discontinuation syndrome characterized by various symptoms such as dizziness, fatigue, and anxiety if stopped abruptly 1.
- Abilify, an antipsychotic, does not have a well-documented discontinuation syndrome but stopping it could lead to a relapse of the underlying psychiatric condition.
- The risk of serotonin syndrome, a potentially life-threatening condition, is a concern when combining certain medications, including SSRIs like Zoloft with other serotonergic agents 1.
Surgical Considerations
- Zoloft may slightly increase the risk of bleeding during surgery, although this risk is generally considered low [no direct evidence from (1) but a consideration in surgical contexts].
- Abilify does not typically interfere with anesthesia or surgical outcomes, but it's essential for the surgical team to be aware of all medications to monitor for potential drug interactions 1.
Recommendation
Given the potential risks associated with stopping these medications and the lack of strong evidence suggesting a need to discontinue them before surgery, it is generally recommended to continue Abilify and Zoloft up to and including the day of knee replacement surgery, under the guidance of your healthcare providers. Your surgical team and psychiatrist should be consulted to make an informed decision based on your specific medical history and the requirements of your procedure 1.
From the Research
Medication Considerations for Knee Replacement Surgery
- Abilify (an antipsychotic) and Zoloft (a selective serotonin reuptake inhibitor, SSRI) are two medications that may be considered for discontinuation before knee replacement surgery.
- According to a study on the effects of perioperative SSRI use in primary total hip and knee arthroplasty 2, patients on SSRIs have lower preoperative baseline functional scores and are associated with increased adverse events, including needing a blood transfusion.
- However, the study does not specifically address the need to discontinue Abilify and Zoloft before knee replacement surgery.
- Another study on switching and stopping antidepressants 3 suggests that antidepressants, including SSRIs like Zoloft, can cause withdrawal syndromes if discontinued abruptly after prolonged use, and gradual dose reduction over days to weeks reduces the risk and severity of complications.
Knee Replacement Surgery Considerations
- Knee replacement surgery is a common and cost-effective procedure for treating painful knee osteoarthritis 4.
- The decision to undergo knee replacement surgery involves consideration of various factors, including patient and surgeon preference, and the threshold for intervention is not well defined 4.
- Preoperative magnetic resonance imaging (MRI) can play a role in surgical decision-making for total versus medial unicompartmental knee arthroplasty 5.
- However, none of the studies provide direct evidence on the need to discontinue Abilify and Zoloft before knee replacement surgery.
Thromboprophylaxis Considerations
- A study on apixaban or enoxaparin for thromboprophylaxis after knee replacement 6 found that apixaban did not meet the prespecified statistical criteria for noninferiority, but its use was associated with lower rates of clinically relevant bleeding.
- However, this study does not address the consideration of discontinuing Abilify and Zoloft before knee replacement surgery.