From the Guidelines
You should stop taking Echinacea at least 2 weeks before undergoing surgery. The use of complementary medicines like Echinacea poses a challenge to clinicians in the perioperative period and may increase perioperative risk 1. Echinacea has properties that may affect your immune system and potentially interfere with anesthesia medications or increase bleeding risk during surgery. It might also interact with medications commonly used during the perioperative period 1. This herb can alter how your liver processes certain drugs, potentially changing their effectiveness or increasing side effects.
Key Considerations
- Always inform your surgeon and anesthesiologist about all supplements you take, including Echinacea, during your pre-operative consultation 1.
- They may provide specific guidance based on your individual health situation and the type of surgery planned.
- After surgery, consult with your healthcare provider before resuming Echinacea to ensure it won't interfere with your healing process or any post-surgical medications you're taking.
Perioperative Risk
The American Society of Anesthesiology recommends that dietary supplements be discontinued 1 to 2 weeks before surgery out of maximal precaution 1. Bleeding complications attributable to dietary supplements may have several mechanisms, including alteration in platelet activation and interaction with components of the coagulation cascade 1.
Patient Education
Discussion with patients in the preoperative visit is a crucial time to educate patients as well as gather vital information 1. Patients should be specifically asked about use of dietary supplements and cannabinoids, as many will not volunteer this information 1. The preoperative clinic visit provides the best opportunity to educate patients about the perioperative management of various supplements as this visit is typically scheduled at least 2 weeks before the planned procedure 1.
From the Research
Echinacea and Surgery
- The use of Echinacea, a popular herbal supplement, has been studied in the context of surgery, with a focus on potential adverse interactions with anesthetic medications and other drugs administered during surgery 2, 3, 4, 5, 6.
- Studies have shown that Echinacea can increase the risk of perioperative bleeding, interact with the cardiovascular system, and affect the central nervous system, among other potential adverse effects 2, 3, 4, 5.
- The American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) recommend stopping herbal medications, including Echinacea, 1-2 weeks before elective surgical procedures to minimize potential adverse interactions 2.
- A review of the literature found that Echinacea is loosely associated with surgical bleeding independent of anticoagulants, and that physicians should be aware of the potential anticoagulant effects of herbal supplements, including Echinacea 4.
- It is essential for patients to disclose their use of herbal medications, including Echinacea, to their physicians before surgery, and for physicians to inquire about the use of these medications during preoperative evaluation 2, 3, 6.
Preoperative Considerations
- Patients taking Echinacea should be advised to discontinue its use 1-2 weeks before surgery to minimize potential adverse interactions 2, 3.
- A retrospective review of surgery patients found that approximately one-fourth of patients used natural products, including Echinacea, and that these patients were more likely to be older and taking multiple medications 6.
- The study highlights the need for established guidelines regarding the discontinuation of selected natural products, including Echinacea, prior to surgery, and for further education on the perioperative implications of these products 6.
Potential Adverse Effects
- Echinacea can cause hepatotoxicity if used beyond 8 weeks, and should not be used with other known hepatotoxic drugs 5.
- Echinacea can also interact with other medications, including immunosuppressants, and should not be given with these medications 5.
- The potential adverse effects of Echinacea, including increased bleeding tendencies and drug interactions, should be carefully considered in the preoperative period 2, 3, 4, 5.