Perioperative Management of Buspar and Adderall
Adderall can be safely continued through surgery, while Buspar (buspirone) can also be continued without interruption before surgery. 1
Adderall (amphetamine and dextroamphetamine)
Recommendation
- Continue Adderall through the perioperative period, including the morning of surgery 2
- There is no need to stop Adderall before surgery based on current evidence
Rationale
- The 2021 Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement does not recommend discontinuing amphetamines preoperatively 1
- Research specifically examining patients on chronic prescription amphetamines showed they underwent general anesthesia safely without stopping their medication 2
- Concerns about catecholamine depletion and cardiovascular instability have not been substantiated in clinical studies 2
Precautions
- Anesthesiologists should be informed about Adderall use as there is a potential risk of:
- Interaction with butorphanol or nalbuphine, which may increase risk of serotonin syndrome 1
- Possible interaction with other serotonergic medications used during surgery
Buspar (buspirone)
Recommendation
- Continue Buspar (buspirone) through the perioperative period, including the morning of surgery
- No specific recommendation to discontinue buspirone appears in the SPAQI consensus statement 1
Rationale
- Buspirone works primarily through 5-HT1A receptors with a complex mechanism of action 3
- Unlike benzodiazepines, buspirone:
- Lacks anticonvulsant and muscle-relaxant properties
- Causes minimal sedation
- Has not been associated with abuse, dependence, or withdrawal symptoms 3
- Has a short half-life (2.1 hours) with its active metabolite having a half-life of 6.1 hours 3
Precautions
- Monitor for potential side effects including headaches, dizziness, nervousness, and lightheadedness 3
- Be aware of buspirone's pharmacology when considering other perioperative medications that affect serotonergic systems
Important Considerations for Both Medications
- Inform the anesthesiologist about all medications the patient is taking
- If the patient has been taking either medication long-term, abrupt discontinuation could potentially lead to withdrawal symptoms or exacerbation of the underlying condition
- For patients taking both medications, be aware of potential serotonergic effects when combined with other perioperative medications
Contrast with Other Medications Requiring Discontinuation
Unlike these medications that can be continued, certain other medications do require preoperative discontinuation:
- Ergotamine: Hold at least 2 days prior to operation 1
- Butalbital: Should be held but requires careful management if used long-term 1
- Naltrexone: Should be held 3-4 days before surgery (oral) or 24-30 days (intramuscular) 1
This evidence-based approach ensures patient safety while avoiding unnecessary medication disruption that could lead to withdrawal or symptom recurrence.