Is Keflex (Cephalexin) safe to take after open heart surgery while on SGLT2 inhibitors, Valsartan/Sacubitril, Spironolactone, Clopidogrel, Beta-blockers, and Statins?

Keflex Safety Post-Open Heart Surgery with Current Cardiac Medications

Keflex (cephalexin) is safe to use after open heart surgery in patients taking SGLT2 inhibitors, valsartan/sacubitril, spironolactone, clopidogrel, beta-blockers, and statins, as there are no clinically significant drug interactions between cephalexin and these cardiac medications. 1

Antibiotic Safety Profile

• Cephalosporins, including Keflex, are recommended as first-line prophylactic antibiotics in cardiac surgery, with second- or third-generation cephalosporins showing superior outcomes for surgical site infection prevention. 1
• Cephalexin has no documented interactions with any of the cardiac medications in your regimen and can be safely administered in the post-cardiac surgery setting. 1

Critical Medication Management Considerations Post-Cardiac Surgery

SGLT2 Inhibitor Management (Most Important)

Your SGLT2 inhibitor should have been discontinued 3-4 days before surgery and should NOT be restarted immediately post-operatively. 2, 3, 4

• Do not restart the SGLT2 inhibitor until you are eating and drinking normally (typically 24-48 hours post-surgery) AND capillary ketones are <0.6 mmol/L. 4
• The risk of euglycemic diabetic ketoacidosis (euDKA) persists even after surgery, with blood glucose appearing normal (<250 mg/dL) despite dangerous metabolic acidosis. 2, 4
• Emergency or urgent cardiac surgery carries a higher ketoacidosis risk (1.1%) compared to elective procedures (0.17%). 3, 4

Valsartan/Sacubitril (Entresto) Management

Continue valsartan/sacubitril as soon as clinically feasible post-operatively, as this medication reduces mortality and morbidity in heart failure patients. 2

• This medication should be restarted promptly once hemodynamic stability is achieved and you can take oral medications. 2
• Temporary perioperative hypotension may occur but does not contraindicate continuation of therapy. 2
• The combination with beta-blockers provides synergistic mortality benefit in heart failure with reduced ejection fraction. 5, 6

Spironolactone (Aldosterone Antagonist)

Continue spironolactone perioperatively unless contraindicated by acute kidney injury or severe hyperkalemia. 2

• Mineralocorticoid antagonists are life-saving therapies in heart failure and should be maintained throughout the perioperative period. 2
• Monitor potassium levels closely post-operatively, especially when combined with valsartan/sacubitril. 2

Clopidogrel Management

Clopidogrel management depends on whether you have coronary stents and the timing of your surgery. 2

• If you have drug-eluting stents (DES) placed within the past 12 months or bare metal stents (BMS) within 4-6 weeks, clopidogrel should be continued if possible, as the risk of stent thrombosis outweighs bleeding risk. 2
• If clopidogrel was held for surgery, it should be restarted as soon as surgical hemostasis is secure, typically within 24-48 hours post-operatively. 2
• Aspirin should be continued throughout the perioperative period if you have coronary stents. 2

Beta-Blocker Management

Continue beta-blockers throughout the perioperative period without interruption. 2

• Beta-blockers are specifically recommended in high-risk cardiac patients undergoing surgery and should never be abruptly discontinued. 2
• Abrupt withdrawal can precipitate rebound tachycardia, hypertension, and myocardial ischemia. 2
• If unable to take oral medications, consider intravenous beta-blocker administration to maintain therapy. 2

Statin Management

Continue statin therapy throughout the perioperative period. 2

• Perioperative statin use is independently associated with reduced in-hospital mortality in patients with left ventricular dysfunction undergoing major surgery. 2
• Statins should be restarted as soon as oral intake resumes. 2

Key Safety Monitoring Post-Cardiac Surgery

• Monitor for signs of euDKA if SGLT2 inhibitor was recently discontinued: nausea, vomiting, abdominal pain, general weakness despite normal blood glucose. 3, 4
• Maintain adequate hydration to reduce risk of metabolic complications. 3, 4
• Monitor potassium levels closely given the combination of spironolactone and valsartan/sacubitril. 2
• Assess volume status carefully, as heart failure patients are susceptible to both fluid overload and dehydration post-operatively. 2

Common Pitfalls to Avoid

• Do NOT restart SGLT2 inhibitor too early – wait until normal oral intake is established and ketones are checked. 4
• Do NOT discontinue beta-blockers abruptly – this can cause life-threatening rebound effects. 2
• Do NOT hold valsartan/sacubitril indefinitely – restart as soon as hemodynamically stable to maintain heart failure control. 2
• Do NOT assume normal blood glucose means no ketoacidosis – euDKA presents with normal glucose levels. 2, 4