Is it safe to restart Eliquis (apixaban), Trazodone, Buspar (buspirone), Levothyroxine, and Finasteride in a patient with a history of ethanol (ETOH) abuse, status post (s/p) fall and left hip fracture, on post-operative day 0 (POD0), who has not yet been restarted on their home medications?

From the Guidelines

I strongly recommend restarting most of your patient's home medications with caution regarding Eliquis, prioritizing medications essential for thyroid function and psychiatric stability, while temporarily holding anticoagulation therapy to minimize bleeding risk at the surgical site. For a post-operative hip surgery patient with alcohol use and recent fall, it is crucial to balance the risk of thromboembolism with the risk of bleeding, as highlighted in the context of fall prevention and management guidelines 1.

When considering the patient's medication regimen, it is essential to prioritize the restart of levothyroxine, buspirone (Buspar), and trazodone immediately, as these medications are vital for maintaining thyroid function and psychiatric stability. Finasteride can be safely restarted as it does not significantly impact surgical recovery. However, the decision to restart Eliquis (apixaban) should be made in consultation with the surgical team, taking into account the timing for anticoagulation resumption, typically 24-48 hours after surgery, depending on the patient's bleeding risk 1.

It is also important to verify the correct dosages of the patient's medications from their outpatient records and assess for potential interactions with any new post-operative medications. The thyroid medication, levothyroxine, should be administered on an empty stomach to ensure optimal absorption.

The rationale behind temporarily holding Eliquis is to prevent excessive bleeding at the surgical site, which is a critical consideration in the post-operative period, especially in patients with a history of falls and alcohol use, as discussed in the context of fall prevention guidelines 1. Clear documentation of the medication reconciliation in the patient's chart and communication of the plan to the nursing staff and patient are essential for ensuring continuity of care and minimizing risks associated with medication management.

From the Research

Medication Management for Patient with ETOH and Fall

• The patient is currently being treated for ETOH (ethanol) intoxication and a recent fall, and is asking to be restarted on their home medications, which include eliquis, trazadone, buspar, levothyroxine, and finasteride.
• According to the studies, there is no direct information on the management of these specific medications in the context of acute alcohol intoxication and a recent fall.
• However, it is known that alcohol can interact with various medications and exacerbate certain medical conditions, such as thyroid dysfunction 2.
• Levothyroxine, a thyroid hormone replacement medication, may be affected by alcohol use, as alcohol can cause direct suppression of thyroid function and indirect suppression by blunting thyrotropin-releasing hormone response 2.
• Additionally, the use of certain medications, such as trazadone and buspar, may be influenced by the patient's alcohol use and potential withdrawal syndrome 3, 4.
• The decision to restart the patient's home medications should be made on a case-by-case basis, taking into account the patient's individual medical history, current clinical condition, and potential interactions between the medications and alcohol 5.
• It is essential to closely monitor the patient's vital signs, cognitive state, and potential alcohol-related complications, as well as their response to the medications, to ensure safe and effective management 4.