Immunosuppressants/Steroids Before & After Surgical Weight Loss

NOTE: These are general guidelines, your surgeon may elect to use a different protocol so please discuss this with your specific provider. It is very important to have a plan in place when it comes to these medications, otherwise it could result in your surgery being canceled or delayed!

Steroids (prednisone, methylprednisolone, Medrol Dose-Pak, etc):

Sleeve/SIPS/Band:

Ideally a patient will wean off chronic oral steroids (prednisone) completely by 4 weeks prior to surgery, and hold it for 4 weeks after surgery.
- - Short-term steroids such as a Medrol dose pack or intra-muscular injections need to be held for 4 weeks prior and 4 weeks after also.
  - Injectable steroids in joints or epidural space need to be held for 2 weeks prior and 2 weeks after.
  - Topical and/or inhaled steroids are ok and do not need to be stopped.

Bypass:

- - Gastric bypass patients cannot take steroids ever, therefore if a patient takes chronic steroids they are not a candidate for the procedure at all.
  - Short-term steroids such as a Medrol dose pack or intra-muscular injections need to be held for 4 weeks prior and 4 weeks after also.
  - Injectable steroids in joints or epidural space need to be held for 2 weeks prior and 2 weeks after.
  - Topical and/or inhaled steroids are ok and do not need to be stopped.

Methotrexate: Ideally a patient will stop methotrexate 4 weeks prior to any weight loss surgery, and resume it 4 weeks after surgery. If the patient cannot tolerate a drug-free interval it is ok in certain cases to continue through and after surgery, as there is some literature to suggest it is safe.

Plaquenil: Ideally a patient will stop plaquenil 4 weeks prior to any weight loss surgery, and resume it 4 weeks after surgery. If the patient cannot tolerate a drug-free interval it is ok in certain cases to continue through and after surgery, as there is some literature to suggest it is safe.

TNF Inhibitors (Remicade, Humira, Enbrel, etc): These medications should be held for 1 dosing cycle. This translates to: