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.
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- 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.
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Bypass:
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- 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.
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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:
- Remicade: 6-8 weeks depending on dose
- Humira: 2 weeks
- Enbrel: 1 week
- TNF Inhibitors can be resumed 2 weeks after surgery.
If you take any of these medications and are unsure what you should do prior to surgery, please contact us at provider@curryweightloss.com!
I had RNY surgery 5 years ago followed by TKR with less than a perfect result. I talked to my PCP and was told to use Diclifenaco on my knee 3 times a day. I was told by another RNY patient her PCP told her not to use this as it is steroid medicine and will effect RNY patients.?
What are your thoughts?
We recommend avoiding NSAID’s for all RNY patients due to the risk of a marginal ulcer. The risk of a topical NSAID may be less than taking it orally, but some does still get absorbed into the blood stream.
Will taking gastro protectants like proton pump inhibitors and h2 blockers be of value if spaced at an appropriate duration several years after RNY surgery? As an asthmatic, many docs will prescribe a medrol pack to slow down mucus production in the lungs.
Cases like this should always be discussed with your surgeon. I would be inclined to allow a short course of steroids for asthma, but definitely would recommend Prilosec (or equivalent) during the course of treatment.
Dr. Curry