Medication Advice

Inform your doctor of all the medications you are taking.

Medications to continue taking, even on the day of procedure with small amount of plain water:

Anti-hypertensive medication
Thyroid medication

Medications to stop:

Category of Medication	Examples of Medication	Date to Stop
Blood-thinning medication*	Aspirin (Cardiprin), Warfarin (Marevan), Clopidogrel (Placta), Ticlopidine (Ticlid), Dipyridamole (Perazodin), Rivaroxaban (Xarelto), Apixaban (Eliquis)	To follow doctor’s instructions
Possibly blood-thinning supplements*	Echinacea, Ephedra, Garlic, Gingko (Tanakan), Ginseng, Valerian, Hypericum (St. John’s Wort), Kava (Kavain), Traditional Chinese Medicine (TCM), Ayurvedic, Jamu	Stop 1 week before procedure unless otherwise advised
Iron supplements	Ferrous Gluconate (Sangobion), Ironhydroxide polymaltose complex tablet and drops (Maltofer)	Stop 1 week before procedure unless otherwise advised
Diabetes medication	Refer to below

Note: If you are unsure of which medication to take/stop, please bring along your medication.

* This list is not exhaustive. If you are unsure, please approach our staff for help.

Only for Patients with Diabetes

Morning Procedure (No breakfast on day of procedure)

You should take your diabetes medications and insulin as usual the day before the procedure. You may adjust your diabetes medications as follows. If you are unsure of how to adjust your medications, please check with your usual diabetes doctor.

Category of Medication	Medication Instructions Before Procedure	Medication Instructions After Procedure
Dapagliflozin, Empagliflozin, Combination drugs containing dapagliflozin/ empagliflozin	Do not take 2 days before and on the day of procedure if going for colonoscopy.	Resume the medication when eating well.
Other Oral diabetes Medications Victoza/ Byetta/ Saxenda	Omit your morning diabetes medications.	Once a day medication can be taken after the procedure, at lunchtime. Take any lunch/evening medications as usual – do not take any extra dose to replace any missed morning dose.
Basal insulin Insulatard, Lantus, Toujeo, Levemir, Soliqua	Take 70% of your usual morning dose, or to follow doctor’s instructions.	Take any dose due at lunch/ dinner/ bedtime as usual.
Short or rapid acting insulins Actrapid, Novorapid, Apidra, Humalog	Do not take breakfast dose*.	Take dinner insulin as usual.
Pre-mixed insulins Mixtard, Novomix, Humalog Mix, Ryzodeg	Do not take morning dose	Take ½ your morning dose before lunch and your usual dinner dose. If you usually take insulin at lunchtime, take your usual lunch dose - do not take extra to replace any missed morning dose.
Insulin Pump	Stay on usual basal. Omit breakfast bolus*.	Take lunch bolus as usual.

*If you have high blood glucose and have a correction factor/scale to follow from your diabetes doctor, take your usual correction dose.

Treat low blood glucose (< 4 mmol/L) with 15g rapid-acting carbohydrates, such as 3 - 4 glucose tablets, 3 - 4 chewable sweets, even during the time when you are not supposed to take any food. Re-check your blood glucose 15 minutes after treating and repeat treatment until your blood glucose is above 4 mmol/L.

Afternoon Procedure (Light breakfast on day of procedure)

Category of Medication	Medication Instructions Before Procedure	Medication Instructions After Procedure
Dapagliflozin, Empagliflozin, Combination drugs containing dapagliflozin/ empagliflozin	Do not take 2 days before and on the day of procedure if going for colonoscopy.	Resume the medication when eating well.
Other Oral diabetes Medications Victoza/ Byetta/ Saxenda	Omit your morning and lunch diabetes medications.	Take any evening medications as usual. Do not take an extra dose to replace any missed morning/ lunch dose.
Basal insulin Insulatard, Lantus, Toujeo, Levemir, Soliqua	Take 70% of your usual morning dose, or To follow doctor’s instructions.	Take any dose due at dinner/bedtime as usual.
Short or rapid acting insulins Actrapid, Novorapid, Apidra, Humalog	Do not take breakfast and lunch dose*.	Take dinner insulin as usual.
Pre-mixed insulins Mixtard, Novomix, Humalog Mix, Ryzodeg	Take ½ your morning dose, or To follow doctor’s instructions.	Take your usual dinner dose.
Insulin Pump	Stay on usual basal. Take breakfast bolus according to the amount of carbohydrates you eat. Skip lunch bolus*.	Take your usual dinner bolus.