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AI-Generated response:

My patient is coming to the OR and has been taking Valerian – what are the anesthetic implications of this supplement?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

Valerian should be discontinued 2-3 weeks prior to surgery due to its potential to increase sedative effects of anesthetic drugs and risk of withdrawal reactions; caution is advised with concurrent use of opioids and benzodiazepines due to increased sedation risk.[1]

  • Valerian can potentiate the sedative effects of anesthetics and other sedative drugs used during surgery.[1]

  • Abrupt discontinuation of valerian after long-term use can lead to withdrawal reactions; gradual tapering is recommended.[1]

  • Concurrent use of valerian with opioid agonists like Dilaudid and morphine can cause excessive sedation and somnolence, requiring careful dose management.[1]

  • Valerian interacts with diazepam and other benzodiazepines, potentially increasing CNS depression.[1]

  • Patients on valerian should discuss the use of this supplement with their healthcare provider before surgery to manage risks effectively.[1]

Additional info

When managing a patient who has been taking valerian, it is crucial to consider the interaction of this herb with anesthetic agents and other perioperative medications. Valerian acts on the central nervous system by binding to barbiturate binding sites and inhibiting the breakdown of GABA, which can enhance the effects of CNS depressants used in anesthesia. Therefore, knowing the patient's history of valerian use allows for better planning and adjustment of anesthetic doses to ensure patient safety and comfort during surgical procedures. Additionally, since valerian can cause withdrawal symptoms, it is important to taper it rather than abruptly discontinuing it to avoid complicating the patient's postoperative recovery. This careful management helps prevent excessive sedation or withdrawal issues that could affect the surgery's outcome and the patient's recovery phase.

References

Reference 1

1.

Elsevier ClinicalKey Drug Monograph

Content last updated: January 4, 2024.

Contraindications And Precautions Prior to undergoing surgery, the surgeon and anesthesiologist should be notified of the use of valerian; the herb has the potential to increase the sedative effects of drugs commonly used during surgical procedures. It may be wise to discontinue valerian 2 to 3 weeks prior to an elective procedure, when possible. Due to the potential for benzodiazepine-like withdrawal reactions with valerian, abrupt discontinuation of the herb following long-term therapy is not recommended; valerian should be gradually tapered after long-term use when possible.

Interactions Dilaudid: (Moderate) Concomitant use of opioid agonists with valerian may cause excessive sedation and somnolence. Limit the use of opioid pain medication with valerian to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect.

Interactions Diazepam: (Major) Any substances that act on the CNS, including psychoactive drugs and drugs used as anesthetic adjuvants (e.g., barbiturates, benzodiazepines), may theoretically interact with valerian, Valeriana officinalis. The valerian derivative, dihydrovaltrate, binds at barbiturate binding sites; valerenic acid has been shown to inhibit enzyme-induced breakdown of GABA in the brain; the non-volatile monoterpenes (valepotriates) have sedative activity. These interactions are probably pharmacodynamic in nature. There is a possibility of interaction with valerian at normal prescription dosages of anxiolytics, sedatives, and hypnotics (including barbiturates and benzodiazepines). Patients who are taking barbiturates or other sedative/hypnotic drugs should avoid concomitant administration of valerian. Patients taking medications such as tricyclic antidepressants, lithium, MAOIs, skeletal muscle relaxants, SSRIs and serotonin norepinephrine reuptake inhibitors (e.g., duloxetine, venlafaxine) should discuss the use of herbal supplements with their health care professional prior to consuming valerian; combinations should be approached with caution in the absence of clinical data. Patients should not abruptly stop taking their prescribed psychoactive medications.

Interactions Simplist Dilaudid: (Moderate) Concomitant use of opioid agonists with valerian may cause excessive sedation and somnolence. Limit the use of opioid pain medication with valerian to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect.

Interactions Morphine; Naltrexone: (Moderate) Concomitant use of opioid agonists with valerian may cause excessive sedation and somnolence. Limit the use of opioid pain medication with valerian to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect.

Interactions RelCof C: (Moderate) Concomitant use of opioid agonists with valerian may cause excessive sedation and somnolence. Limit the use of opioid pain medication with valerian to only patients for whom alternative treatment options are inadequate. If concurrent use is necessary, use the lowest effective doses and minimum treatment durations needed to achieve the desired clinical effect.

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