Perioperative IBD Pharmacotherapy Management 

Immunomodulators:

 • Stop MTX one week prior to elective surgery

 • Stop AZA/6MP the day of surgery and resume post op day 1

Biologics:

 • Do not delay urgent/emergent surgery

 • Time elective surgery with drug trough

 • Resume in CD patients at high risk of recurrence 2-4 weeks after surgery

 • Discontinue in UC patients undergoing colectomy

Steroids:

 • Reduce dose as much as possible prior to surgery

 • Rapid taper (goal dose mg per day of prednisone) & intraoperative stress dose



Gastroenterology Review @GIreview



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