Herbal Mojo Before Surgery: What to Stop and When
Stop taking Herbal Mojo two weeks before an elective procedure, and tell your surgical team you have been taking it. That is the safe default for herbal supplements before surgery, and the rest of this page explains why the timing advice varies and which of the seven ingredients are behind it.
How long before surgery should you stop
Two to three weeks is the standing recommendation for herbal supplements as a class. A review in Continuing Education in Anaesthesia, Critical Care and Pain states that because pharmacokinetic and pharmacodynamic data are lacking, the American Society of Anesthesiologists recommends discontinuing herbal medications two to three weeks before surgery.
That window errs on the side of caution, and the review says so. It exists because the data needed to set a shorter one does not exist for most herbs.
Herbal Mojo is taken only when needed rather than daily, so there is no dose to taper. In practice this means not taking it at all once a date is booked.
Why you will see 36 hours quoted for Ginkgo
It comes from one 2001 paper and it is not the current consensus. Ang-Lee, Moss and Yuan, writing in JAMA in 2001, proposed discontinuation times tailored to each herb where pharmacokinetic data existed, and gave 36 hours for Ginkgo Biloba.
More recent perioperative guidance has moved the other way. The Society for Perioperative Assessment and Quality Improvement consensus statement recommends discontinuing Ginkgo Biloba two weeks before surgery, which lines up with the general herbal advice rather than shortening it.
If you have seen the 36-hour figure elsewhere, that is where it comes from. Follow the longer window and your surgical team instruction rather than the shorter one.
Which ingredients in the formula are the reason
Ginkgo Biloba, on bleeding. It inhibits platelet-activating factor, and that antiplatelet action is the most established herb and surgery interaction in the anaesthesia literature. It is why this page exists.
Herbal Mojo contains 49 mg of Ginkgo per capsule, taken as needed rather than daily, which is a lower exposure than the daily supplement doses those recommendations were written for. That is a reason to tell your team the actual amount and frequency, not a reason to skip the conversation.
Tribulus Terrestris is worth mentioning for a different reason. A case report in the American Journal of Case Reports notes that tribulus appears to be a moderate CYP3A4 inhibitor, and CYP3A4 clears a wide range of drugs including agents used around anaesthesia.
Eurycoma Longifolia matters if you take propranolol. In a 2010 crossover study in 14 healthy young men, it reduced propranolol's bioavailability by 29 per cent, so your team should know if you take both.
Saw Palmetto and Xanthoparmelia Scabrosa have no established surgical interaction. For Xanthoparmelia that reflects an absence of published study rather than evidence of safety, and your team should have the full list regardless.
What about the PDE5 mechanism
It is weaker than the marketing in this category suggests, and worth mentioning anyway. Icariin, from Horny Goat Weed, inhibits PDE5 in an isolated enzyme assay at roughly eighty times weaker than sildenafil, and has not been tested in men.
Osthole, from Cnidium Monnieri, is often described the same way. The study behind that claim tested coumarins on isolated rabbit tissue and did not test PDE5 inhibition.
Nobody has measured what the finished formula does to blood pressure. Anaesthesia involves deliberate blood pressure management, so an unmeasured vasoactive effect is exactly the sort of thing an anaesthetist wants told rather than assumed away.
Risk at a glance
| Ingredient | Surgical relevance | Guidance |
|---|---|---|
| Ginkgo Biloba | Antiplatelet action, the most established herb and surgery interaction | SPAQI consensus recommends stopping two weeks before surgery |
| Tribulus Terrestris | Appears to be a moderate CYP3A4 inhibitor, the enzyme system that clears many drugs | Tell your team, particularly if you take a statin |
| Eurycoma Longifolia | Reduced propranolol absorption in a study of healthy men | Tell your team if you take propranolol |
| Horny Goat Weed (Epimedium) | Inhibits PDE5 in a laboratory assay, untested in men | Mention it alongside any blood pressure medication |
| Cnidium Monnieri | Relaxed isolated rabbit tissue. PDE5 inhibition was not tested | Mention it alongside any blood pressure medication |
| Xanthoparmelia Scabrosa | No published interaction or surgical data | Include on the list you give your team |
| Saw Palmetto | No established surgical interaction | Include on the list you give your team |
| Herbal supplements generally | Interaction profile with anaesthesia largely unstudied | ASA recommends stopping two to three weeks before elective surgery |
What to tell your surgical team
Bring the pack or the ingredient list rather than relying on memory. Herbal Mojo publishes the milligram amount of every ingredient, which is more than most supplements give an anaesthetist to work with.
Say how often you actually take it, not just that you take it. As-needed use a few times a month is a different exposure from a daily capsule, and that distinction changes the answer you get.
Disclosure matters more than the timing. Surveys cited in the anaesthesia literature find that most surgical patients do not tell their team about herbal use at all, which is the actual problem the two-week rule is trying to work around.
Common questions
How far in advance should I stop? Two weeks is the safe default, and two to three weeks is what the ASA recommends for herbal supplements generally. Ask your surgical team for the window they want.
I have seen 36 hours quoted for Ginkgo. Which is right? Follow the longer window. The 36-hour figure is from a 2001 JAMA paper; more recent perioperative consensus recommends two weeks for Ginkgo.
What if surgery is an emergency and I have not stopped? Tell the team immediately what you took and when. That information affects bleeding and anaesthesia decisions even with no time to plan.
When can I take it again afterwards? Ask your surgeon, particularly if you have been prescribed anything new during recovery. There is no daily dose to restart, so there is no cost to waiting for a clear answer.