An extensive medication history, including the use of nonprescription agents and herbal products, is the foundation of effective perioperative medication management. Decisions about stopping or continuing medications perioperatively should be based on withdrawal potential, the potential for disease progression if therapy is interrupted, the potential for drug interactions with anesthesia, and the patient's short-term quality of life. In general, medications with withdrawal potential should be continued perioperatively, nonessential medications that increase surgical risk should be discontinued before surgery, and clinical judgment should be exercised in other cases.