Prior to surgery, guanethidine should be discontinued 72 hours prior to surgery and the anesthesiologist should be made aware that the patient is taking guanethidine.

In patients with bronchial asthma, their asthma may be aggravated by the depletion of catecholamines by guanethidine.  Also, sympathomimetic amines may interfere with the hypotensive effect of guanethidine.

With impaired renal function, the blood pressure lowering effect of guanethidine may further decrease renal function.

Guanethidine should not be given to patients with severe cardiac failure, since guanethidine may interfere with the compensatory circulatory adjustment in patients with congestive heart failure.

Cardiac patients should be watched for the guanethidine unwanted side effects of weight gain or edema.  This edema may be reduced by the administration of a thiazide.

Guanethidine should be used cautiously in patients with a history of peptic ulcer disease.

Patients with coronary insufficiency , cerebrovascular disease, or recent myocardial infarction my be worsened by hypotension.

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