As individuals age, several physiological changes occur, and the prevalence of polypharmacy increases, both of which can significantly impact medication management during the perioperative period. The multidisciplinary team collaborates to recommend necessary medication modifications around surgery. These decisions are based on a thorough evaluation of patient-specific factors, surgical considerations including anaesthetic requirements and medication-related factors. This chapter will provide an overview of important considerations for different medication classes in the perioperative period. In general, optimal perioperative medication management aims to ensure patient safety before, during and after surgery. Comprehensive medication management, including clear communication between healthcare providers and the patient, and close monitoring during the perioperative period are vital for optimising surgical outcomes in older persons.