Adult cardiac surgery is an essential therapeutic approach to reduce short- and long-term mortality and morbidity in patients with acute or chronic cardiac diseases. The outcomes after cardiac surgery rely not only on patient selection and surgical expertise, but also on the management of underlying conditions as well as on the pharmacological prevention and treatment of complications. Therefore, perioperative medical treatment and prophylaxis are key factors in ensuring the perioperative and longterm success of cardiac surgery and in impacting a patient’s quality of life and healthcare costs. Pharmacological therapy affects outcome(s) after adult cardiac surgery across 3 distinct stages: preoperative, intraoperative and postoperative (1). Preoperatively, the medical/surgical team may need to initiate, interrupt or maintain medications to mitigate the risk for intra- and immediate postoperative complications. Intraoperatively, managing blood glucose levels and administering prophylactic antibiotics in a timely and effective manner are essential to reduce infectious complications and ensure the best possible surgical outcomes. Postoperatively, restarting or initiating new medications in a timely fashion is essential for preventing ischaemic events, controlling arrhythmias, managing cardiovascular risk factors and treating heart failure (HF) and reducing mortality, all of which contribute to optimal long-term prognoses.