Should You Stop Taking Ozempic Before Elective Surgery?

Five medical societies have united on guidance and two recent studies shed new light on the topic.

Update: An October 2024 Clinical Practice Guidance joint statement by multiple medical societies (American Society of Anesthesiologists (ASA), American Gastroenterological Association, American Society for Metabolic and Bariatric Surgery, International Society of Perioperative Care of Patients with Obesity, and the Society of American Gastrointestinal and Endoscopic Surgeons) states that most patients should continue taking their GLP-1 drugs before elective surgery. Patients at the highest risk for significant gastrointestinal (GI) side effects should follow a liquid diet for 24 hours before the procedure. Standard pre-procedure fasting instructions call for 8 hours fasting time and no liquids 2 hours before a procedure.

Anesthesiologists Originally Said, All Patients Should Stop

The American Society of Anesthesiologists (ASA) recommended in June 2023 that all patients, regardless of whether or not they have type 2 diabetes, should stop taking GLP-1 weekly-administered drugs (such as Ozempic) the week prior to an elective procedure or the day before if they are taking a daily dosage form of a GLP-1 (such as Rybelsus). They said this will help empty the stomach before surgery to avoid respiratory complications during surgery. Now, they share the recommendations of the other medical societies that do not call for stopping the medication. Joint Guidance: https://www.asahq.org/about-asa/newsroom/news-releases/2024/10/new-multi-society-glp-1-guidance

Gastroenterologists Say No, Not All Patients Need to Stop (for endoscopic procedures)

In November 2023, in response to the ASA guidance, the American Gastroenterological Association (AGA) recommended that it does not support all patients stopping GLP-1 drugs (like Ozempic) prior to elective endoscopy procedures.  Instead, "AGA suggests doctors individualize the approach to each patient on a GLP-1 receptor agonist prior to a procedure."  They also recommend "in lieu of stopping GLP-1 RAs, patients can also be placed on a liquid diet one day prior to their procedure."

Some Say it Depends on Why You're Taking Ozempic

Taking Ozempic for Type 2 Diabetes: No (in most cases)

Authors of a recent study in Anaesthesia (a U.K. publication) reviewed the medical literature for studies that looked at the connection between GLP-1 drugs associated with delayed gastric emptying (like Ozempic) and the risk of pulmonary aspiration  during the "peri-operative" time period (before. during, or after surgery). Since it is important to maintain consistent blood sugar levels, many experts advise not to stop the drug prior to surgery unless an endocrinologist has prescribed an alternative treatment plan.

Taking Ozempic for Weight Loss Only: Yes

The authors of the Anaesthesia study found that anesthesiologists recommend stopping the drug for at least three "half-lives" before a procedure if the patient is only taking the drug for obesity. This would be about 3 weeks in advance of surgery for a patient taking semaglutide (Ozempic brand name), because Ozempic has about a 7-day "half-life."

A drug "half-life" refers to how long it takes for about 50% of the drug concentration to remain in your body. After three drug half-lives, only about 12% of the drug still remains in your body. Not all GLP-1 drugs have such a long half-life as Ozempic. For example, Victoza (liraglutide) has a half-life of only 13 hours, so it would only have to be discontinued 39 hours before surgery under these guidelines. (Table 3 in the article lists common GLP-1 drugs' half-lives and withhold times.)

New Research Supports Continuing GLP-1 Meds Before Surgery

Stanford researchers suggest that a less conservative approach might be appropriate for both type 2 diabetes and obesity patients. They found that, despite the fact that some GLP-1 patients have solid contents in their stomach while under full anesthesia, these patients do just as well as those not taking the GLP-1 medications.

The Stanford study, published as a research letter in JAMA, states that the rates of postoperative respiratory complications for GLP-1 users vs. non-users were similar (3.5% for those taking one of the drugs and 4% for those who had not been prescribed the drugs). The authors argue that patients may not need to go off the medications before surgery. Caveat: The authors note that their findings "do not apply to patients using GLP-1 receptor agonists under light or moderate sedation without an anesthesiologist or other advanced airway practitioner."

Pre-Surgery Fasting

Regardless of medication decisions, all of the experts recommend similar pre-procedure fasting instructions, such as fasting for 8-12 hours. AGA also recommends that patients taking GLP-1 drugs limit their diet to clear liquids the day before their procedure.

References:

American Society of Anesthesiologists Multi-Society Guidance Press Release:
https://www.asahq.org/about-asa/newsroom/news-releases/2024/10/new-multi-society-glp-1-guidance

ASA (American Society of Anesthesiologists) Press Release: https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative

Aspiration Risks of Ozempic: https://www.peoplespharmacy.com/articles/if-you-need-surgery-while-on-ozempic-or-wegovy-be-very-careful

AGA (American Gastroenterological Association) Press Release https://gastro.org/press-releases/continue-glp1-drugs-before-endoscopy/

David A. Milder, Tamara Y. Milder, Sophie S. Liang, Peter C.A. Kam . Glucagon-like peptide-1 receptor agonists: a narrative review of clinical pharmacology and implications for peri-operative practice, Anaesthesia, May 2024. 10.1111/anae.16306
(a U.K. publication, authors of the study are from Australia)
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.16306

Stanford Press Release: https://fsi.stanford.edu/news/some-good-news-diabetics-facing-surgery-while-taking-ozempic

JAMA article: Dixit AA, Bateman BT, Hawn MT, Odden MC, Sun EC. Preoperative GLP-1 Receptor Agonist Use and Risk of Postoperative Respiratory Complications. JAMA. 2024;331(19):1672–1673. doi:10.1001/jama.2024.5003
https://jamanetwork.com/journals/jama/article-abstract/2817853?guestAccessKey=0234613c-2e74-444c-ac25-4f9e82f9b24b