Should You Stop Taking Ozempic Before Elective Surgery?
Anesthesiologists say yes, while gastroenterologists say not necessarily. Two recent studies shed new light on the topic.
Anesthesiologists Say Yes, 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 say this will help empty the stomach before surgery to avoid respiratory complications during surgery.
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:
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