Do You Need to Stop Ozempic, Wegovy or Zepbound Before Surgery? What the Guidance Says
Under 2024 guidance from five medical societies, most people can keep taking a GLP-1 before surgery or endoscopy. The one-week pause now applies only when the care team judges the risk to be high, and a 24-hour liquid diet is the main safeguard.
By Kymata Health Editorial Published Last checked
This guide
GLP-1 Companion- Question
- Do I need to stop my GLP-1 before surgery or a colonoscopy, and for how long?
- Sources
- 7 cited
- Quick answers
- 3 questions
- Clinician review
- None; sources cited inline
Key takeaways
5 points- Joint 2024 guidance from US gastroenterology, bariatric surgery and anesthesiology societies says GLP-1 treatment may be continued before surgery in people without added risk of slow stomach emptying1.
- If the team decides to pause it, the suggestion is to skip daily drugs on the day of surgery and weekly drugs (Ozempic, Wegovy, Zepbound) for the week before1.
- The risk is food left in the stomach: in one ultrasound study, 56% of fasted GLP-1 users had increased stomach contents vs 19% of non-users3.
- A BMJ cohort of 43,365 adults with type 2 diabetes found no rise in aspiration during upper endoscopy with GLP-1s (4.15 vs 4.26 per 1,000), but procedures were stopped about twice as often5.
- Never stop on your own. Tell the surgeon, anesthesia team or endoscopist which drug and dose you take and when you last took it16.
The short answer
In October 2024 the American Gastroenterological Association, the American Society for Metabolic and Bariatric Surgery, the American Society of Anesthesiologists, the International Society of Perioperative Care of Patients with Obesity and the Society of American Gastrointestinal and Endoscopic Surgeons issued joint guidance. It says the decision should be shared between you, the procedure team, anesthesia and your prescriber, and that GLP-1 therapy may be continued in people without elevated risk1.
The guidance names five things that raise the risk of slow stomach emptying and aspiration: being in the dose-escalation phase rather than on a steady maintenance dose, a higher dose, weekly rather than daily dosing, current stomach symptoms (nausea, vomiting, abdominal pain, indigestion or constipation), and other conditions that slow the stomach, such as gastroparesis or Parkinson's disease1.
When the team decides a pause is needed, the guidance says nobody knows the right length. It suggests following the original 2023 anesthesiology advice: hold daily drugs on the day of surgery and weekly drugs for one week before1. It also warns that stopping can cause harm, such as high blood sugar in people with diabetes, and that pausing only because someone has obesity, with none of the risk factors above, would be weight bias1.
Why anesthesia teams ask about GLP-1s
The Wegovy and Zepbound labels both say the drugs slow stomach emptying and that there have been rare postmarketing reports of food or fluid being inhaled into the lungs (pulmonary aspiration) under general anesthesia or deep sedation, in people who still had stomach contents despite following the usual fasting rules67. Both labels add that the data are not enough to say whether a longer fast or a temporary pause reduces the risk, and tell patients to inform their providers before any planned procedure67.
Studies of stomach contents show the problem. In a 2024 JAMA Surgery study of 124 fasted patients, 56% of weekly GLP-1 users had increased stomach contents vs 19% of non-users, an adjusted prevalence ratio of 2.483. In a 2023 chart review of 404 upper endoscopies, which measured what was suctioned from the stomach, increased stomach contents were found in 24.2% of semaglutide users vs 5.1% of others, and one aspiration occurred, in the semaglutide group4.
A one-week pause does not clear these drugs. Semaglutide has a half-life of about a week and stays in the blood for about 5 to 7 weeks after the last 2.4 mg dose6; tirzepatide's half-life is about 5 days7. In both studies above, how long the drug had been paused made no clear difference to stomach contents34.
Does that mean more aspiration?
Not clearly. A 2024 BMJ study of 43,365 adults with type 2 diabetes compared GLP-1 users with users of SGLT-2 inhibitors in the 30 days before an upper endoscopy. Aspiration rates were 4.15 vs 4.26 per 1,000 (risk ratio 0.98), but the procedure had to be stopped more often with a GLP-1 (9.79 vs 4.91 per 1,000), possibly because of food left in the stomach5.
That study used insurance billing codes, covered only people with diabetes and only endoscopy, so it does not settle the question for higher obesity doses or for surgery under general anesthesia5. Industry ties: one author reported consulting for Novo Nordisk, the maker of Ozempic and Wegovy, and serving on data monitoring committees for two of its trials5.
The 24-hour liquid diet and other safeguards
The US guidance suggests a liquid diet for at least 24 hours before the procedure when there is concern about slow emptying, as already happens before colonoscopy and bariatric surgery1. On the day, the team may check the stomach with a bedside ultrasound, or choose an anesthesia technique that protects the airway faster (rapid sequence induction), or postpone1.
Guidance differs between countries. 2025 recommendations from Australian and New Zealand professional bodies (ADS, ANZCA, GESA and NACOS) say to continue GLP-1s around procedures and to give everyone taking them a 24-hour clear-fluid diet followed by the standard 6-hour fast2. That panel said the absence of stomach symptoms cannot be used to judge risk, and that it could not recommend a pause long enough to return stomach emptying to normal2. Follow the instructions of the team doing your procedure.
Disclosures: two authors of the US guidance reported paid consulting or speaking for Novo Nordisk, and several others for device makers1. The Australian and New Zealand authors declared no conflicts2.
Before your procedure
Bring this up when the procedure is booked, not the night before. The US guidance asks for the risk check to happen early enough to change the plan, including diet changes or bridging medicine if a pause is needed1.
- Tell every team involved which GLP-1 you take, the dose, the day of your last injection or pill, and whether you are still increasing the dose16.
- If you have diabetes, ask who will manage your blood sugar if the drug is paused1.
- Report nausea, vomiting, bloating, indigestion or constipation on the day of the procedure, even if you fasted correctly1.
- Follow liquid-diet and fasting instructions exactly, and ask when to restart and at what dose.
- Extra caution applies if you have gastroparesis or Parkinson's disease, or recently started or raised your dose1. For the drugs' other warnings, see our GLP-1 cancer and pancreatitis risk page.
Quick answers
Questions
3 answersDo I need to stop Ozempic before a colonoscopy or endoscopy?
Usually not under the 2024 US guidance, which covers endoscopy as well as surgery, but the team doing the procedure makes the call1. Colonoscopy prep already includes a liquid diet, which is the safeguard the guidance recommends1.
How long before surgery should I stop Zepbound or Wegovy?
Only if your team decides a pause is needed; the US guidance then suggests one week for weekly injections1. Tirzepatide's half-life is about 5 days7 and semaglutide's about a week6, so the drug is not fully gone after a week.
Is it safe to keep taking my GLP-1 right up to surgery?
For most people without risk factors, the US guidance says it can be continued, with a liquid diet and day-of checks if there is concern1. Both labels say the data are not enough to know whether changing fasting or pausing lowers the aspiration risk67.
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References
Every study and document cited in this guide, numbered as in the text.
Sources
7 sources- 1Multi-society clinical practice guidance for the safe use of glucagon-like peptide-1 receptor agonists in the perioperative period. Surg Endosc, 2025. PMID 39370500
- 22025 ADS/ANZCA/GESA/NACOS clinical practice recommendations on the peri-procedural use of GLP-1/GIP receptor agonists. Anaesth Intensive Care, 2025. PMID 40814081
- 3Glucagon-Like Peptide-1 Receptor Agonist Use and Residual Gastric Content Before Anesthesia. JAMA Surg, 2024. PMID 38446466
- 4Relationship between perioperative semaglutide use and residual gastric content: A retrospective analysis of patients undergoing elective upper endoscopy. J Clin Anesth, 2023. PMID 36870274
- 5Glucagon-like peptide-1 receptor agonists before upper gastrointestinal endoscopy and risk of pulmonary aspiration or discontinuation of procedure: cohort study. BMJ, 2024. PMID 39438043
- 6WEGOVY (semaglutide) injection and tablets: prescribing information. U.S. Food and Drug Administration (Drugs@FDA), 2026.
- 7ZEPBOUND (tirzepatide) injection: prescribing information. U.S. Food and Drug Administration (Drugs@FDA), 2026.
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