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GLP-1 Medications Before Surgery: What Guidance Says

GLP-1 drugs slow stomach emptying, which matters for anesthesia. See what the labels, ASA and multi-society guidance say, and what to tell your team.

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By the Healthy Weight Loss 4 U Clinical Content Team · Published October 20, 2026 · Updated October 20, 2026 · 8 min read

In short

GLP-1 medicines slow stomach emptying, and the Zepbound, Wegovy, Ozempic and Mounjaro labels each warn of rare reports of pulmonary aspiration under general anesthesia or deep sedation, while saying data are insufficient to say how to prevent it [1][2][3][4]. ASA's 2023 guidance suggested considering a hold; a 2024 guidance from five societies said most patients may continue, with the care team weighing individual risk [5][6][7].

Key takeaways

  • Zepbound, Wegovy, Ozempic and Mounjaro labels all carry a warning section on pulmonary aspiration during general anesthesia or deep sedation, and each tells patients to inform providers before planned procedures [1][2][3][4].
  • A summary of one retrospective study reported increased residual stomach content in 24.2% of semaglutide patients versus 5.1% of controls at upper endoscopy [11].
  • ASA's June 2023 guidance suggested considering a hold, but described its evidence as sparse and limited to several case reports [5].
  • The October 2024 guidance from ASA, AGA, ASMBS, ISPCOP and SAGES said most patients may continue GLP-1 medicines, and that the escalation phase is linked to higher risk [6][7][8].
  • A 2025 consensus statement in the British Journal of Anaesthesia suggested 24 hours without solids and 4 to 8 hours without clear liquids for these patients [9].

Why do GLP-1 medications matter for anesthesia?

GLP-1 medicines slow how fast the stomach empties, and the concern is that food left in the stomach could be inhaled into the lungs during general anesthesia or deep sedation, which is called pulmonary aspiration. Patients receive preoperative fasting recommendations for this reason, and the labels describe rare cases where stomach contents remained despite reported fasting [1].

The Zepbound label states that tirzepatide delays gastric emptying, that the delay is largest after the first dose, and that the effect diminishes over time [1]. The label also notes that slower emptying may affect how well other oral medicines are absorbed (Section 7.2), which is one more reason the care team needs a full medicine list [1].

This article summarizes what the labels and professional guidance say. It is not an instruction to start, stop or change any medicine. Decisions about a particular operation belong to the surgical and anesthesia teams, together with the clinician who prescribes the GLP-1 medicine.

What do the drug labels say about anesthesia and sedation?

Each of the four labels reviewed has a warning section on pulmonary aspiration during general anesthesia or deep sedation, and each says there are not enough data to know how to prevent it. In Zepbound (revised 04/2026) this is Section 5.9; in Wegovy (06/2026) and Ozempic (05/2026) it is Section 5.10; in Mounjaro (8/2026) it is Section 5.9 [1][2][3][4].

The Zepbound text reads as follows in its main points. The drug delays gastric emptying. There have been rare postmarketing reports of pulmonary aspiration in patients receiving GLP-1 receptor agonists who were undergoing elective surgeries or procedures requiring general anesthesia or deep sedation and who had residual gastric contents despite reported adherence to preoperative fasting recommendations [1].

It then says that available data are insufficient to inform recommendations to mitigate the risk, including whether modifying preoperative fasting recommendations or temporarily discontinuing the drug could reduce retained gastric contents. The wording in Wegovy and Ozempic is the same apart from the drug name [2][3]. Mounjaro's section carries the same content [4].

The last sentence is the practical one: the labels instruct prescribers to tell patients to inform healthcare providers before any planned surgery or procedure if they are taking the medicine [1][2][3][4]. The labels do not tell patients to stop the drug. They say the evidence cannot yet settle that question.

How common is retained stomach content, and does it cause aspiration?

Several studies find more food left in the stomach on GLP-1 medicines, but actual aspiration appears rare and the link between the two is unclear. The figures below come from a 2024 editorial in the World Journal of Gastrointestinal Endoscopy that summarizes studies of upper endoscopy; I did not open the original papers, so treat the numbers as that editorial's account [11].

Residual gastric content at upper endoscopy in two retrospective studies summarized in a 2024 editorial

Source: [11] Singh et al., World J Gastrointest Endosc 2024, summarizing Silveira et al. (J Clin Anesth 2023) and a matched case-control study [11]. Studies differ in design and are not comparable with each other.

In the first study, a single-center retrospective analysis, increased residual gastric content was found in 24.2% of semaglutide patients versus 5.1% of controls, and the authors noted that fasting intervals exceeded recommendations. A matched-pair case-control study found gastric residue in 5.4% of people on GLP-1 receptor agonists versus 0.49% of controls [11].

On actual aspiration, the editorial cites a study of 4,134 endoscopies in GLP-1 users with 2 aspiration events, about 4.8 per 10,000. It also cites a historical rate of 4.6 per 10,000 endoscopies regardless of medication. Another retrospective cohort with matched controls found no significant difference in retained food [11]. The editorial describes the evidence as inconclusive and the relationship between residual content and aspiration as unclear. These are retrospective studies of endoscopy, not randomized trials of surgery [11].

What did the American Society of Anesthesiologists say in 2023?

In June 2023, the ASA Task Force on Preoperative Fasting issued consensus-based guidance that suggested clinicians consider holding GLP-1 medicines before elective procedures. The ASA news release is dated June 29, 2023. It suggested considering a hold on the day of the procedure for daily medicines and a week before for weekly ones, regardless of whether the drug was for type 2 diabetes or weight loss [5].

The guidance also described day-of-procedure checks. Severe nausea, vomiting, retching, bloating or abdominal pain should prompt clinicians to consider delaying an elective procedure. If the medicine was not held and there are no symptoms, the team could use full-stomach precautions or a gastric ultrasound. For urgent or emergency cases, the guidance said to treat the patient as having a full stomach. For diabetes, it said to consider consulting an endocrinologist about bridging therapy if a medicine is held longer than its dosing schedule, to avoid high blood sugar [5].

The task force was candid about the evidence. It described the literature as sparse, limited to several case reports, and said it was making suggestions rather than evidence-based standards. ASA's page now notes that in October 2024 the Society issued an Affirmation of Value for a newer multi-society document and points readers to it for current recommendations [5].

What changed in the 2024 multi-society guidance?

The October 2024 guidance shifted from a general suggestion to hold toward individual risk assessment, and said most patients may continue their GLP-1 medicine. It was issued by the American Society of Anesthesiologists, the American Gastroenterological Association, the American Society for Metabolic and Bariatric Surgery, the International Society of Perioperative Care of Patients with Obesity, and the Society of American Gastrointestinal and Endoscopic Surgeons [6][8]. ASA's release is dated October 29, 2024; AGA's, October 30, 2024; the document appeared in Surgery for Obesity and Related Diseases, Surgical Endoscopy and Clinical Gastroenterology and Hepatology [6][8].

Its key points, as summarized by ASA, are listed below [6][7].

  • Most patients at low risk for delayed gastric emptying can continue their GLP-1 medicine for elective surgery.
  • Risk factors include the escalation phase (typically four to eight weeks of increasing doses), higher doses, weekly dosing, current gastrointestinal symptoms, and conditions that slow emptying such as gastroparesis or Parkinson's disease.
  • Patients with nausea, vomiting, abdominal pain, shortness of breath or constipation should generally wait before elective surgery, and those in the escalation phase should generally postpone elective surgery until it ends.
  • For patients whose symptoms or dose suggest delayed emptying, a liquid diet for 24 hours before the procedure can be used, and teams may adjust the anesthesia plan or use point-of-care ultrasound.
  • Withholding a GLP-1 medicine solely because a patient has obesity or overweight could constitute bias and should be avoided.

The authors, led by Kindel and colleagues, state that the document should be considered guidance, not an evidence-based guideline, given limited data. It also says that if a hold is chosen, the best duration is unknown, and that holding must be weighed against high blood sugar and the cost and hypoglycemia risks of bridging therapy [7]. AGA's summary adds that the risk of delayed emptying decreases over time for most patients [8].

What did the 2025 consensus statement add?

A 2025 consensus statement from the Society for Perioperative Assessment and Quality Improvement (SPAQI) used a systematic review and a Delphi process to recommend longer fasting rather than routine stopping. It was published in the British Journal of Anaesthesia (2025;135:48 to 78) by Oprea and colleagues [9].

Its summary findings were that GLP-1 receptor agonists delay emptying of both solids and liquids, that standard ASA fasting guidance is insufficient for these patients, and that suggested fasting is 24 hours for solids and 4 to 8 hours for clear liquids depending on caloric content. It added that stopping long-acting agents for fewer than four to five weeks may not fully restore normal emptying, and it emphasized continuing the medicines in patients without symptoms to preserve blood sugar and cardiovascular benefits [9].

How the major guidance documents differ (all are guidance for clinicians, not patient instructions)
DocumentDatePosition on holdingOther points
ASA consensus-based guidance [5]June 2023Suggested considering a hold: day of procedure for daily drugs, one week before for weekly drugsDelay elective cases with severe GI symptoms; full-stomach precautions in urgent cases; evidence described as sparse
Multi-society guidance (ASA, AGA, ASMBS, ISPCOP, SAGES) [6][7][8]October 2024Most patients may continue; individual risk assessment24-hour liquid diet for some patients; defer elective surgery in escalation phase; avoid bias; not an evidence-based guideline
SPAQI consensus statement, Br J Anaesth [9]2025Continuing emphasized in patients without symptoms24 hours without solids; 4 to 8 hours without clear liquids; systematic review plus Delphi

The documents do not fully agree on detail, which reflects the thin evidence. They agree that the question is about aspiration risk, that symptoms matter, and that the care team should decide case by case.

What should you tell your surgical and anesthesia team?

Tell every member of the team that you take a GLP-1 medicine, and leave the decision about your medicine to them. ASA's patient education page lists what to report [10].

  • Every GLP-1 medicine you use, including combined GLP-1 and GIP products, plus all other medicines and supplements [10].
  • Whether you recently started the medicine or are increasing the dose, since stomach emptying is slower during the escalation phase of roughly four to eight weeks [10].
  • Whether your dose is higher than typically prescribed [10].
  • Any current constipation, nausea, vomiting, stomach pain or trouble breathing, and any condition that slows emptying such as Parkinson's disease [10].
  • In an emergency, if you are awake and alert, that you take a GLP-1 medicine [10].

The same ASA page says not to stop the medicine without medical guidance, because most of the time you can keep taking it as usual, and because stopping can raise blood sugar. It recommends consulting your anesthesiologist, surgeon and the physician who prescribes the medicine [10].

What this means in practice

  • Read the label for your own medicine: all four labels cited here carry a warning about aspiration and ask patients to inform providers before procedures [1][2][3][4].
  • Bring a complete list of medicines to the pre-operative visit, since slowed emptying can also affect how oral medicines are absorbed [1][10].
  • Report the date of your last dose change and any nausea, vomiting, abdominal pain or constipation, because current guidance treats the escalation phase and symptoms as risk factors [6][7].
  • Do not stop, hold or restart your medicine on your own. The surgical, anesthesia and prescribing teams decide, and guidance documents differ on the details [5][7][9][10].
  • Expect extra steps to be possible, such as a liquid diet, longer fasting, ultrasound of the stomach or a changed anesthesia plan, depending on your risk [6][9].
  • Remember the evidence limits: the aspiration reports are rare, the supporting studies are retrospective, and the guidance authors call it guidance rather than an evidence-based guideline [1][7][11].

When to talk to a clinician

Raise your GLP-1 medicine as soon as an operation, endoscopy, colonoscopy or other procedure with sedation is planned, ideally at the first scheduling call. Early notice gives the surgical, anesthesia and prescribing teams time to decide how to proceed. If you develop nausea, vomiting or abdominal pain close to your procedure, contact the team right away rather than waiting for the day itself.

At Healthy Weight Loss 4 U, every program begins with a clinician evaluation, and that evaluation is where to raise any upcoming surgery or procedure. Whether a medicine is right for you, and how it fits around a procedure, is for a licensed clinician to decide in coordination with your surgical and anesthesia teams; nothing here promises an outcome.

Frequently asked questions

Do GLP-1 labels tell patients to stop the drug before surgery?
No. The Zepbound, Wegovy, Ozempic and Mounjaro labels say there have been rare reports of pulmonary aspiration and that available data are insufficient to say whether temporarily stopping the drug or changing fasting rules would help. They instruct patients to inform healthcare providers before planned surgeries or procedures [1][2][3][4].
Why does a slower stomach matter during anesthesia?
Pulmonary aspiration means stomach contents reaching the lungs during general anesthesia or deep sedation. GLP-1 drugs delay gastric emptying, and the labels describe rare reports of aspiration in people who had food left in the stomach despite following fasting instructions [1][2]. Aspiration is reported as rare in the available data [11].
Did ASA tell patients to stop GLP-1 drugs?
ASA's June 2023 guidance suggested clinicians consider holding these drugs, for one day before for daily products and a week before for weekly ones, and described the evidence as sparse [5]. In October 2024 ASA and four other societies issued newer guidance saying most patients may continue, depending on individual risk [6][8]. Your own team decides.
What is the escalation phase and why does it matter?
The escalation phase is the period, typically four to eight weeks, when the dose is being stepped up. The 2024 multi-society guidance associates it with a higher risk of delayed gastric emptying, and ASA's release says elective surgery should generally be postponed until it ends [6][7]. The Zepbound label says the delay is largest after the first dose [1].
What is a liquid diet before a procedure for these patients?
The 2024 multi-society guidance says patients with symptoms or higher-risk dosing may follow a liquid diet for at least 24 hours before the procedure [6][7]. The 2025 SPAQI statement suggests 24 hours without solids and 4 to 8 hours without clear liquids depending on calories [9]. Your procedure team gives your specific instructions.
Does this apply to colonoscopy and endoscopy too?
Possibly. The labels refer to procedures requiring general anesthesia or deep sedation, and the 2024 guidance covers surgery and endoscopy [1][2][8]. Much of the retained stomach content data comes from upper endoscopy studies [11]. Ask the facility scheduling your procedure what it needs from you.
What if I need emergency surgery?
ASA's 2023 guidance said that in urgent or emergent cases, clinicians should treat the patient as having a full stomach and manage accordingly [5]. ASA's patient page says that if you are awake and alert, you should tell the team that you take a GLP-1 medicine [10].

Sources

  1. ZEPBOUND (tirzepatide) injection, prescribing information, Sections 5.9, 7.2, 12.2 (revised 04/2026). U.S. Food and Drug Administration (Drugs@FDA), 2026. www.accessdata.fda.gov/drugsatfda_docs/label/2026/217806Orig1s050lbl.pdf
  2. WEGOVY (semaglutide) prescribing information, Section 5.10 (revised 06/2026). Novo Nordisk, 2026. www.novo-pi.com/wegovy.pdf
  3. OZEMPIC (semaglutide) prescribing information, Section 5.10 (revised 05/2026). Novo Nordisk, 2026. www.novo-pi.com/ozempic.pdf
  4. MOUNJARO (tirzepatide) prescribing information, Section 5.9 (revised 8/2026). Eli Lilly and Company, 2026. uspl.lilly.com/mounjaro/mounjaro.html
  5. American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on GLP-1 Receptor Agonists. American Society of Anesthesiologists (news release dated June 29, 2023), 2023. www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative
  6. Most Patients Can Continue Diabetes, Weight Loss GLP-1 Drugs Before Surgery, Those at Highest Risk for GI Problems Should Follow Liquid Diet Before Procedure. American Society of Anesthesiologists (news release dated October 29, 2024), 2024. www.asahq.org/about-asa/newsroom/news-releases/2024/10/new-multi-society-glp-1-guidance
  7. Multi-society clinical practice guidance for the safe use of glucagon-like peptide-1 receptor agonists in the perioperative period (Kindel et al.). Surgical Endoscopy 39:180-183; doi:10.1007/s00464-024-11263-2, 2025. link.springer.com/10.1007/s00464-024-11263-2
  8. AGA summary of the multisociety GLP-1 perioperative guidance (released October 30, 2024). American Gastroenterological Association, 2024. gastro.org/?p=89260
  9. Perioperative management of patients taking glucagon-like peptide 1 receptor agonists: SPAQI multidisciplinary consensus statement (Oprea et al.). British Journal of Anaesthesia 135(1):48-78; doi:10.1016/j.bja.2025.04.001, 2025. medicine.yale.edu/publication-details/guidelines-for-perioperative-glp-1-receptor-agonist-management/
  10. Drugs for Diabetes or Weight Loss: What To Know Before Surgery. American Society of Anesthesiologists (Made for This Moment patient education), undated, accessed 2026-10-19. madeforthismoment.asahq.org/preparing-for-surgery/risks/drugs-diabetes-weight-loss/
  11. Impact of glucagon-like peptide receptor agonists on endoscopy and its preoperative management: Guidelines, challenges, and future directions (Singh, Suresh Kumar, Aswath). World Journal of Gastrointestinal Endoscopy 16(6):292-296; doi:10.4253/wjge.v16.i6.292, 2024. wjgnet.com/1948-5190/full/v16/i6/292.htm
General information, not medical advice. Results vary and treatment depends on evaluation by a licensed clinician. This article was prepared by the Healthy Weight Loss 4 U Clinical Content Team from the published sources listed above. Nothing here is a recommendation for a specific person, and no treatment is started without an evaluation by a licensed clinician.

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