When to Stop GLP-1 Before Surgery: Current Guidelines for Every Medication (2026)

Quick-Reference: GLP-1 Medications and Surgery Hold Times

If your surgeon or anesthesiologist tells you to hold your medication, here are the timelines based on the 2023 ASA consensus guidance (still the most commonly referenced framework for hold timing):

Hold times based on 2023 ASA Consensus-Based Guidance on Preoperative Management of Patients on GLP-1 Receptor Agonists. The 2024 Multi-Society Clinical Practice Guidance introduced a risk-based approach where most patients may continue. Always follow your specific surgical team's instructions.

A Closer Look at Each Medication

Not all GLP-1s are identical. Here's what matters for surgical timing with each one.

Why Do GLP-1 Medications Matter Before Surgery?

GLP-1 medications — Ozempic, Wegovy, Mounjaro, Zepbound, and others — work partly by slowing down how fast your stomach empties food. That's actually a feature, not a bug. It's one of the reasons you feel full longer and eat less. For diabetes management, it helps smooth out blood sugar spikes after meals.

But here's where it gets tricky with surgery.

Before any procedure that uses general anesthesia or deep sedation, your stomach needs to be as empty as possible. That's why every patient is told to fast — usually no solid food for 6 to 8 hours and no clear liquids for 2 hours before the procedure. When you're under anesthesia, your normal gag and cough reflexes are turned off. If there's food or liquid sitting in your stomach, it can flow backward into your esophagus and get inhaled into your lungs. This is called aspiration, and it can cause aspiration pneumonia — a serious, sometimes life-threatening complication.

GLP-1 medications can make the standard fasting period insufficient for some patients. Even after following the usual “nothing to eat after midnight” instructions, food may still be sitting in your stomach because of delayed gastric emptying.

What Aspiration Actually Looks Like (And Why It's Taken Seriously)

When we say “aspiration,” here's what that means in practice. During anesthesia, if food or stomach acid flows backward from your stomach into your throat and gets inhaled into your lungs, it causes a chemical burn to the lung tissue. This can lead to:

• Aspiration pneumonia — a lung infection caused by bacteria from the stomach contents. This can require ICU admission, IV antibiotics, and mechanical ventilation.
• Acute respiratory distress syndrome (ARDS) — in severe cases, the lung damage triggers widespread inflammation that makes breathing extremely difficult.
• Airway obstruction — solid food particles can physically block airways.

The severity ranges from mild (a small amount of clear fluid that the lungs can clear) to life-threatening (a large volume of particulate matter that causes bilateral pneumonia). The reason every surgical team takes this seriously is that even though it's rare, the consequences when it DOES happen can be devastating.

The FDA updated the labels on all GLP-1 receptor agonists in late 2024 to reflect this (most labels revised November 2024; Zepbound revised December 2024). The new warning section reads: “There have been rare postmarketing reports of pulmonary aspiration in patients receiving GLP-1 receptor agonists undergoing elective surgeries or procedures requiring general anesthesia or deep sedation who had residual gastric contents despite reported adherence to preoperative fasting recommendations.” (FDA prescribing information for Ozempic, Wegovy, Mounjaro, Zepbound, Saxenda, Victoza, Trulicity — revised late 2024.)

Here's the nuance most pages don't tell you: This effect on gastric emptying is usually strongest during the first weeks of treatment — the dose-escalation phase — when side effects like nausea and bloating are most common. Over time, most patients develop what doctors call tachyphylaxis: the gastric-slowing effect diminishes as your body adjusts to the medication. The ASA's own consensus document acknowledges that the effects on gastric emptying “are reported to be reduced with long-term use.” So someone who has been on a stable dose for six months with no GI symptoms is in a very different position from someone who just started their first dose three weeks ago.

What Are the Current Guidelines? (And Why They Keep Changing)

This is the part that confuses everyone — and honestly, it's confusing for good reason. The guidelines have changed significantly over the past three years, and not every hospital or surgeon has caught up. If you feel like you're getting conflicting advice, you probably are. Here's why.

*Visual summary of guideline evolution. See detailed breakdown below.*

The 2023 ASA Consensus Guidance: “Hold It”

In June 2023, the American Society of Anesthesiologists released the first formal guidance on GLP-1s and surgery. Their recommendation was straightforward:

• Daily GLP-1s (Rybelsus, Saxenda, Victoza, Byetta): Hold on the day of the procedure.
• Weekly GLP-1s (Ozempic, Wegovy, Mounjaro, Zepbound, Trulicity): Hold for 7 days before the procedure.

These applied regardless of whether you take the medication for diabetes or weight loss, regardless of dose, and regardless of surgery type. If the medication wasn't held and the patient had no GI symptoms, they recommended “full stomach precautions” or using a gastric ultrasound to check stomach contents.

The catch: The ASA was transparent that this guidance was based on “sparse” evidence — “limited only to several case reports.” They were being cautious, which made sense. But it meant every surgeon's office started telling patients to hold their GLP-1 for a week, no questions asked.

This guidance is still the most commonly cited framework. Many hospitals haven't updated their pre-op protocols yet, which is why you'll still see “stop 7 days before” on a lot of paperwork and websites.

(Source: American Society of Anesthesiologists, “Consensus-Based Guidance on Preoperative Management of Patients on Glucagon-Like Peptide-1 Receptor Agonists,” published June 29, 2023.)

The 2024 Multi-Society Update: “Most Can Continue”

In October 2024, five major medical societies — the ASA, AGA, ASMBS, ISPCOP, and SAGES — jointly published updated guidance that represented a significant shift. Their headline recommendation:

Most patients should continue taking their GLP-1 medication before elective surgery.

Instead of a blanket “hold for everyone,” they introduced a risk-based approach:

• Low risk (stable dose, no GI symptoms, no other gastric emptying conditions): Continue your GLP-1 as prescribed. Proceed with standard fasting.
• Elevated risk (dose escalation phase, higher doses, mild GI symptoms): A 24-hour liquid-only diet before surgery, along with potential adjustments to the anesthesia plan (like rapid sequence induction) and possible day-of gastric ultrasound.
• High risk (active severe GI symptoms like vomiting, bloating, abdominal pain): Consider delaying elective surgery until symptoms resolve.

If a hold IS needed, they deferred to the original ASA timing: day-of for daily, 7 days for weekly.

The guidance also raised an important point that gets overlooked: withholding GLP-1 medications carries its own risks. For diabetic patients, stopping can cause dangerous blood sugar spikes. Withholding only from obese or overweight patients “could constitute bias or discrimination,” the guidance noted. And for many patients, insurance and cost logistics make stopping and restarting complicated.

(Source: “Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period,” published in Clinical Gastroenterology and Hepatology, Surgical Endoscopy, and Anesthesiology, October 29, 2024.)

The 2025 AAOS Meeting Abstract: “14 Days for Joint Replacement”

In March 2025, a study presented at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting added another data point. Researchers used the TriNetX database to study patients who took Ozempic (semaglutide) before total hip or knee replacement surgery and found that shorter cessation intervals were linked to higher anesthesia complications:

• Delayed emergence from anesthesia: Elevated risk when last Ozempic dose was 5, 3, or 1 day(s) before surgery.
• Aspiration: Elevated risk at 7, 5, 3, and 1 day(s) before surgery.
• Aspiration pneumonitis: Elevated risk at 7, 5, and 1 day(s) before surgery.
• Conversion to intubation: Elevated risk at 7, 5, 3, and 1 day(s) before surgery.
• Patients who continued Ozempic through surgery had the highest risk for all complications studied.

The researchers' conclusion: for total joint arthroplasty, ceasing GLP-1A 14 days before surgery was optimal for minimizing these complications in this cohort.

(Source: “Optimal Timing for Cessation of GLP-1 Agonist Before Elective Total Hip and Knee Arthroplasty,” presented at AAOS 2025 Annual Meeting, published via TriNetX Research Network data.)

The Peer-Reviewed Meta-Analysis: “Maybe We're Overreacting”

On the other end of the spectrum, a 2024 systematic review and meta-analysis published in the American Journal of Gastroenterology (led by researchers at Brigham and Women's Hospital and Houston Methodist) quantified how much GLP-1 medications actually delay gastric emptying. They included 15 studies that met criteria. In the five studies using gastric emptying scintigraphy (the gold-standard test, 247 patients), GLP-1 RA delayed gastric emptying by approximately 36 minutes on average compared to placebo. On liquid-emptying tests, there was no significant delay at all.

The researchers concluded that while the delay is measurable, it's relatively modest compared to the 6- to 8-hour fasting periods required before surgery.

Separately, the Houston Methodist blog summary of related research noted a database analysis estimating aspiration risk at roughly 3 in 100,000 patients on GLP-1s — though this specific figure should be treated as a rough estimate, not a definitive rate, as the underlying study details were not fully published.

(Sources: Hiramoto B, McCarty TR, et al. “Quantified Metrics of Gastric Emptying Delay by Glucagon-Like Peptide-1 Agonists.” American Journal of Gastroenterology, June 2024. PubMed ID: 38634551. Houston Methodist Hospital blog summary, July 2024.)

The Guideline Comparison Matrix

Here's every major guideline in one place so you can see exactly where they agree and where they differ:

This table is why the advice you're getting seems inconsistent. Different providers are following different guidelines — and some hospitals haven't updated their protocols since 2023. None of them are “wrong” per se. They're working with different evidence and different risk tolerance.

What This All Means for You

The guidance has evolved from “always hold” (2023) to “individualized risk assessment” (2024) to “even longer for certain surgeries” (2025), with some researchers questioning whether a blanket hold is needed at all.

Here's our honest take: The truth is somewhere in the middle. The aspiration risk is real but rare. The guidelines are moving toward a more nuanced, risk-based approach. And the most important thing you can do is communicate with your surgical team and let them make the call for YOUR specific situation.

If your surgeon's office tells you to hold for 7 days, that's based on established guidance — follow it. If your anesthesiologist says you can continue with a liquid diet modification, that's based on the newer guidance — follow that. What you should NOT do is make the decision on your own or hide your medication use from your team.

Are You Higher Risk or Lower Risk? A Quick Self-Check

The 2024 multi-society guidance and the ASA's patient-facing information both identify specific factors that increase concern about delayed gastric emptying before surgery. This isn't a formal medical assessment — it's a starting point for the conversation with your team.

*Visual risk assessment guide. Always discuss your individual situation with your surgical team.*

If you fall into the lower-risk category, the 2024 multi-society guidance says you may be able to continue your GLP-1 with standard fasting protocols. But — broken record alert — discuss it with your surgical team.

(Sources: ASA patient guidance at madeforthismoment.asahq.org; 2024 Multi-Society Clinical Practice Guidance.)

Does the Type of Surgery Matter?

Yes, significantly. Here's how the guidance breaks down by procedure type.

*Surgery-type-specific guidance overview. Individual instructions from your team take priority.*

Elective Surgery Under General Anesthesia

This is where the bulk of the guidance applies. Follow the risk-based approach above. If you're lower risk, you may continue with standard fasting (or a 24-hour liquid diet if your team prefers extra caution). If you're higher risk, your team may hold the medication, adjust the anesthesia plan, or use a day-of gastric ultrasound.

Endoscopy and Colonoscopy

The American Gastroenterological Association addressed this separately. For endoscopy, GLP-1 medications generally do not need to be stopped, especially for patients taking them for diabetes (where maintaining blood sugar control is important). Standard colonoscopy prep — which already involves a liquid diet and bowel prep — typically takes care of the gastric emptying concern.

If you have severe GI symptoms, your gastroenterologist may recommend additional precautions or consider a transabdominal ultrasound to check stomach contents before the procedure.

(Source: AGA Rapid Clinical Practice Update on Management of Patients Taking GLP-1 Receptor Agonists Prior to Endoscopy.)

Joint Replacement (Hip and Knee)

Based on the 2025 AAOS study, 14 days may be the optimal hold time for semaglutide before total joint arthroplasty. This is more conservative than the standard 7-day recommendation, and it's specific to this surgery type. If you're scheduled for hip or knee replacement and you're on Ozempic or Wegovy, bring this study up with your orthopedic surgeon.

Plastic Surgery (Tummy Tuck, BBL, Breast Augmentation, etc.)

Plastic surgeons tend to be the most conservative. Many require holding GLP-1s for 2 to 4 weeks before surgery. There are actually two reasons for this — not just one.

The aspiration risk is the obvious concern. But the second issue is nutritional status. GLP-1 medications reduce appetite significantly, and some patients — especially those who've lost weight rapidly — develop nutritional deficiencies that impair wound healing. If your body doesn't have adequate protein, vitamins, and minerals, surgical incisions take longer to heal, infection risk goes up, and aesthetic outcomes can suffer.

Some plastic surgeons require:

• Pre-albumin blood tests several months before surgery to check protein status
• A high-protein nutritional shake daily starting one week before surgery and continuing two weeks after
• A complete metabolic panel to check for other deficiencies
• A minimum of 4 weeks off GLP-1 before surgery, with 4 to 6 weeks before restarting after

If you've been eating very little due to your GLP-1's appetite suppression, your surgeon needs to know that. It directly affects your body's ability to recover.

Bariatric Surgery (Gastric Sleeve, Gastric Bypass)

This is a nuanced situation because you're likely on a GLP-1 for weight loss, and the bariatric surgeon may have recommended it as part of your pre-surgical weight loss plan. A liquid diet before bariatric surgery is already standard practice, which partially addresses the gastric emptying concern. The multi-society guidance authors include bariatric surgeons (ASMBS), so the risk-based framework was designed with these patients in mind. Follow your bariatric surgeon's protocol.

Dental Surgery Under IV Sedation or General Anesthesia

Routine dental work with local anesthesia (novocaine, lidocaine) has no relevance to GLP-1 concerns. But dental surgery under IV sedation or general anesthesia — such as wisdom tooth extraction or oral surgery — falls under the same guidelines as any other sedation procedure. Tell your oral surgeon and the anesthesia provider about your GLP-1 use.

Minor Procedures Under Local Anesthesia Only

If your procedure uses only local anesthesia (like a dermatological procedure, dental work with local numbing, or an office-based procedure with no sedation), the aspiration risk doesn't apply. Your protective airway reflexes stay intact. You can generally continue your GLP-1 as usual. Still tell your provider — it's good practice.

Emergency Surgery

There's no time to hold. The surgical team will treat you as a “full stomach” patient and take precautions accordingly — typically rapid sequence induction for intubation. If you're awake and able to communicate, tell the emergency team immediately that you're on a GLP-1. This changes how they manage your airway.

What If You Already Took Your Dose and Surgery Is Soon?

This is one of the most common — and most anxiety-inducing — situations. You took your weekly Ozempic injection three days ago, and your surgery is tomorrow. Or you just realized you were supposed to hold it and didn't.

First: Don't panic. And don't hide it.

Hiding your GLP-1 use from your surgical team is far more dangerous than disclosing it. If they don't know, they can't take precautions. If they do know, they have options.

What Your Anesthesiologist Can Do

If you disclose that you took your GLP-1 recently and it wasn't held as recommended, here's what typically happens:

1. They assess your symptoms. No nausea, no bloating, no vomiting? That's a good sign.
2. They may use a point-of-care gastric ultrasound to literally look at your stomach and see if there's residual food or liquid. If your stomach is empty, they can proceed normally.
3. They may proceed with “full stomach precautions.” For general anesthesia, this means rapid sequence induction — a faster intubation technique designed to protect your airway.
4. For sedation cases, they may recommend switching to general anesthesia (which allows for airway protection) or rescheduling.
5. In rare cases, they may postpone the surgery — but only if the risk is deemed too high and the procedure isn't urgent.

Will You Gain Weight If You Stop for Surgery?

We know this is a real concern. It's the question people feel embarrassed to ask, but it matters — because some patients avoid disclosing their GLP-1 use to their surgeon because they're afraid of being told to stop.

For a 1- to 2-week hold: Unlikely to cause meaningful weight regain. The medication's appetite-suppressing effects don't disappear overnight. You may notice slightly increased hunger as the drug wears off, but 7 to 14 days is not enough to undo months of progress.

Obesity specialist Dr. Louis Aronne has noted that after stopping a GLP-1 for weight management, noticeable changes typically take about a month to appear. A short surgical hold is well within that buffer.

For a 3- to 4-week hold (as some plastic surgeons require): You may experience more noticeable hunger and potentially a few pounds of fluctuation. This is temporary and reversible once you restart.

The bottom line: A temporary hold for surgical safety is not going to derail your weight loss journey. But hiding your medication from your surgeon could put your life at risk. Please don't make that trade.

What If You Take GLP-1 for Diabetes?

This is more medically complex. Stopping your GLP-1 will affect blood sugar control. Uncontrolled blood sugar heading into surgery carries its own serious risks, including infection and poor wound healing.

Both the 2023 ASA guidance and the 2024 multi-society update address this directly: If your GLP-1 is held for longer than one dosing cycle, consult your endocrinologist or prescribing doctor about bridging therapy — an alternative diabetes medication to keep blood sugar in range during the hold period.

This is one of the strongest reasons the 2024 guidance shifted toward letting most patients continue: the risks of uncontrolled blood sugar can be just as concerning as the risks of delayed gastric emptying.

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If Your Team Says Continue: What to Do Before Surgery

Even if you're cleared to keep taking your GLP-1, your team may recommend extra precautions. Here's what that looks like in practice.

The 24-Hour Liquid Diet (Exactly What It Means)

If you're on a higher dose or your team wants additional risk reduction, you may be asked to follow a 24-hour liquid-only diet before surgery. This is the same concept as colonoscopy prep — give your stomach extra time to empty completely.

Standard Fasting Rules Still Apply

Even if you're continuing your GLP-1, you still follow your team's standard fasting instructions. Typically: no solid food for 6 to 8 hours before surgery, no clear liquids for 2 hours before. These rules exist for ALL patients, not just those on GLP-1s.

Restarting Your GLP-1 After Surgery

This is the question that almost every other page on this topic either skips or answers vaguely. Here's what we know.

When to Restart

There are no formal universal guidelines on exact restart timing. The general principle: restart when you can eat and drink normally without significant nausea or vomiting, and your surgical team gives clearance.

Factors that may delay your restart:

• Surgery involved your GI tract (stomach, intestines) — you may need longer for your gut to recover.
• You're on opioid pain medications post-surgery — opioids also slow gastric emptying. Adding a GLP-1 on top of that can compound the effect.
• You can't tolerate solid food yet — if you're still on IV nutrition or having significant nausea.
• Your surgeon has a specific protocol — especially common after plastic surgery (some require 4 to 6 weeks post-op before resuming).

Do You Need to Re-Titrate?

If you held for less than 2 to 3 weeks, you can usually restart at the same dose you were on. If you held for 4 or more weeks, your prescribing provider may recommend starting at a lower dose and titrating back up to reduce the chance of GI side effects when you restart. Think of it like getting re-acclimated.

Ask your prescribing doctor specifically: “I held my [medication] for [X weeks] for surgery. Should I restart at my previous dose or at a lower dose?”

Your Pre-Surgery GLP-1 Checklist

Print this, screenshot it, or save it to your phone. It covers every step from the moment surgery is scheduled to the day after.

What If You Get Conflicting Instructions?

This happens more often than you'd expect. Your prescribing doctor says continue. Your surgeon says hold for two weeks. Your pre-op packet doesn't mention GLP-1s at all. The nurse on the phone isn't sure. Now you're stuck.

Here's how to handle it:

1. Don't try to resolve it yourself. You shouldn't have to be the referee between your medical providers.
2. Ask the higher-risk provider to coordinate. Usually, that's the anesthesiologist. Call the surgical team and say: “I'm getting different instructions about my GLP-1 from my prescriber and your office. Can my anesthesiologist and my prescribing doctor coordinate directly?”
3. When in doubt, the more conservative approach is usually safer. If one provider says continue and another says hold, holding for the recommended period is unlikely to cause harm (except in diabetic patients where blood sugar management is a concern — and that's precisely why the providers need to talk to each other).
4. Get the final answer in writing. A MyChart message, an email, or written instructions. You want clarity, not a game of telephone.

The underlying problem: Many hospitals haven't updated their pre-op protocols since 2023. The nurse reading from a form may be giving you 2023 guidance, while your endocrinologist is aware of the 2024 update. This is a systems problem, not a “someone is wrong” problem. The fix is direct communication between your providers.

Other Medications to Know About Before Surgery

While we're focused on GLP-1s here, you should know that they're not the only medications that get adjusted before surgery. If you're on any of these, mention them to your surgical team as well:

• SGLT2 inhibitors (Jardiance, Invokana, Farxiga): Typically held 3 to 4 days before surgery due to risk of diabetic ketoacidosis.
• Metformin: Often held 1 to 2 days before surgery, especially if you're having a procedure involving contrast dye or if there's risk of kidney stress.
• Blood thinners (Eliquis, Xarelto, Coumadin, aspirin): Hold times vary by medication and procedure — your surgeon will give specific instructions.
• Insulin: Requires a customized plan, usually in coordination with your endocrinologist. Do NOT stop insulin on your own.

If you take multiple medications for diabetes or weight management, make sure your surgical team has the complete list — not just the GLP-1.

What About Compounded Semaglutide or Tirzepatide?

If you're using compounded semaglutide or compounded tirzepatide from a compounding pharmacy (rather than brand-name Ozempic, Wegovy, Mounjaro, or Zepbound), the same pre-surgery guidelines apply. Compounded formulations are not FDA-approved but work through the same mechanism of action. The gastric-emptying effect is the same concern for anesthesia regardless of the product source.

Treat it identically for surgery purposes. And make sure to tell your surgical team the exact dose and how often you're taking it — compounded formulations may have different concentrations than brand-name products.

Looking for a provider? See our verified comparison of telehealth GLP-1 programs.

Frequently Asked Questions: GLP-1 Medications and Surgery

The Real-World Timeline: Putting It All Together

To make all of this practical, here's how the timeline actually works for the most common scenarios — someone on a weekly GLP-1 (like Ozempic, Wegovy, Mounjaro, or Zepbound) with elective surgery coming up.

What to Do Next

The 5 things that matter most — everything else is detail:

1. Tell your surgical team you're on a GLP-1. Name, dose, frequency, last dose date. Do it the moment surgery is scheduled — not the day of.
2. Ask specifically whether to hold or continue. Don't assume either way. Get clear instructions.
3. If you have GI symptoms, report them immediately. Nausea, vomiting, bloating, or abdominal pain can change the plan.
4. If you're diabetic, coordinate bridging therapy. Don't hold your GLP-1 without a backup plan for blood sugar.
5. Follow YOUR team's instructions. Not the internet's. Not your friend's. Not ours. Your surgical team knows your case.

You now know more about GLP-1 medications and surgery than 99% of patients walking into a pre-op appointment. Use that knowledge. Call your surgical team. Ask the right questions. Bring the checklist.

And if you're looking for a GLP-1 provider — whether you're starting for the first time, restarting after surgery, or switching from a compounding pharmacy to a telehealth platform — we've compared the top options with verified pricing and honest reviews.

Verified pricing. Honest reviews. No hidden costs.

How We Researched This Guide

We built this guide by synthesizing every current authoritative source on GLP-1 medications and surgery:

• ASA 2023 Consensus-Based Guidance on Preoperative Management of Patients on GLP-1 Receptor Agonists (published June 2023)
• 2024 Multi-Society Clinical Practice Guidance from ASA, AGA, ASMBS, ISPCOP, and SAGES — published in Clinical Gastroenterology and Hepatology, Surgical Endoscopy, and Anesthesiology (October 2024)
• ASA Patient-Facing Guidance at madeforthismoment.asahq.org — “Drugs for Diabetes or Weight Loss: What To Know Before Surgery” (medically reviewed, updated October 2025)
• 2025 AAOS Study — “Optimal Timing for Cessation of GLP-1 Agonist Before Elective Total Hip and Knee Arthroplasty,” presented at AAOS 2025 Annual Meeting (March 2025)
• Houston Methodist Meta-Analysis — published in American Journal of Gastroenterology (June 2024)
• Cleveland Clinic Journal of Medicine — “Should glucagon-like peptide 1 receptor agonists be withheld during the preoperative period?” (April 2025)
• FDA Prescribing Information for Ozempic, Wegovy, Rybelsus, Mounjaro, Zepbound, Saxenda, Victoza, Trulicity — specifically Section 5.9/5.10/5.11 (Pulmonary Aspiration During General Anesthesia or Deep Sedation), updated November 2024
• PMC Review Articles on GLP-1 receptor agonists and perioperative management

We review and update this guide when new guidelines, studies, or FDA label changes are published. All medical information is verified against primary sources. This content is not medical advice — always follow your specific surgical team's instructions.

Sources

1. American Society of Anesthesiologists. “Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists.” Published June 29, 2023. asahq.org
2. Kindel TL, Wang AY, Wadhwa A, et al. “Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period.” Clinical Gastroenterology and Hepatology; Surgical Endoscopy; Anesthesiology. Published October 29, 2024. PMC (free full text)
3. American Society of Anesthesiologists. “Drugs for Diabetes or Weight Loss: What To Know Before Surgery.” Made For This Moment. asahq.org
4. Chokshi SN, Hou N, Ford MC, et al. “Optimal Timing for Cessation of GLP-1 Agonist Before Elective Total Hip and Knee Arthroplasty.” Presented at AAOS 2025 Annual Meeting, March 2025. Abstract PDF
5. Hiramoto B, McCarty TR, et al. “Quantified Metrics of Gastric Emptying Delay by Glucagon-Like Peptide-1 Agonists: A Systematic Review and Meta-Analysis.” American Journal of Gastroenterology, June 2024;119(6):1126-1140. PubMed
6. FDA Prescribing Information for Ozempic (semaglutide injection). Section 5.9/5.10: Pulmonary Aspiration During General Anesthesia or Deep Sedation. Revised November 2024. accessdata.fda.gov
7. FDA Prescribing Information for Wegovy (semaglutide injection). Section 5.11. Revised November 2024. accessdata.fda.gov
8. FDA Prescribing Information for Zepbound (tirzepatide injection). Revised December 2024. accessdata.fda.gov
9. FDA Prescribing Information for Rybelsus (semaglutide tablets). Section 5.9. Revised November 2024. accessdata.fda.gov
10. American Gastroenterological Association. “Most patients can continue GLP-1 anti-obesity drugs before surgery.” October 30, 2024. gastro.org
11. KFF Health Tracking Poll. “Prescription Drug Costs, Views on Trump Administration Actions, and GLP-1 Use.” November 2025. kff.org
12. Cleveland Clinic Journal of Medicine. “Should glucagon-like peptide 1 receptor agonists be withheld during the preoperative period?” April 2025. ccjm.org
13. UCLA Health. “Medications to Stop Before Surgery — Endocrine Surgery.” uclahealth.org