You Are on a GLP-1 and Surgery, an Endoscopy or a Colonoscopy Is Booked

Start with the label itself, because it is the same across the class and it is short.

On September 6, 2024 the FDA sent GLP-1 receptor agonist manufacturers a safety labeling change notification under section 505(o)(4) of the Federal Food, Drug, and Cosmetic Act. The resulting supplement for Ozempic (semaglutide, Novo Nordisk, NDA 209637/S-032) was approved on November 1, 2024, and equivalent revisions followed across the class. The current Ozempic and Wegovy labels carry the warning as section 5.10; the Mounjaro and Zepbound (tirzepatide, Eli Lilly) labels carry it as section 5.9. The text is near-identical. The Zepbound version reads:

"ZEPBOUND delays gastric emptying. 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. Available data are insufficient to inform recommendations to mitigate the risk of pulmonary aspiration during general anesthesia or deep sedation in patients taking ZEPBOUND, including whether modifying preoperative fasting recommendations or temporarily discontinuing ZEPBOUND could reduce the incidence of retained gastric contents. Instruct patients to inform healthcare providers prior to any planned surgeries or procedures if they are taking ZEPBOUND."

Two things in that paragraph matter most. The reports are described as rare. And the FDA states plainly that it does not know whether stopping the medication, or changing the fasting rules, reduces the risk. The label therefore gives patients one instruction: tell your healthcare providers before any planned procedure.

The Medication Guide in your carton says the same in plain language — the medicine may increase the chance of food getting into your lungs during surgery or other procedures, so tell all your healthcare providers before you are scheduled for one. The European label agrees: section 4.4 of the EMA Summary of Product Characteristics for Wegovy states that cases of pulmonary aspiration have been reported in patients receiving GLP-1 receptor agonists undergoing general anaesthesia or deep sedation, and that the increased risk of residual gastric content should be considered before such procedures.

Semaglutide and tirzepatide both slow the rate at which the stomach passes food onward; the labels state this in their clinical pharmacology sections, and it is part of why the medicines reduce appetite. In everyday life that produces the familiar fullness and, in the early weeks, the nausea most people on these drugs recognize.

Under anesthesia the same property becomes a safety question. When you are put to sleep or deeply sedated, the reflexes that normally keep stomach contents out of the airway are switched off, and fasting rules exist so the stomach is empty by then. The postmarketing reports the FDA describes are cases where a patient had fasted exactly as instructed and still had food or liquid in the stomach, because the medicine had slowed the clock. Pulmonary aspiration — stomach contents reaching the lungs — is the outcome the anesthesia team is trying to prevent.

This is why the warning covers deep sedation and not only general anesthesia. Colonoscopies and upper endoscopies are performed at a range of sedation depths, which is why the gastroenterology societies published guidance on this setting before the label changed.

It is also why your recent symptoms are relevant information. The 2024 multisociety guidance lists nausea, vomiting, abdominal pain, dyspepsia and constipation as symptoms suggestive of delayed gastric emptying, and notes the risk is higher during dose escalation than at a stable maintenance step, and higher with weekly than daily formulations. Whether that applies to you is for the team to assess; your job is to describe it accurately.

Because the label declines to recommend a fix, the practical guidance sits with the professional societies, and it has moved.

On June 29, 2023 the American Society of Anesthesiologists published consensus-based guidance on the preoperative management of adults and children on GLP-1 receptor agonists. It described the evidence as sparse and limited to case reports, suggested holding the medication before elective procedures with different handling for daily and weekly products, and advised that urgent or emergency surgery proceed with the patient treated as having a full stomach. We are deliberately not reproducing the intervals it proposed: a number lifted from a 2023 document and applied without an anesthesiologist is exactly the misuse this page exists to prevent.

In November 2023 the American Gastroenterological Association issued a Rapid Clinical Practice Update (Hashash, Thompson and Wang, Clinical Gastroenterology and Hepatology) on managing patients on GLP-1 receptor agonists before endoscopy, building on an August 2023 statement from five GI societies — the AGA, AASLD, ACG, ASGE and NASPGHAN — that found no data to support stopping GLP-1 agonists before elective endoscopy and encouraged endoscopists to exercise best practices in the absence of actionable data.

Then, on October 29, 2024, a multisociety clinical practice guidance was published — Kindel and colleagues, representing 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. The paper also records that the American Society of Anesthesiologists Administrative Council affirmed the value of this document in May 2024. Its central statement is that GLP-1 receptor agonist therapy may be continued preoperatively in patients without elevated risk of delayed gastric emptying and aspiration. For patients who carry that risk it describes tools the team can use, including a liquid-only diet before the procedure and point-of-care gastric ultrasound to check the stomach directly, and it frames the decision as shared between the patient and the procedural, anesthesia and prescribing teams.

The honest summary: the 2023 ASA guidance leaned toward holding; the 2024 multisociety guidance, which the ASA affirmed, leans toward continuing for most people with a risk assessment for the rest. Which one your hospital follows, and how it applies to you, is not something a website can tell you.

The hold-or-continue question has three parties, and you are the one who connects them.

The anesthesia team owns airway safety on the day: fasting instructions, the sedation plan and any extra precautions. The prescriber owns the medication plan: whether a pause is acceptable for your diabetes or weight management, what happens to a titration schedule if a dose is skipped, and how you restart. The surgeon or endoscopist owns the procedure and usually books your pre-operative assessment.

None of them can act on information they have not been given. Every GLP-1 label puts one instruction on you — inform your healthcare providers before any planned procedure — and the useful version of it is early. Mention it when the procedure is booked, repeat it at the pre-operative assessment, and say it again to the nurse on the day. Duplicated information costs nothing; missing information can cancel a procedure at the door.

If you are seeing your prescriber before the date, put the procedure at the top of the list. The practical questions in questions to ask at your GLP-1 follow-up include what to do before a planned procedure, and this is the appointment to ask it. If the surgical team and the prescriber have not spoken to each other, you are allowed to ask them to.

This site does not tell you how many days to hold, whether to skip your next injection or when to restart. The FDA label says the data to answer those questions are insufficient, and the people with your chart in front of them are the only ones who can fill the gap.

Pre-operative assessments are short and the medication section is a checklist. Exact answers make it a one-minute conversation instead of a follow-up phone call.

Bring the product name and strength exactly as printed on the pharmacy label, and the carton if there has been any confusion about which product or step you are on. Bring the date and time of your last dose, not the day you were meant to take it. Bring how long you have been at the current step, because the 2024 guidance treats the escalation phase differently from a stable maintenance phase. Bring a plain description of what you have felt in the last couple of weeks — nausea, vomiting, bloating, feeling full for hours after a small meal, constipation — with rough dates. And bring the full list of everything else you take, including over-the-counter items and supplements.

Those are also the things worth logging from today until the procedure: each dose with its date and time; each episode of fullness, nausea or vomiting, with the day and what you had eaten; and any change the team asks you to make, written down with who asked and when, so the prescriber and the anesthesia team work from the same record.

This is the practical layer GLP-1 Tracker is built for. It keeps dose dates and times, injection sites and your own notes in one place on your iPhone, and the guide to preparing a GLP-1 summary for your doctor walks through turning that into a page you can hand over. What the app does not contain is any rule about procedures: it will never suggest pausing, never prompt a restart, and its educational medication-level view is an illustration built from what you logged, not a measurement the anesthesia team should look at.

If a dose has already slipped in the run-up to the date, do not try to correct it yourself; tell the team, and see what to do about a missed GLP-1 dose for what to have ready when you make that call.

If the team asked you to pause, they will also tell you when and how to resume, and that instruction belongs with the prescriber rather than being improvised at home. After a gap, prescribers sometimes revisit where a person restarts — the missed-dose page covers why that is a clinical question rather than a calendar one — and the answer can differ depending on how long the pause was and which step you were on.

The days after surgery or a colonoscopy are also days when nausea, poor appetite and constipation are common for reasons unrelated to a GLP-1: anesthesia, pain medication, bowel preparation and a disrupted routine all contribute. Keep logging what you feel and when; if the picture has not cleared by the time you speak to the prescriber, dated notes are what separate a post-procedure hangover from a medication question.

If the experience raised a question you did not get to ask — whether this will happen every time, whether a different plan is possible next time — write it down for the next appointment. Procedures on a GLP-1 are now routine enough that clinics have answers ready; they simply need to be asked.