How long before surgery should Ozempic (semaglutide) be stopped?

Perioperative Management of Ozempic (Semaglutide) Before Surgery

For patients taking Ozempic (semaglutide), it should be discontinued at least 3 weeks before elective surgery to minimize the risk of pulmonary aspiration due to delayed gastric emptying. 1

Rationale for Discontinuation

Ozempic (semaglutide) is a GLP-1 receptor agonist with a long half-life of approximately 7 days. This medication significantly delays gastric emptying, which creates concerns in the perioperative setting:

• Delayed gastric emptying increases risk of pulmonary aspiration during anesthesia induction
• The effect persists even after discontinuation due to the long half-life
• Higher doses used for weight loss may cause more pronounced gastric stasis 1

Timing of Discontinuation

The timing of discontinuation should be based on the drug's pharmacokinetics and the patient's clinical context:

For Weight Loss Indication:

• Stop Ozempic at least 3 weeks before surgery (approximately three half-lives, allowing 88% of the drug to be cleared) 1
• Discontinuation for only 1 week is insufficient to ensure an empty stomach pre-operatively 1

For Diabetes Management:

• Stop Ozempic at least 3 weeks before surgery if possible 1
• For patients with diabetes, consult with the treating endocrinologist regarding:
  • Risk-benefit assessment of early discontinuation
  • Need for alternative glycemic control during the washout period

Special Considerations

Risk Assessment Factors

• Recent initiation or dose increases (higher risk)
• Presence of gastrointestinal symptoms (nausea, vomiting, abdominal distention)
• Concurrent medications that may further delay gastric emptying:
  • Opioids
  • Proton pump inhibitors
  • Tricyclic antidepressants 1

Emergency Surgery

For urgent/emergency surgeries where adequate discontinuation time is not possible:

• Implement aspiration risk reduction strategies
• Consider gastric ultrasonography to assess gastric contents
• Use airway protection with rapid sequence intubation when indicated 1

Resumption After Surgery

Ozempic can typically be resumed once the patient:

• Is eating normally
• Has stable renal function
• Shows no signs of acute illness or metabolic derangement

Comparison with Other Medications

This recommended 3-week discontinuation period for Ozempic is notably longer than many other commonly used medications:

• Antiplatelet agents: 5-7 days 1
• Direct oral anticoagulants: 2-5 days depending on renal function 1, 2
• SGLT2 inhibitors: 3-4 days 3

Clinical Practice Recommendations

1. Document the indication and dose of Ozempic
2. Record when the medication was started and last dose taken
3. Assess for symptoms of delayed gastric emptying
4. For elective procedures, plan for the 3-week washout period
5. Consider prokinetic drugs (metoclopramide, erythromycin) pre-operatively if unable to discontinue for the full recommended period 1
6. Use a shared decision-making approach with patients to discuss risks and benefits

The extended discontinuation period for Ozempic reflects the unique pharmacokinetic properties of semaglutide and the importance of minimizing aspiration risk during surgery while balancing the benefits of glycemic control in patients with diabetes.