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

Perioperative Management of Ozempic (Semaglutide) Before Surgery

For patients taking weekly Ozempic (semaglutide), discontinuation is recommended at least 3 weeks before elective surgery to allow for adequate drug clearance and minimize the risk of pulmonary aspiration. 1

Rationale for Discontinuation

GLP-1 receptor agonists like semaglutide significantly delay gastric emptying, which increases the risk of pulmonary aspiration during anesthesia induction. This risk is particularly concerning in the perioperative setting:

• Semaglutide has a long half-life of approximately 7 days 1
• Studies show an association between perioperative GLP-1 RA use and increased risk of pulmonary aspiration (OR 10.23,95% CI 2.94-35.82) 1
• The Pharmacovigilance Risk Assessment Committee of the European Medicines Agency has highlighted the gastric emptying delay as a significant concern 1

Recommended Timing Based on Indication

For Patients Taking Ozempic for Weight Loss:

• Stop at least 3 weeks (three half-lives) before surgery 1
• This allows approximately 88% of the drug to be cleared from the system
• Benefits of discontinuation outweigh risks in this population

For Patients Taking Ozempic for Diabetes Management:

• Consult with the treating endocrinologist regarding the optimal timing of discontinuation 1
• Consider the balance between aspiration risk and glycemic control
• Generally, still aim for at least 3 weeks (three half-lives) discontinuation when possible 1
• Discuss alternative diabetes management strategies during the perioperative period

Risk Assessment Factors

Several factors should be considered when determining the exact timing of Ozempic discontinuation:

• Recent initiation or dose increase: Higher risk of delayed gastric emptying
• Presence of gastrointestinal symptoms: Nausea, vomiting, or abdominal distention indicates higher risk
• Co-prescribed medications: Opioids, proton pump inhibitors, and tricyclic antidepressants can further delay gastric emptying 1
• Urgency of surgery: Emergency procedures may not allow for optimal discontinuation timing

Risk Mitigation Strategies

If Ozempic cannot be discontinued for the recommended period before surgery:

1. Consider using point-of-care gastric ultrasound to assess residual gastric contents 1
2. Implement rapid sequence intubation to reduce aspiration risk 1
3. Consider prokinetic medications (e.g., metoclopramide) preoperatively 1
4. In high-risk patients, consider gastric decompression 1

Common Pitfalls to Avoid

• Insufficient discontinuation time: The American Society of Anesthesiologists' recommendation of stopping weekly GLP-1 RAs just 1 week before surgery may be inadequate for semaglutide given its 7-day half-life 1
• Overlooking tachyphylaxis: Long-term users may have some adaptation to the gastric emptying effects, but this doesn't eliminate the risk 1
• Focusing only on fasting guidelines: Standard fasting guidelines alone are insufficient to mitigate the risk of aspiration in patients taking semaglutide 1

Resuming Ozempic After Surgery

Resume Ozempic only when:

• The patient is eating normally
• No signs of acute illness or metabolic derangement are present
• Patient has fully recovered from anesthesia

By following these evidence-based recommendations, the risk of perioperative pulmonary aspiration can be minimized while maintaining optimal patient outcomes.