Does zepbound need to be stopped prior to surgery?

Perioperative Management of Zepbound (Tirzepatide)

Zepbound should be withheld for at least 3 days before elective surgery due to its effects on gastric emptying and increased risk of pulmonary aspiration during general anesthesia or deep sedation. 1

Mechanism and Concerns

Zepbound (tirzepatide) is a GLP-1 receptor agonist that:

• Delays gastric emptying, which increases the risk of retained gastric contents 1
• Can lead to pulmonary aspiration during general anesthesia or deep sedation 1
• Has a long half-life that extends its effects on gastric motility

Evidence-Based Recommendations

The FDA label for Zepbound specifically warns about pulmonary aspiration risk during general anesthesia or deep sedation, noting:

• There have been rare postmarketing reports of pulmonary aspiration in patients receiving GLP-1 receptor agonists undergoing elective surgeries 1
• Patients should inform healthcare providers prior to any planned surgeries if they are taking Zepbound 1

Recent anesthesia guidelines recommend:

• For patients taking GLP-1 receptor agonists for weight management, these drugs should be withheld for at least three half-lives before an elective surgical procedure 2
• This recommendation is based on emerging case reports of regurgitation or aspiration during general anesthesia and endoscopic evidence of retained solids or liquids 2

Practical Management Algorithm

1. For elective surgery requiring general anesthesia or deep sedation:

   • Hold Zepbound for at least 3 days before surgery
   • Inform anesthesiologist about Zepbound use
   • Consider more stringent NPO guidelines

2. For emergency surgery:

   • Inform anesthesiologist about Zepbound use
   • Consider rapid sequence induction
   • Implement more vigilant monitoring for aspiration

3. For procedures under local anesthesia without sedation:

   • Individualized approach based on the nature of the procedure
   • Consider holding if there's any risk of conversion to general anesthesia

Resumption After Surgery

• Resume Zepbound once eating and drinking normally (typically 24-48 hours after surgery)
• Ensure no complications from surgery before restarting

Special Considerations

• Diabetes management: For patients using Zepbound for diabetes, monitor blood glucose closely during the perioperative period and consider alternative glucose-lowering strategies
• Weight management: For patients using Zepbound for weight management, brief interruption should not significantly impact long-term outcomes

Common Pitfalls to Avoid

• Failure to communicate: Ensure all members of the surgical team are aware of Zepbound use
• Inadequate NPO time: Standard NPO guidelines may be insufficient for patients on Zepbound
• Overlooking the risk: The delayed gastric emptying effect persists even after skipping just one dose

While there are no specific studies on Zepbound in surgery, the evidence from other GLP-1 receptor agonists and the FDA warning support a cautious approach to minimize the risk of potentially serious aspiration complications.