How far in advance should I stop taking Wegovy (semaglutide) before a colonoscopy procedure?

Wegovy (Semaglutide) Discontinuation Before Colonoscopy

Wegovy (semaglutide) should be discontinued at least 2 months before a colonoscopy procedure to ensure optimal bowel preparation quality and minimize potential complications. 1

Rationale for Discontinuation

The FDA label for semaglutide (Wegovy/Ozempic) specifically states that the medication should be discontinued at least 2 months before a planned pregnancy due to its long washout period 1. This same washout period is relevant for colonoscopy preparation for several reasons:

1. GLP-1 Receptor Agonist Effects: Semaglutide, as a GLP-1 receptor agonist, slows gastric emptying and intestinal transit, which can interfere with bowel preparation effectiveness.

2. Medication Management Guidelines: The American Gastroenterological Association recommends that GLP-1 receptor agonists should be stopped 1-7 days before colonoscopy procedures 2.

3. Long Half-Life: Semaglutide has a particularly long half-life compared to other GLP-1 receptor agonists, which is why the FDA recommends the 2-month washout period.

Bowel Preparation Considerations

Optimal bowel preparation is crucial for colonoscopy effectiveness:

• Split-Dose Regimen: The US Multi-Society Task Force on Colorectal Cancer strongly recommends a split-dose bowel cleansing regimen for elective colonoscopy 3.

• Timing: The second dose of split preparation should begin 4-6 hours before colonoscopy and be completed at least 2 hours before the procedure 3.

• Quality Impact: Poor bowel preparation can lead to missed lesions, increased procedure time, and the need for repeat procedures at shortened intervals, increasing healthcare costs 3.

Algorithm for Wegovy Management Before Colonoscopy

1. Stop Wegovy: Discontinue Wegovy at least 2 months before scheduled colonoscopy 1.

2. Bowel Preparation Selection:

   • Use a split-dose bowel preparation regimen 3
   • For morning procedures: Split-dose approach is preferred 3
   • For afternoon procedures: Same-day preparation is an acceptable alternative 3

3. Preparation Timing:

   • Begin second portion of preparation 4-6 hours before colonoscopy
   • Complete preparation at least 2 hours before procedure 3

4. Dietary Modifications:

   • Follow a low-residue/low-fiber diet for breakfast and lunch the day before colonoscopy 2
   • Clear liquids are allowed up to 2 hours before the procedure 2

Special Considerations

• Monitoring: Patients previously on Wegovy may need additional monitoring for adequate bowel preparation due to potential residual effects on gastrointestinal motility.

• Preparation Quality: Target a 90% adequate preparation rate as recommended by guidelines 2.

• Resumption: Consult with the prescribing physician about when to resume Wegovy after the colonoscopy is completed.

Common Pitfalls to Avoid

1. Insufficient Discontinuation Time: Failing to stop Wegovy early enough may result in inadequate bowel preparation due to its long half-life and effects on gastrointestinal motility.

2. Inadequate Hydration: Ensure adequate hydration before, during, and after preparation to prevent dehydration and electrolyte disturbances 2.

3. Poor Timing of Preparation: The quality of bowel preparation decreases significantly when the interval between the last dose of preparation and colonoscopy exceeds 5 hours 3.

4. Ignoring Split-Dose Recommendations: Split-dose preparation is superior to day-before regimens for detecting polyps of all sizes 3.