How many days before surgery should tirzepatide (Mounjaro) be discontinued?

Discontinuation of Mounjaro (Tirzepatide) Before Surgery

Stop Mounjaro 7 days before elective surgery to allow adequate clearance of the medication and minimize the risk of delayed gastric emptying and pulmonary aspiration during anesthesia. 1

Rationale for 7-Day Discontinuation

The 7-day preoperative discontinuation period is based on tirzepatide's pharmacokinetic profile and safety considerations:

• Tirzepatide has an elimination half-life of approximately 5 days, requiring extended time for complete drug clearance 1
• The drug's effect on gastric emptying persists throughout its presence in the system, creating aspiration risk during anesthesia 1
• A 7-day cessation period allows for approximately 1.4 half-lives to elapse, reducing residual drug effects to acceptable levels for most surgical procedures 1

Key Safety Considerations

Aspiration Risk

GLP-1 receptor agonists and dual agonists like tirzepatide significantly delay gastric emptying, which poses specific anesthetic risks:

• Studies demonstrate an odds ratio of 10.23 (95% CI: 2.94-35.82) for pulmonary aspiration in elective surgery patients using GLP-1 receptor agonists 1
• The European Medicines Agency Pharmacovigilance Risk Assessment Committee has highlighted delayed gastric emptying as a significant concern with these medications 1
• Even with long-term use, the persistence of gastric emptying effects remains uncertain due to unclear tachyphylaxis patterns 1

Procedure-Specific Modifications

The 7-day recommendation applies to elective surgeries with general anesthesia or procedures requiring airway management:

• For minor procedures with minimal bleeding risk and no airway manipulation, shorter discontinuation periods may be considered 1
• For urgent or emergency surgery, inform the anesthesiologist immediately about recent tirzepatide use, as residual gastric emptying effects may persist and require modified anesthetic techniques 2
• The anesthesiologist may need to implement rapid sequence intubation or other aspiration precautions if surgery cannot be delayed 1

Postoperative Resumption

Resume tirzepatide 24-48 hours after surgery once the patient can tolerate oral intake without nausea and surgical site healing is progressing normally 2:

• Wait until hemostasis is secure and bleeding risk has normalized 2
• Ensure adequate oral intake capacity before restarting to minimize gastrointestinal side effects 2
• For procedures with higher bleeding risk, consider delaying resumption to 48-72 hours postoperatively 1

Critical Pitfalls to Avoid

• Do not confuse tirzepatide with anticoagulants or antiplatelet agents, which have different evidence-based discontinuation protocols (typically 3-7 days for antiplatelet agents) 1
• Do not assume the American Society of Anesthesiologists' recommendation for daily GLP-1 agonists (stop 1 day before) applies to weekly tirzepatide, as the longer half-life requires extended discontinuation 1
• Always verify the patient's last dose timing, as patients may have taken their weekly injection shortly before the surgical consultation 1
• Consider rescheduling elective surgery if the patient took tirzepatide within the past 7 days, particularly for procedures requiring general anesthesia 1

Glycemic Management During Discontinuation

For patients using tirzepatide for type 2 diabetes management:

• Monitor blood glucose levels during the discontinuation period, as glycemic control may deteriorate 1
• Consider temporary bridging with short-acting insulin if needed to maintain glucose levels between 100-180 mg/dL perioperatively 1
• The A1C goal for elective surgeries should be <8% whenever possible 1