The short answer
Not always, and never on your own. The 2023 anesthesia advice was to hold a weekly GLP-1 for one week before elective surgery. Since October 2024, guidance from five medical societies says to decide case by case: many people can continue, a liquid-only diet for 24 hours before helps when the stomach may be slow, and if your team does hold it, the timing is still one week for a weekly shot and the day of surgery for a daily pill.
At GLP-1 SOS this question usually arrives the week a surgery date is booked, often after three offices gave three different answers. The confusion is real: the advice changed in 2024. Here is what the labels, the 2023 advice and the 2024 guidance each say.
At a glance
Before any surgery or sedation
1
Tell the team early
Every GLP-1 label asks you to tell your providers before any planned surgery or procedure. Do it when the date is set.
2
Holding is no longer automatic
The 2024 guidance replaced the blanket one-week hold with a shared decision based on your own risk.
3
The day before may be liquids
If your stomach may still be slow, a liquid-only diet for at least 24 hours is a main tool, much like colonoscopy prep.
Why anesthesia teams care about your GLP-1
GLP-1 medicines slow how fast the stomach empties. Under general anesthesia or deep sedation, the reflexes that protect your airway relax, so food left in the stomach can come up and be breathed into the lungs: pulmonary aspiration. Every current label, from Wegovy and Ozempic to Zepbound and Mounjaro, warns of rare reports of aspiration in people on GLP-1s who still had food in the stomach despite following the usual fasting rules.
The labels also say the data are not enough to know whether changing the fasting rules or pausing the medication lowers that risk. So they do not tell you to stop; they tell you to inform your providers before any planned procedure. A short pause does not clear the drug quickly anyway; see how long a GLP-1 stays in your system.
Lab note
The rule moved from “stop for a week” to “decide together, and make sure the stomach is empty.”
In June 2023, the American Society of Anesthesiologists (ASA) suggested holding a weekly GLP-1 for one week before elective surgery, and a daily one on the day of surgery, for everyone, whatever the dose or reason. In October 2024, the ASA joined four other societies (gastroenterology, bariatric surgery, perioperative obesity care and endoscopic surgery) in joint guidance, and the ASA’s 2023 page now points readers to it.
The 2024 guidance asks you, your surgeon, the anesthesia team and your prescriber to decide together. It names five things that raise the risk of a slow stomach: the dose-escalation phase, a higher dose, weekly rather than daily dosing, current stomach symptoms such as nausea, vomiting, belly pain or constipation, and conditions like gastroparesis. Without them, it says the GLP-1 may be continued. If the team holds it, the 2023 timing stays.
From the guidance and research
The numbers behind the advice
56% vs 19%
of weekly GLP-1 users versus non-users still had a fuller-than-expected stomach on ultrasound after standard fasting (124 adults, JAMA Surgery, 2024)
24 hours
minimum liquid-only diet before a procedure when a slow stomach is a concern (2024 multisociety guidance)
1 week
hold for a weekly GLP-1 if the team decides to hold; a daily pill is held on the day of surgery
Sources: multisociety guidance, Surgical Endoscopy, 2025 (online October 2024); ASA guidance, June 2023; Sen et al., JAMA Surgery, 2024.
What to do once you have a date
- Tell every office you take a GLP-1, by name and dose. Surgeon, anesthesia team and the person sedating you for a scope may all be different. Give the drug, dose, shot day and your last dose increase.
- Ask one direct question: hold it or keep it? Ask who makes the call and get the answer in writing. If they say hold a weekly shot, it is the dose in the week before surgery.
- Ask whether to eat liquids only the day before. If you are still escalating, on a higher dose or have stomach symptoms, a liquid diet for at least 24 hours may be part of the plan. Follow your team’s exact fasting times.
- If you have diabetes, plan your blood sugar. If Ozempic, Mounjaro or Rybelsus is held, the 2023 ASA guidance suggests your diabetes team plan a bridge to avoid high readings. Readings can drift up when a GLP-1 pauses, as described in what happens when you stop a GLP-1.
- Report symptoms on the day, honestly. Nausea, vomiting, bloating or belly pain can mean food is still in the stomach. The team may do a quick stomach ultrasound, change the anesthesia plan or move the date.
- Ask when to restart, and at what dose. No label sets a post-surgery restart rule. If two or more weekly Wegovy doses are missed, the label says to restart the build-up at a lower dose, so ask your prescriber before the next shot.
From our support desk at GLP-1 SOS
If you wrote to us tonight about your surgery, here is what we would say.
We would not tell you whether to hold your shot; that is for your surgeon, anesthesia team and prescriber, deciding with you. Call when the date is set and write down the answers. List every supplement on your pre-op form, including GLP-1 SOS Daily Gut Relief, and ask whether to pause it. Once you are back on normal meals and your team agrees, 2 capsules with dinner support regular bowel movements and digestive comfort while your routine returns. Water and a daily walk are the brand-free start.*
We answer real questions from real people every day. Write to us if yours is not here.
*GLP-1 SOS Daily Gut Relief supports regular bowel movements and digestive comfort. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
Before the procedure
Fine to mention, or call before you go in
Usually fine to mention at pre-op
- You are on a steady maintenance dose
- Mild fullness after big meals
- You took your weekly dose as usual and feel well
- You use a daily GLP-1 pill
Call the surgical team before the day
- Nausea, vomiting or retching in the days before
- Bloating or belly pain that has not settled
- You just started or just went up a dose
- Constipation for several days
Symptoms on the day can change the plan. Better the team hears it from you by phone than at the bedside.
When to call your doctor
Call your surgeon, anesthesia team or prescriber before the procedure, or the same day, if:
- You are vomiting, retching or cannot keep liquids down in the days before surgery
- Bloating or belly pain has not settled
- You have severe belly pain that spreads to your back, a possible sign of pancreatitis
- Your medication was held and your blood sugar runs far above your usual range
- You took your weekly dose after being told to hold it
Never stop or skip a GLP-1 for surgery on your own. Make the decision with the people who will be in the room.
From the people behind the Lab
You do not have to figure this out alone.
GLP-1 SOS is the daily companion made for life on a GLP-1. Plain answers like this one, a support team that replies to real questions from real people, and daily formulas like GLP-1 SOS Daily Gut Relief, designed around the side effects that come with the medication. The GLP-1 Lab is our free education arm: no login, no paywall, no hype. Side effects are part of the road. Suffering through them is not.
Questions people also ask
Do I have to stop Ozempic or Wegovy a week before surgery?
Not automatically anymore. The 2023 anesthesia advice said to hold a weekly GLP-1 for one week before elective surgery. The 2024 guidance from five societies made it a case-by-case decision: many people can continue, especially on a steady dose without stomach symptoms. If your team decides to hold, it is still one week. Ask your surgeon and anesthesia team which applies to you.
Do I need to stop Zepbound or Mounjaro before a colonoscopy or endoscopy?
Usually not as a rule, but tell the team. The labels’ warning covers deep sedation as well as general anesthesia. The 2024 guidance suggests liquids only for at least 24 hours before when a slow stomach is a concern, similar to colonoscopy prep. If you are nauseated, bloated or just went up a dose, call the endoscopy office before the day.
What if I already took my weekly shot and my surgery is in a few days?
Call the surgical team now with the date and dose, and do not skip meals or take anything to empty your stomach. Under the 2023 ASA guidance, if you feel well the team can proceed with extra stomach precautions or check with ultrasound; with symptoms, they may delay. Early notice gives them options.
Do I need to stop Rybelsus or the Wegovy pill before surgery?
Tell the team you take a daily pill. The 2024 guidance counts daily dosing as lower risk than weekly, and if your team decides to hold it, you skip it on the day of surgery only. If you have diabetes, ask how to manage your blood sugar that day.
When can I restart my GLP-1 after surgery?
When your surgeon says you are eating and drinking normally and your prescriber agrees on the dose. The labels give no post-surgery restart rule. If two or more weekly Wegovy doses were missed, the label says to restart the build-up lower. Expect some fullness again, and know when vomiting needs a call.
Sources (5)
- Wegovy (semaglutide) injection and tablets, Prescribing Information. Novo Nordisk / FDA, revised June 2026.
- Zepbound (tirzepatide) injection, Prescribing Information. Eli Lilly, revised August 2026.
- Multi-society clinical practice guidance for the safe use of glucagon-like peptide-1 receptor agonists in the perioperative period (ASMBS, ASA, AGA, ISPCOP, SAGES). Surgical Endoscopy, 2025; published online October 2024.
- American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists. American Society of Anesthesiologists, June 29, 2023.
- Glucagon-Like Peptide-1 Receptor Agonist Use and Residual Gastric Content Before Anesthesia. JAMA Surgery, 2024.
Reviewed by the GLP-1 SOS editorial team · Education, not medical advice · Talk to your prescriber about your dose and your symptoms.
