Ozempic and Surgery: When to stop and restart?

Ozempic (semaglutide) should generally be stopped at least 1 week before surgery to reduce the risk of delayed gastric emptying and aspiration during anesthesia. Restarting Ozempic after surgery should only occur when the patient can safely tolerate oral intake and under the supervision of a healthcare provider. This approach minimizes perioperative risks and supports safe recovery.

Why is Ozempic Paused Before Surgery?

Ozempic is a glucagon-like peptide-1 (GLP-1) receptor agonist, which slows gastric emptying as part of its mechanism of action. This delayed gastric emptying can result in residual food or liquid in the stomach, even after recommended fasting periods. During anesthesia, this increases the risk of regurgitation and aspiration of gastric contents, a potentially serious complication that can lead to aspiration pneumonia or other pulmonary issues.

When Should Ozempic Be Stopped Before Surgery?

Some experts recommend stopping Ozempic at least 7 days (1 week) before elective surgical procedures. A recent prospective study found that patients who had taken semaglutide within 10 days of surgery had a significantly higher risk of increased residual gastric content compared to those who had not, despite standard fasting. Some surgical specialties may recommend even longer discontinuation periods depending on the procedure and patient risk factors, but 1 week is a widely accepted minimum.

Your healthcare provider can help weigh your risk of stomach-related side effects during your surgery, as well as the risks of stopping Ozempic before the surgery. Each person is different, and your healthcare provider may or may not recommend stopping Ozempic before your specific surgery.

When Can Ozempic Be Restarted After Surgery?

Ozempic should only be restarted once the patient is able to safely eat and drink without significant nausea or vomiting. Resumption must be guided by a healthcare provider, especially if the patient is still on IV nutrition or unable to tolerate oral intake. There are no strict universal guidelines for the exact timing, but most recommendations suggest waiting until normal gastrointestinal function has returned and oral intake is established.

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What Are the Risks of Continuing Ozempic Around Surgery?

Continuing Ozempic too close to surgery can:

• Increase the risk of delayed gastric emptying, leading to more residual stomach contents at the time of anesthesia.
• Heighten the risk of aspiration, which can cause serious pulmonary complications.
• Increase the risk of hypoglycemia if fasting is prolonged, particularly in diabetic patients.

While these risks exist, a recent large cohort study examined the risk of postoperative complications—including aspiration pneumonia and delayed gastric emptying—among patients taking GLP-1 receptor agonists like semaglutide (Ozempic) before surgery. The study found that while GLP-1 RA use was associated with a higher risk of delayed gastric emptying, there was no significant increase in the risk of postoperative aspiration pneumonia compared to patients not using these medications.

Key Takeaways

• Ozempic is typically stopped at least 1 week before surgery to reduce the risk of delayed gastric emptying and aspiration during anesthesia.
• Restarting Ozempic should only occur when you can safely eat and drink, and always under the supervision of your healthcare provider.
• Continuing Ozempic too close to surgery increases the risk of complications such as delayed gastric emptying, aspiration, and hypoglycemia.
• Recent research shows that while Ozempic increases delayed gastric emptying, it does not significantly raise the risk of postoperative aspiration pneumonia. Always follow your provider’s guidance for the safest outcome.

This is not all the information you need to know about Ozempic (semaglutide) for safe and effective use and does not take the place of your doctor’s directions. Review the full patient medication guide and discuss this information and any questions you have with your doctor or other health care provider.

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