June 23, 2023 – If you’re taking Ozempic or Rybelsus for type 2 diabetes, Wegovy for weight loss, or other medications in the same drug class, it is not clear how long before planned surgery you should stop taking the drug to be safe.
The generic name for these medications is semaglutide. Semaglutide can control blood sugar for people with diabetes and can slow down how long food stays in the belly, helping people who want to lose weight feel full longer.
Keeping blood sugar steady during surgery is important, and so is having elective or planned surgery on an empty stomach.
The biggest risks of a full stomach during surgery are actively vomiting and partially or fully blocking the tube that delivers anesthesia to the lungs. Stomach contents can also come up slowly on their own. Either way, “aspiration” as doctors call it, can be dangerous.
These medications have surged in popularity for weight loss, leaving doctors wondering how long to tell patients to stop the drugs in advance. Ozempic and Wegovy are injections taken once a week, and Rybelsus is a tablet taken once a day, so the advice will likely be different for different forms of semaglutide.
But there is not enough evidence yet to know what the safest timing should be, experts said. Until medical societies come up with official guidance, doctors are checking with each other on Twitter, including this post from John Shields, MD, an orthopedic surgeon at Atrium Health Wake Forest Baptist Davie Medical Center in Bermuda Run, NC:
Shield’s post yielded a lot of reactions and comments. In the first week, the post was retweeted 30 times and earned 250 “likes,” along with more than 70 replies and comments. Shields noted the general consensus was to hold off on semaglutide for 1 to 2 weeks before surgery, but there were a lot of different opinions.
“A Hot Issue”
One medical society that has been working on guidance for the past 3 weeks is the American Society of Anesthesiologists (ASA). The ASA is the largest anesthesia provider group with 56,000 members. ASA President Michael Champeau, MD, is very aware of the issues surrounding these medications during anesthesia and surgery.
“It’s a really hot issue now. We are getting emails from our members looking for guidance,” he said.
The ASA plans to release guidance for doctors in the next week or two but is holding back on full “official guidelines” until more studies are done.
Meanwhile, doctors are trying to figure out if they should tell people to stop taking these medicines — also known as glucagon-like peptide 1 receptor agonists or GLP-1s — 12 hours, 24 hours, or up to 2 weeks before planned surgery.
Doctors’ Advice
Anesthesiologist Cliff Gevirtz, MD, has so far encountered only a few surgical patients taking GLP-1s for weight loss. “And thankfully no aspiration,” said Gevirtz, clinical director of office-based ambulatory anesthesia services at Somnia Anesthesia in Harrison, NY.
The key word is “planned” surgery. There are also emergency surgeries where doctors cannot ask a patient or do not have time to do an ultrasound scan to check how full or empty the stomach might be.
They treat all these cases as though someone just ate a full meal. Anesthesiologists will do a “rapid sequence induction.” This involves giving the medicine that makes a patient go to sleep, giving another medicine that paralyzes them quickly, then inserting a breathing tube — all within about 30 seconds.
There is also a drug called metoclopramide that can help speed up the emptying of food or drinks from the stomach, but it has to be given 30 minutes in advance, so it does not help in emergency procedures.
The approach at the MetroHealth System in Cleveland differs depending on whether a person is taking a GLP-1 for diabetes or weight loss, said Ronnie Fass, MD, a gastroenterologist and the division director of gastroenterology and hepatology and the medical director of their Digestive Health Center.
Presently, clinicians at MetroHealth instruct patients to discontinue medications for diabetes on the day of surgery.
For those who take semaglutide for type 2 diabetes, and because the medication is taken once a week, “there is growing discussion among surgeons that the medication should not be stopped prior to surgery. This is to ensure that patients’ diabetes is well controlled before and during surgery,” Fass said.
In patients taking semaglutide for weight loss only, “there is no clear answer at this point,” he added.
“Personally,” Fass said, “if a patient is taking [semaglutide] for weight loss only, I would consider stopping the medication before surgery.”