If you take Ozempic, Wegovy, Mounjaro or Zepbound and have surgery, an endoscopy or any procedure with deep sedation coming up, tell your care team early. All four FDA labels now carry the same warning: these drugs slow stomach emptying, and there have been rare reports of people inhaling stomach contents under anesthesia even after fasting as instructed. The labels do not say whether you should stop the drug first. That call belongs to your surgeon, anesthesia team and prescriber together.
Below: the label wording, the studies behind the concern, the 2023 American Society of Anesthesiologists (ASA) advice, the 2024 multi-society update, and what to tell your team.
The warning is titled "Pulmonary Aspiration During General Anesthesia or Deep Sedation." It is section 5.10 in the Wegovy and Ozempic labels, and section 5.9 in the Mounjaro and Zepbound labels. The text is nearly word for word the same in all four. The Zepbound version reads:
It opens with "ZEPBOUND delays gastric emptying," then says: "There have been rare postmarketing reports of pulmonary aspiration in patients receiving GLP-1 receptor agonists undergoing elective surgeries or procedures requiring general anesthesia or deep sedation who had residual gastric contents despite reported adherence to preoperative fasting recommendations." (Zepbound label, 5.9)
It goes on to say the available data are insufficient to know whether changing fasting rules or temporarily stopping the drug would reduce leftover stomach contents.
The one clear instruction is to doctors: "Instruct patients to inform healthcare providers prior to any planned surgeries or procedures." The patient counseling section of the tirzepatide labels puts it in plainer words. It tells prescribers to explain that the drug "may cause their stomach to empty more slowly which may lead to complications with anesthesia or deep sedation during planned surgeries or procedures" (Zepbound label, 17).
A few terms, in plain words:
Fasting before anesthesia is meant to leave the stomach empty, because anything left in it can come back up and be breathed in while you are under.
GLP-1 drugs slow the stomach down. So a person can fast for the usual number of hours and still have food in the stomach. Two studies that the multi-society guidance cites show the size of the gap:
Both studies found something that matters for the "should I stop?" question. In the Brazil study, people with and without leftover stomach content had stopped semaglutide for about the same number of days on average (10.5 vs 10.2). In the Houston study, how long the drug had been paused was not linked to leftover content. These are observational studies, so they show links, not cause.
On June 29, 2023, the ASA Task Force on Preoperative Fasting published consensus-based guidance. It said the evidence was thin, limited to a few case reports, and offered these suggestions for elective procedures (ASA, 2023):
Urgent procedures go ahead with "full stomach" precautions. The ASA kept its standard fasting rules, since there was no evidence for a better fasting time.
In October 2024, five groups published a joint document online: the American Gastroenterological Association (AGA), the American Society for Metabolic and Bariatric Surgery (ASMBS), the American Society of Anesthesiologists, the International Society of Perioperative Care of Patients with Obesity (ISPCOP), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). The lead author is Tammy Kindel. The same text appeared in three journals: Surgery for Obesity and Related Diseases, Clinical Gastroenterology and Hepatology and Surgical Endoscopy (Kindel et al., 2024). The ASA's own page now notes that in October 2024 it issued an "Affirmation of Value" for this newer document.
The guidance says it is "guidance, and not an evidence-based guideline," because the data are still thin. Its main points:
The document also says it may need updating for newer drugs that act on two or three hormone receptors. The Zepbound label describes tirzepatide as a GIP receptor and GLP-1 receptor agonist, so it is one of these (Zepbound label, 12.1).
| Source | Stop before surgery? | Other steps |
|---|---|---|
| FDA labels (all four) | No recommendation; data insufficient | Tell your providers before any planned procedure |
| ASA, June 2023 | Consider holding: day of (daily), 1 week before (weekly) | Delay if symptoms; full-stomach precautions or ultrasound if not held |
| Multi-society, 2024 | Shared decision; many can continue; if held, same timing as ASA 2023 | 24-hour liquid diet, gastric ultrasound, rapid sequence induction |
| UK consensus, 2025 | Continue before surgery | Full risk assessment and steps to lower aspiration risk |
The UK row comes from a 2025 consensus statement by the Association of Anaesthetists and seven other UK groups, covering GLP-1 and dual GIP/GLP-1 drugs (El-Boghdadly et al., Anaesthesia 2025). Advice differs between countries and hospitals, so follow your own hospital's plan.
Both newer documents and the tirzepatide labels point at the same timing. The Zepbound label says the delay in stomach emptying "is largest after the first dose and this effect diminishes over time" (Zepbound label, 12.2). The multi-society guidance lists the escalation phase as a risk factor. So a recent dose increase is worth mentioning to your team.
This same effect is behind the tirzepatide birth control warning, where the label advises a backup method for 4 weeks after starting and after each increase. Our sibling post on Mounjaro, Zepbound and birth control pills explains that rule.
If you are told to hold a dose, it also helps to know how long the drug lasts. The Wegovy label says semaglutide stays in the blood for about 5 to 7 weeks after the last dose (Wegovy label, 12.3), and tirzepatide's half-life is about 5 to 6 days (Zepbound label, 12.3). One held dose does not clear the drug. See how long Ozempic stays in your system and how long tirzepatide stays in your system for the details.
Bring this up when the procedure is scheduled, not on the day. The multi-society guidance wants the risk check done early enough to change the plan. Have these ready:
Then follow the plan your team gives you. Do not stop or skip on your own because of something you read, including this article. Ask too how and when to restart afterward. The label's normal missed-dose rules are written for a forgotten dose, not a planned hold.
Dose Track keeps the date, drug and strength of every dose you log, plus any side effects you record, so you can give the pre-op nurse your last dose and last increase without guessing. You can also set a reminder for your restart day.
For brand details, see the Ozempic, Wegovy, Mounjaro and Zepbound guides.
This article is general information, not medical advice. Talk to your surgeon, anesthesia team and prescriber before you start, change, hold or stop any medicine.