Your last dose before the procedure

Where these dates come from

Two documents, and the calendar uses both. The first is the consensus statement the American Society of Anesthesiologists issued in June 2023, which was the profession’s opening position on holding a GLP-1 before a procedure [1]. The second arrived in October 2024: a joint statement from the ASA alongside the American Gastroenterological Association, the American Society for Metabolic and Bariatric Surgery, the International Society for the Perioperative Care of Patients with Obesity, and the Society of American Gastrointestinal and Endoscopic Surgeons [2].

The later document keeps the 2023 holds as its starting point, but changes what they are for. They became the opening move in an individualized risk assessment rather than a rule to apply: aspiration risk on one side, and on the other the cost of stopping a drug unexpectedly — blood sugar slipping out of control in type 2 diabetes, weight coming back, and nausea returning when the drug restarts.

The default holds

• Anything dosed weekly — Wegovy, Ozempic, Zepbound, Mounjaro, compounded semaglutide or tirzepatide, and the older weekly agents such as Trulicity and Bydureon — is held for one week ahead of the procedure.
• Anything dosed daily — the tablets Rybelsus and Foundayo, and the daily injection Saxenda — is taken as normal until the day itself, when the dose is skipped.

Both documents attach the same caveat. Marked GI symptoms on the morning of surgery — nausea, vomiting, a distended abdomen, dyspepsia — are grounds to postpone, whether or not the hold was observed. Where postponing is not an option, the patient is managed as though the stomach were full: rapid-sequence induction, with or without cricoid pressure, or a regional technique instead where one will serve.

What it does and what it cannot do

All this does is convert the ASA default holds into dates on your own calendar, so that the conversation with your prescriber and your anesthesia team can be about specifics instead of generalities. It is not a substitute for that conversation. The 2024 guidance is explicit that hold-or-continue is decided case by case: what you get here is the cautious default, and your team is the one that decides whether to keep it, extend it, or replace it with something else once they have weighed your indication, the procedure itself, and how your stomach is behaving that week.

If the dose has already gone in

Enter a last-dose date that falls nearer the procedure than the default hold allows and the calendar sorts it into one of three situations:

• Clear. The last dose sits at or outside the default hold. Give the anesthesia team the exact date anyway, at the pre-op visit.
• Inside the window. The last dose falls within the hold but is not right up against the procedure. Expect the team to consider managing you as a full stomach, with rapid-sequence induction.
• Very close. A weekly GLP-1 taken fewer than 3 days out. Call the surgical office and the anesthesia team today, not at the pre-op visit. Postponement, full-stomach precautions and a regional technique are all on the table, and that is their call to make.

The summary you can hand over

Underneath the result there is a panel that gathers what you entered, the dates it worked out, whichever of the three situations applies, and the source it is all drawn from, into one block of text. Print it, keep it as a PDF, or paste it into a message through your patient portal. Take it to the pre-op visit and ask the anesthesia team to sign off on it or change it for the procedure you are actually having.

Important disclaimer

The dates here are the ASA default holds and nothing more. This page does not know which operation you are having, why you were put on a GLP-1, how your kidneys are working, what dose you have settled at, or any of the other things an anesthesia team weighs. Whether to hold, to carry on, or to do something else entirely is settled with your surgeon, the clinician who prescribed the drug, and the anesthesia team — not here.

Related tools and research

• Stopping a GLP-1 for surgery — the ASA and multisociety documents in full
• GLP-1 washout calculator — what the half-life says is still circulating, day by day
• GLP-1 drug interaction checker
• GLP-1 side-effect timeline