Hold the Ozempic before surgery, US doctors say

[June 30, 2023]  By Julie Steenhuysen

CHICAGO (Reuters) - People taking popular diabetes and weight loss drugs such as Novo Nordisk's Ozempic and Wegovy or Eli Lilly's Mounjaro should temporarily stop taking them before having elective surgery to avoid possible serious complications, the American Society of Anesthesiologists (ASA) said on Thursday.

The group has received anecdotal reports from across the country that patients taking the drugs may be at increased risk of vomiting and aspirating food into the lungs and airways during general anesthesia or deep sedation, Dr. Michael Champeau, president of the ASA, said in an interview.

"This is a big deal because the aspiration of gastric contents - sucking food that was in the stomach ... into your lungs - is such a catastrophic complication," Champeau said.

That complication is why patients need to fast before surgery. "It's a major concern for us," he said.

The guidance involved a relatively new class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists. The treatments can help lower blood sugar levels, but they also delay stomach emptying, which can decrease hunger and reduce the amount of food people eat, a side effect that has made the treatments wildly popular as weight loss medications.

Initial reports suggest that patients who have experienced gastric side effects, such as nausea or vomiting, while taking GLP-1 agonists were more likely to have increased residual food in their stomach, the group said.

Champeau said the ASA has received numerous requests from members for guidance in the past month about how to manage the problem in patients who are now on GLP-1 agonists.

A pharmacist displays boxes of Ozempic, a semaglutide injection drug used for treating type 2 diabetes made by Novo Nordisk, at Rock Canyon Pharmacy in Provo, Utah, U.S. March 29, 2023. REUTERS/George Frey/File Photo

According to ASA's interim guidance, issued on Thursday, people taking GLP-1 drugs on a daily basis should skip treatment the day of the surgery. For those taking the drug weekly, ASA recommends stopping treatment a week before the scheduled surgery.

They caution that people who take the drugs for diabetes control should consult their endocrinologist about any treatments that could be used in the interim before surgery.

If patients have nausea on the day of surgery, physicians should reschedule the procedure.

Champeau said the group's advice reflected the totality of the available evidence and the potential risk to patients.

The ASA is calling for more research on the risks of these treatments for patients who need anesthesia during surgery and would consider writing formal guidelines as more evidence becomes available.

The companies were not immediately available for comment.

(Reporting by Julie Steenhuysen; Editing by Stephen Coates)

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