The short answer

Do not stop your GLP-1 on your own before surgery or a colonoscopy — but do tell every member of your care team that you take one, as early as possible. Current guidance from the major anesthesia and gastroenterology societies says most people can continue their medication, while some higher-risk patients are asked to follow a liquid diet the day before or to skip one weekly dose. That call belongs to your surgical or endoscopy team, not to you alone.

If you are a senior on Wegovy, Ozempic, Zepbound, or Mounjaro, this question will almost certainly come up: colonoscopies, cataract surgery, and joint replacements are among the most common procedures in the Medicare population. Here is what the current guidance actually says, in plain English.

Why anesthesiologists care about GLP-1s

GLP-1 medications slow how quickly food leaves your stomach — that is part of how they reduce appetite. Under anesthesia, a stomach that has not fully emptied creates a risk that food or liquid could come back up and enter the lungs (called aspiration). Anesthesia teams take this seriously, which is why standard pre-procedure fasting rules exist in the first place, and why GLP-1s got their attention as these drugs became widespread.

Early case reports of retained stomach contents in GLP-1 users prompted the American Society of Anesthesiologists (ASA) to issue cautious advice in 2023, suggesting patients hold a weekly dose before elective procedures. That early advice is what many people still see repeated online — but it is no longer the whole story.

What the current guidance says

In 2024, five major medical societies — including the ASA, the American Gastroenterological Association, and the Society of American Gastrointestinal and Endoscopic Surgeons — published joint clinical practice guidance on GLP-1s in the period around surgery. The key points:

  • Most patients can continue their GLP-1 before a procedure if they are not at elevated risk of delayed stomach emptying.
  • The decision should be individualized — made together by you, your prescriber, and the procedure team, weighing the risks of pausing the drug against the aspiration concern.
  • If a team does decide to hold the medication, the usual approach is to skip the weekly injection one week before the procedure (or hold a daily formulation the day of).
  • Stopping is not risk-free either. For people who take a GLP-1 for diabetes, holding it can send blood sugar up at exactly the wrong time. The guidance explicitly warns against blanket stop-everyone policies.

Who counts as higher risk

The joint guidance flags a handful of factors that make retained stomach contents more likely. You are considered higher risk if you:

  • are still in the dose-escalation phase (your dose was recently increased), rather than on a stable maintenance dose
  • take a higher dose of your medication
  • are having active stomach symptoms — nausea, vomiting, belly pain, or significant constipation — in the days before the procedure
  • have another condition that already slows the stomach, such as gastroparesis or Parkinson's disease

If any of these apply, say so when the surgical center calls with your pre-procedure instructions. Our guide to GLP-1 side effects in seniors explains what counts as an active stomach symptom.

What higher-risk patients are asked to do

For patients at elevated risk, the guidance recommends a liquid diet for at least 24 hours before the procedure — the same thing a colonoscopy prep already requires — rather than automatically stopping the medication. On the day of the procedure, the anesthesia team may also use a bedside ultrasound of the stomach to check whether it is empty, and adjust their anesthesia technique if it is not.

The colonoscopy case is simpler than you think

Here is some genuinely reassuring news: if your procedure is a colonoscopy, the standard prep — clear liquids the day before, then the bowel-cleansing solution — already matches what the guidance asks of higher-risk GLP-1 users. Tell the endoscopy center you take a GLP-1 when you schedule, follow their prep instructions exactly, and ask directly: "Do you want me to skip my shot the week before?" Different centers have different protocols, and the answer you get is the one that counts.

Why you should never just stop on your own

It can feel safest to quietly skip a few weeks of shots before a procedure. It is not. Stopping abruptly means losing appetite control and, for those with diabetes, losing blood-sugar control during the stress of surgery and recovery — a period when your body needs stability most. Depending on how long you pause, you may also need to restart at a lower dose and re-escalate. Our article on what happens when you stop a GLP-1 covers this in detail.

There is also a practical wrinkle for Bridge participants: a $50-copay prescription works on a monthly cycle, and pausing can put your refill timing out of sync. If a planned pause is coming, mention it to your pharmacy.

Questions to ask before your procedure

Bring this short list to your pre-op or pre-procedure call:

  1. "I take [drug name] weekly for weight management — do you want me to hold any doses before the procedure?"
  2. "Should I follow a liquid diet the day before?"
  3. "My last dose will have been X days before — is that acceptable, or should we reschedule the dose?"
  4. "Who decides on the day of the procedure if there is a concern — and could my procedure be cancelled?"
  5. "When do I restart my medication afterward?"

That last question matters: restarting timing varies with the procedure and how your stomach feels afterward. More conversation starters in questions to ask your doctor about GLP-1s.

If you are looking for a prescriber who regularly manages GLP-1s in Medicare patients — someone comfortable coordinating with a surgical team — our provider directory lists Medicare-friendly GLP-1 prescribers by state.

Data note

Data as of July 2026, based on the 2024 multi-society clinical practice guidance (ASA, AGA, ASMBS, ISPCOP, SAGES) on GLP-1 receptor agonists in the perioperative period. Protocols vary by surgical center and continue to evolve — always follow your own care team's instructions. This article is educational and is not medical advice.