Continue to use your regular medications as instructed with a sip of water on the day of surgery.
Ozempic or Mounjaro
Ozempic (semaglutide) and Mounjaro (tirzepatide) are once-weekly injectable medications used primarily to manage type 2 diabetes and for weight loss. They act by mimicking gut hormones (GLP-1 for Ozempic; GLP-1 and GIP for Mounjaro), improving insulin secretion, reducing glucagon levels, slowing gastric emptying, and reducing appetite.
Special Care is Needed Before Surgery
These medications delay stomach emptying, increasing the risk of regurgitation and aspiration during anaesthesia or sedation — a potentially life-threatening complication.
Recommendations for Perioperative Management
Withhold Ozempic & Mounjaro for at least 1 week before elective procedures with GA or sedation
For daily GLP-1 agonists (e.g., liraglutide/Saxenda/Victoza): hold the day before surgery.
Preoperative Fasting and "Sip Til Send"
Patients should follow standard fasting protocols, with clear fluids allowed until 2 hours before anaesthesia, unless high aspiration risk is suspected.
"Sip til Send" protocols (per local guidelines) may need to be modified or withheld if the patient has not stopped GLP-1 agonists as recommended.
Aspirin:
If you are taking aspirin under your doctor’s orders (e.g. you have
previously had a blood clot, stroke, heart attack, etc) it is preferable that you
continue taking your aspirin unless specifically asked to cease it by me.
Vitamin E:
You should avoid medicines containing vitamin E for four weeks after surgery.
Warfarin:
In most circumstances I do not stop Warfarin for straight forward hand surgery if the INR is around 2.
I am more concerned about the rare but catastrophic complications of Heart attack or Stroke than the small increased risk of bleeding or bruising after surgery.
Note most hand surgery is performed with a tourniquet which stops any bleeding at the time of surgery. For major bone surgery it should be ceased 2 - 3 days prior to your surgery after consultation with your treating Physician / Cardiologist.
Xarelto (rivaroxiban) and Eliquis (apixaban)
inhibit blood clotting factor Xa.
They should be stopped 2 days before major surgery ( eg Bone surgery, FCR Interposition arthroplasty ) and withheld one day before minor surgery (eg Trigger finger).
These can be resumed the day after surgery if there is no bleeding.
Diabetics:
Take ½ your dose of insulin on the day of surgery.
Notify hospital staff that you are diabetic on admission to hospital. You may need regular monitoring of your blood sugar while you are fasting.
Where possible Diabetic patients will be operated on at the start of an operating list
For Specific Drug questions I have found this Website to be very useful.