The “should I hold my GLP-1 today?” question comes up the moment a flu, stomach bug, or scheduled surgery lands — and the FDA labels for Wegovy, Ozempic, Zepbound, and Mounjaro do not spell out a clear sick-day protocol. The American Society of Anesthesiologists (ASA) issued the first formal guidance in June 2023, and a multi-society update led by ASA, AGA, and ASMBS followed in October 2024. The decision table below stitches the surgery rules together with the label warnings about dehydration and acute kidney injury so you have one reference card to talk through with your prescriber.
Decision table
| Situation | Action | Reason |
|---|---|---|
| Stomach flu, vomiting, or unable to keep fluids down | Hold the next dose. Resume only after tolerating fluids by mouth for at least 24 hours. | Dehydration plus a drug that slows gastric emptying raises the risk of acute kidney injury (AKI) — a labeled warning on every GLP-1. |
| Mild cold or URI, no nausea or vomiting | Continue on schedule. | No GI symptoms means no extra dehydration risk. |
| Fever ≥101°F, no GI symptoms | Continue, but track fluid intake closely. | Fever increases water loss; pair the dose with extra fluids. |
| Planned surgery (general anesthesia) — higher-risk (escalation phase, weekly dosing, higher dose, or GI symptoms) | Per ASA: hold 1 day for daily drugs, hold 1 week for weekly drugs. The 2024 multi-society update adds a 24-hour clear-liquid diet before surgery for higher-risk patients who continue. | GLP-1s delay gastric emptying. Retained food raises the risk of aspirating stomach contents during anesthesia. |
| Planned surgery — lower-risk (maintenance dose, no GI symptoms) | Per the October 2024 multi-society guidance, GLP-1 therapy may be continued; confirm with the anesthesia team. | Maintenance use without GI symptoms has not shown the same retained-food signal that drove the 2023 blanket hold. |
| Endoscopy or colonoscopy | Discuss a hold with the GI team, especially if the NPO window is <18 hours. | Endoscopy series have found retained gastric contents despite standard fasting. |
| Dental cleaning or minor procedure (no anesthesia, no NPO) | Continue on schedule. | No anesthesia and no fasting means no aspiration risk. |
| Severe GI illness or hospital admission | Hold until the inpatient team clears resumption. | Acute illness requires dose-by-dose decisions the outpatient prescriber cannot make remotely. |
| Pregnancy or planning a pregnancy | Discontinue. The Wegovy label says stop at least 2 months before a planned pregnancy because of semaglutide’s long half-life. | Animal data show fetal harm and early pregnancy loss; weight loss offers no benefit in pregnancy. |
Quick facts
- Dehydration is the main acute risk. The labels for Ozempic, Wegovy, Mounjaro, and Zepbound list reports of acute kidney injury in patients with vomiting, nausea, diarrhea, or reduced fluid intake.
- GI side effects can mimic illness. Nausea from a new dose step often starts 1–3 days after the injection, while a viral illness builds with fever or household exposure.
- Weekly drugs linger. Semaglutide’s half-life is about 7 days and tirzepatide’s about 5 days, so a hold is not an off switch — slowed emptying persists for days.
- One missed weekly dose is usually fine. Restart becomes the question only if the gap stretches past 2 weeks.
- Daily drugs are simpler to hold. Liraglutide (Saxenda, Victoza) is daily, so a 1-day pause covers the ASA preoperative window; weekly GLP-1s need a full 7-day pause.
- Talk to your prescriber before a long hold. Any hold reaching 2–3 weeks deserves a plan, not a guess.
Restart after a long hold
The labels for Wegovy, Ozempic, Zepbound, and Mounjaro say that if more than 2 consecutive weekly doses are missed, the prescriber should reassess and may step down before climbing back up. The practical pattern most clinics use: a 1-week pause resumes the same dose, a 2–3 week pause may step back one level, and pauses longer than 4 weeks usually restart from the lowest titration step to limit nausea and dehydration on re-entry. Send a portal message rather than guessing at home.
Red flags during illness — call your doctor
- Severe, persistent abdominal pain, especially radiating to the back. Possible acute pancreatitis.
- Vomiting >24 hours with no ability to keep fluids down. Risk of acute kidney injury.
- Dark urine, dizziness on standing, or very low urine output (oliguria). Signs of dehydration.
- Right-upper-quadrant pain, fever, jaundice, or clay-colored stools. Possible gallbladder disease.
- Bloody or coffee-ground vomit, or black tarry stools. Rare but needs same-day evaluation.
- New shortness of breath, racing heart, or confusion. Do not try to ride it out at home.
What this cheat sheet does not cover
This page is the outpatient sick-day decision framework only. It does not cover diabetes-specific sick-day rules (insulin dose adjustment, sulfonylurea hold, ketone monitoring), pediatric protocols, hospitalized-patient management, or interactions with antiemetics. For any of those, the inpatient or pediatric team should drive the plan.