Topline
European medical officials advised patients taking GLP-1 weight loss and diabetes drugs who will be sedated for an upcoming surgery to warn their doctors about their medication use to avoid the risk of a rare respiratory complication called aspiration, a connection several other medical organizations have looked into in the past.
Patient's view of medical surgeons and doctors putting a patient under a general anaesthetic
Key Facts
The European Medicines Agency issued new recommendations Friday, saying patients who take GLP-1 drugs like Ozempic, Wegovy, Mounjaro and Zepbound should inform their doctors ahead of surgery to minimize the risk of adverse respiratory events potentially caused by the drugs.
GLP-1s are medications designed to manage type 2 diabetes and obesity by lowering blood sugar and A1C, interacting with the hunger part of the brain to suppress the appetite and slowing down the process of food emptying from the stomach, causing patients to feel full for longer.
As a result of the delay in stomach emptying, food can remain in the stomach even if a patient fasted the night before surgery, which can lead to rare respiratory complications called aspiration and aspiration pneumonia, according to the EMA.
Though the agency said it couldn’t find a causal link between GLP-1s and aspiration, it found a “biologically plausible risk” after reviewing available evidence like case reports, scientific papers and clinical and non-clinical data to support its decision.
The EMA said it would update the drugs’ product information to include a warning that patients should tell doctors about their GLP-1 drug use before undergoing surgery that requires anesthesia or deep sedation.
What Is Aspiration And Aspiration Pneumonia?
Aspiration happens when substances like food or liquid accidentally enter a person’s airways and lungs, according to the Washington State Department of Social and Health Services. This can then lead to aspiration pneumonia—known as the “silent killer”—which is a serious infection of the lungs. Aspiration pneumonia doesn’t always have many symptoms, and it can become deadly if left untreated. People who eat quickly, have had general anesthesia, have trouble swallowing or coughing, are 65 and older, have a weakened immune system, use feeding tubes, have had a stroke, drink large amounts of alcohol and are unable to chew properly are the most at risk for aspiration and aspiration pneumonia. Symptoms include shortness of breath, wheezing, coughing up blood or pus, chest pain, bad breath, extreme tiredness, fatigue while eating, a choking sensation, pain while swallowing, chronic chest congestion and a fever after eating.
Key Background
The EMA’s decision comes after it asked four GLP-1 drug manufacturers including Novo Nordisk and Eli Lilly in 2023 for more information about the possibility of sedation complications. Aspiration occurs in one of every 2,000 to 3,000 patients who require sedation for surgery, and about half of these patients develop a related lung injury. The Food and Drug Administration began a probe into whether GLP-1s cause side effects like aspiration and hair loss in January, CBS News reports. The American Society of Anesthesiologists also advised patients in 2023 who take the weekly injections to stop taking GLP-1 drugs at least a week before surgery due to an “increased risk of regurgitation and aspiration of food into the airways and lungs during general anesthesia and deep sedation.” Canadian researchers called for patients to stop taking GLP-1s at least three weeks before going under anesthesia due to the risk of aspiration.
Big Number
12%. That’s how many American adults have taken GLP-1 drugs, according to a May report by the nonprofit health policy organization KFF.