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HealthRX.com · Printable surgery planning sheet

Zepbound procedure plan

Fill this in with your surgical and anesthesia teams once a date is set: your Zepbound dose history and symptoms, the hold-or-continue decision, the date of your last injection, any liquid-diet instructions and the restart plan, all in writing.

Companion to “Zepbound Pre-Surgery Hold Window: How Long to Stop Tirzepatide Before an Operation” · healthrx.com/zepbound-v2/pre-surgery-window · Facts checked 2026-10-17

Your procedure

Procedure and date
Anesthesia or sedation plannedgeneral, deep sedation, regional, or local only
Surgeon or proceduralist, and phone
Anesthesia team contact

Your Zepbound details

Current weekly dose (mg) and usual injection day
Date of your most recent dose increase
Nausea, vomiting, bloating, abdominal pain or constipation lately
Other conditions that slow the stomachfor example gastroparesis or Parkinson's disease
Diabetes medicines you also take

What the label and the guidance say

  • Zepbound label: tell your healthcare providers before any planned surgery or procedure that you take Zepbound. Aspiration has been reported with GLP-1 medicines under general anesthesia or deep sedation despite fasting.[1]
  • Zepbound label: data are insufficient to know whether changing fasting rules or pausing Zepbound reduces retained stomach contents.[1]
  • ASA 2023: consider holding weekly GLP-1 drugs a week before the procedure. If nausea, vomiting, retching, bloating or abdominal pain are present, consider delaying an elective procedure.[2]
  • 2024 multi-society guidance: Zepbound may be continued when risk is not elevated. If it is held, weekly drugs are held a week before; a liquid diet for at least 24 hours beforehand can be used when delayed emptying is a concern.[3]
  • ASA 2023: if a GLP-1 drug taken for diabetes is held longer than its dosing schedule, consider an endocrinologist's help to avoid high blood sugar.[2]

The plan your teams agree

Decision: continue or hold Zepbound
If holding: date of your last injection before the procedure
Liquid-only diet from (date and time), if advised
Who made the decision, and when
Restart date and dose after the procedureconfirm with your prescriber

Tell your team, or get help

  • Nausea, vomiting, retching, bloating or abdominal pain on the day of the procedure: tell the anesthesia team before it starts.[2]
  • Severe stomach pain that will not go away, with or without nausea or vomiting: stop Zepbound and call your healthcare provider right away.[1]

Before the day

  • Every team knows I take Zepbound
  • I know whether I am continuing or holding it
  • My last-injection date is written down
  • I know whether I need a liquid-only diet, and from when
  • My diabetes plan is agreed, if I have diabetes
  • I know when, and at what dose, to restart
Sources for the facts on this sheet
  1. Eli Lilly and Company, via DailyMed. Zepbound (tirzepatide) injection, for subcutaneous use: prescribing information and Medication Guide. Effective 2026-08-28. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b
  2. American Society of Anesthesiologists. American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists. Accessed 2026-10-17. https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative
  3. Kindel TL, Wang AY, Wadhwa A, et al. Multi-society clinical practice guidance for the safe use of glucagon-like peptide-1 receptor agonists in the perioperative period. Surg Endosc 2025. PMID 39370500. https://pubmed.ncbi.nlm.nih.gov/39370500/

This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.