GLP-1 agonists and the potential risk of pulmonary aspiration during surgery

The Medicines and Healthcare products Regulatory Agency (MHRA) has released a drug safety update. It alerts healthcare professionals (HCPs) to the potential risk of pulmonary aspiration in people using GLP-1 or dual GIP/GLP-1 receptor agonists (RAs) who undergo surgery or procedures with general anaesthesia or deep sedation.

The GLP-1 and dual GIP/GLP-1 RAs available in the UK include dulaglutide, exenatide, liraglutide, lixisenatide and semaglutide. Tirzepatide is a GLP-1 RA combined with a GIP RA.

In the update, HCPs are reminded that one of the effects of GLP-1 and GIP/GLP-1 RAs is to cause delayed gastric emptying. This may increase the risk of residual gastric contents despite preoperative fasting. Individuals with underlying diabetic gastroparesis, as well as other comorbidities such as obesity or gastroesophageal reflux disease, and symptoms of delayed gastric emptying (such as nausea, vomiting and abdominal pain) may be at higher risk of aspiration.

HCPs should also consider that individuals may have bought these medications for aesthetic weight loss and may not disclose this unless asked directly. They should also be aware that private prescriptions are not always included in medical notes or drug history.

The update also contains advice for HCPs to provide to patients who are taking a GLP-1 or GIP/GLP-1 RA. This includes informing their healthcare team, including the anaesthetist, about this prior to surgery as a modification to the pre-procedure instruction and anaesthetic technique may be required. Prescribed medicines should be taken as usual and not stopped without first discussing it.

The MHRA’s drug safety update can be read here.