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Regardless of the semaglutide dose you're coming from, tirzepatide should be initiated at 2.5 mg
In 2024 consensus-based guidance was formulated by representatives from the American Society of Anesthesiologists (ASA), the American Gastrointestinal Association (AGA), the American Society for Metabolic and Bariatric Surgery (ASMBS), the International Society of Perioperative Care of Patients with Obesity (ISPCOP), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) [19], according to which, use of GLP-1RAs and the management in the perioperative period should be based on shared decision-making of the patient, the anaesthetist, the prescribing care team, and the surgeon [19, 20]

A responsible plan may include adequate protein intake, resistance training, walking or other appropriate activity, body composition tracking when available, lab monitoring, gradual dose escalation when appropriate, nutrition support during appetite reduction, hydration and electrolyte guidance, monitoring fatigue or excessive appetite suppression, and evaluation for hormone, thyroid, or nutrient issues when relevant
The cumulative amount of tirzepatide detected in the remaining 7 breast milk samples over the 28-day sampling window was equivalent to less than 0.02% of the maternal administered dose, with the last measurable concentrations occurring 5 days post-dose