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Mga GLP-1 na Gamot (Ozempic, Wegovy) at ang Iyong Operasyon

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If you take a GLP-1 medication (such as semaglutide — Ozempic or Wegovy) and you are having an operation: what these drugs do, why they matter for your anaesthetic (delayed stomach emptying and aspiration risk), and what you should do before surgery.

Updated Sep 2026
Isang medical injection pen.
Lalong nagiging karaniwan ang mga GLP-1 na gamot at may mga epekto ang mga ito na mahalagang pag-usapan bago ang operasyon at anaesthesia. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ang gamot na ito

Ang mga GLP-1 na gamot ay isang grupo ng mga gamot na maaaring kilala mo sa mga brand name tulad ng Ozempic o Wegovy. Ang buong pangalan nila ay glucagon-like peptide-1 receptor agonists, o GLP-1 agonists sa madaling sabi. Unang ginamit ang mga ito para gamutin ang type 2 diabetes, isang kondisyon kung saan masyadong mataas ang antas ng blood sugar. Malawak na rin itong ginagamit ngayon para makatulong sa pagbabawas ng timbang ng mga taong may obesity [1].

Ginagaya ng mga gamot na ito ang isang natural na hormone na inilalabas ng iyong katawan pagkatapos mong kumain. Dalawang pangunahing bagay ang ginagawa ng hormone na iyon. Binabawasan nito ang iyong gana, kaya mas maaga kang nabubusog at mas kaunti ang iyong kinakain. Pinababagal din nito kung gaano kabilis nawawalan ng laman ang iyong sikmura, kaya mas tumatagal ang pakiramdam ng pagkabusog [2]. Ang resulta para sa maraming tao ay tuloy-tuloy na pagbaba ng timbang at mas mahusay na kontrol sa blood sugar [3].

Kung umiinom o gumagamit ka ng isa sa mga gamot na ito at may nakaplanong operasyon, mahalaga ito sa iyong care team. Lalong nagiging karaniwan ang mga gamot na ito, at parami nang parami ang mga pasyenteng gumagamit nito na nakikita ng mga surgeon [4]. Lumalawak pa ang pananaliksik tungkol sa epekto nito sa operasyon, at ang ilang natuklasan ay hindi pa nagkakasundo [5] [6]. Ang alam sa ngayon ay karamihang nakapagpapanatag ng loob sa simpleng pananalita: ang mga pag-aaral na sumubaybay sa mga pasyenteng may joint replacement ay walang natuklasang malinaw na pagtaas ng mga panandaliang problema pagkatapos ng operasyon [7] [8], at iniuugnay ng ilang pananaliksik ang mga gamot na ito sa mas mababang tsansa ng problema sa sugat o impeksyon [9] [10]. Sinasabi ng kasalukuyang mga guideline na hindi mo kailangang itigil ang iyong gamot bago ang isang elective na procedure, dahil ang pagtigil ay maaaring makagulo sa iyong blood sugar at sa pag-usad ng iyong pagbabawas ng timbang [11].

Ipinaliliwanag ng natitirang bahagi ng pahinang ito kung ano ang ibig sabihin nito para sa iyo sa panahon ng iyong operasyon.

Paano ito nakaaapekto sa iyong operasyon at anaesthetic

Ang pangunahing binabago ng mga gamot na ito kaugnay ng operasyon ay ang iyong sikmura. Dahil pinababagal nila kung gaano kabilis nawawalan ng laman ang iyong sikmura, maaaring mas matagal na manatili roon ang pagkain at likido kaysa sa inaasahan mo o ng iyong care team. Natuklasan ng karamihan ng pag-aaral na ang mga taong gumagamit ng mga gamot na ito ay may mas maraming natitirang laman ng sikmura kaysa sa inaasahan [12]. Mahalaga iyon dahil habang nasa anaesthetic, maaaring umakyat pabalik ang laman ng sikmura at pumasok sa iyong baga. Tinatawag itong aspiration. Kilalang panganib ito sa anumang anaesthetic, at maaaring madagdagan ito ng mga gamot na ito, bagaman nananatiling magkakahalo ang ebidensyang nag-uugnay sa mga ito sa aktwal na pangyayari ng aspiration [12].

Pinaplano ito ng iyong anaesthetist. Ang kasalukuyang gabay sa Australia ay ipagpatuloy ang gamot at malilinaw na likido lamang ang inumin sa loob ng 24 na oras bago ang operasyon, kung saan ang karaniwang oras ng pag-aayuno (fasting) ay nasa loob ng 24 na oras na iyon. Nagsasagawa rin ang ilang team ng ultrasound check ng sikmura bago nito. Tiningnan ng pananaliksik ang mga hakbang na ito at natuklasang maaari silang makatulong na mabawasan ang natitirang laman ng sikmura sa ilang pasyente [13]. Ang iyong team ang magpapasya kung ano ang naaangkop sa iyo.

May magandang balita rin tungkol sa paggaling. Ang mga pag-aaral ng mga taong sumailalim sa hip o knee replacement habang gumagamit ng mga gamot na ito ay walang natuklasang pare-parehong pagtaas ng panandaliang antas ng revision [8]. Iniuugnay ng ilang pananaliksik ang mga ito sa mas mababang tsansa ng impeksyon pagkatapos ng operasyon, kabilang ang impeksyon sa paligid ng bagong kasukasuan [3] [8]. Para sa operasyon sa kamay tulad ng carpal tunnel release, natuklasan ng isang pag-aaral ang maliit na pagbaba ng mga problema sa paghilom ng sugat at walang pagtaas ng ibang maagang komplikasyon [10].

Maingat na pinangangasiwaan ng iyong care team ang lahat ng ito. Nagtutulungan ang mga surgeon, anaesthetist at espesyalista sa diabetes para planuhin ang pinakaligtas na paraan para sa iyo [2]. Inaalam pa ng mga mananaliksik ang pinakamahusay na paraan ng pag-aalaga sa mga taong gumagamit ng mga gamot na ito kaugnay ng operasyon [14]. Sa ngayon, simple ang praktikal na mensahe: sabihin sa iyong team na ginagamit mo ang gamot na ito, sundin nang eksakto ang kanilang mga tagubilin sa pag-aayuno, at sila na ang bahala sa iba.

Ano ang dapat mong gawin

Ipagpatuloy ang iyong GLP-1 na gamot gaya ng dati bago ang iyong operasyon; huwag itong itigil. Sa loob ng 24 na oras bago ang iyong operasyon, malilinaw na likido lamang ang inumin at huwag kumain ng solidong pagkain. Ang malilinaw na likido ay mga inuming nakikita mo ang kabila, tulad ng tubig, malinaw na apple juice, o itim na tsaa o kape na walang gatas. Ang karaniwang oras ng pag-aayuno bago ang anaesthetic ay bahagi ng 24 na oras na iyon, hindi idinaragdag pagkatapos: sa bandang huli, sasabihin din sa iyo ng iyong anaesthetist kung kailan ititigil ang pag-inom ng malilinaw na likido. Sumusunod ito sa kasalukuyang gabay ng anaesthetic sa Australia (ANZCA).

Ipagpatuloy ang paggamit ng iyong gamot ayon sa reseta, at sabihin sa lahat ng kasangkot sa iyong pangangalaga na ginagamit mo ito. Kabilang dito ang iyong surgeon, ang iyong anaesthetist at ang iyong GP. Kabilang din dito ang doktor na nagreseta ng gamot, GP man o espesyalista.

Huwag itong itigil nang mag-isa. Ang pagtigil ay maaaring makaapekto sa iyong blood sugar at sa pag-usad ng iyong pagbabawas ng timbang.

Bago ang iyong procedure, bibigyan ka ng iyong team ng malinaw na mga tagubilin. Sundin nang eksakto ayon sa pagkakasulat ang gabay tungkol sa iyong gamot at tungkol sa pag-aayuno bago nito. Ang pag-aayuno ay nangangahulugang hindi kumakain o umiinom sa loob ng takdang oras bago ang operasyon. Nakatutulong ang mga hakbang na ito na mapanatiling walang laman ang iyong sikmura at mapababa ang mga panganib mula sa anaesthetic.

Kung hindi ka sigurado sa anumang bagay, magtanong. Nagtutulungan ang iyong surgeon, anaesthetist at GP para planuhin ang pinakaligtas na paraan para sa iyo. Walang tanong na masyadong maliit pagdating sa iyong gamot at sa iyong operasyon.

Mga Sanggunian

[1] GLP-1 Receptor Agonists in Orthopaedic Surgery: Implications for Perioperative Care and Outcomes. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.01287

[2] Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia. The Korean Journal of Internal Medicine. 2026. DOI: 10.3904/kjim.2025.277

[3] Semaglutide and Other GLP-1 Agonists: A Boon for the Arthroplasty Industry?. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.014

[4] The Impact of Glucagon-Like Peptide-1 Agonists on Hip and Knee Arthroplasty and Perioperative Considerations. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.002

[5] Glucagon-Like Peptide-1 Receptor Agonists: Have We Found the Holy Grail for Total Joint Arthroplasty?. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.10.027

[6] Impact of Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes in Arthroplasty: A Systematic Review. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.07.015

[7] GLP-1 receptor agonist therapy is not associated with adverse events following shoulder surgery: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.12.005

[8] Glucagon-like peptide-1 receptor agonists in total joint arthroplasty: a comprehensive systematic review of what orthopaedic surgeons should know. Arthroplasty. 2026. DOI: 10.1186/s42836-026-00375-w

[9] The Association Between Glucagon-Like Peptide-1 Receptor Agonists and Postoperative Complications After Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.06.083

[10] Impact of Perioperative Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes Following Carpal Tunnel Release. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100746

[11] Periprocedural use of GLP-1 receptor agonists: ANZCA Clinical Practice Recommendations. ANZCA. 2025.

[12] Perioperative anesthesia management of GLP-1 receptor agonists: a systematic review of potential risks. Perioperative Medicine. 2026. DOI: 10.1186/s13741-026-00662-9

[13] Peri-Procedural Fasting and Gastric Ultrasound Strategies in Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist Users: A Systematic Review With Qualitative Synthesis. Cureus. 2026. DOI: 10.7759/cureus.108216

[14] GLP-1 agonists: a new hope for patients, a new challenge for anaesthetists. Anaesthesiology Intensive Therapy. 2025. DOI: 10.5114/ait/203167

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Glucagon-like peptide-1 receptor agonists induce delayed gastric emptying [1].
  • The pharmacological mechanisms of GLP-1 RA-induced delayed gastric emptying have clinical implications for perioperative aspiration risk during anesthesia [1].
  • Interdisciplinary collaboration between endocrinologists and anesthesiologists is emphasized for safe and individualized perioperative management of patients on GLP-1 RAs [1].
  • GLP-1 agonists may not produce sufficient weight loss to achieve body mass index cutoffs for total joint arthroplasty depending on individual patient factors, including starting bodyweight [2].
  • Further high-quality studies are called for to address the optimal perioperative care of patients on GLP-1RAs due to their increasing popularity in patients with obesity [3].
  • Conflicting findings in the literature highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes [4].
  • Arthroplasty surgeons will encounter an increasing number of patients on GLP-1 agonists [5].
  • It is important for arthroplasty surgeons to understand the implications of GLP-1 agonist use in the perioperative period [5].
  • GLP-1 agonist use should not be a contraindication for proceeding with total shoulder arthroplasty based on data showing no association with adverse events following shoulder surgery [6].
  • Elective preprocedural cessation of GLP-1RAs and GLP-1/GIPRAs is not recommended due to insufficient data supporting cessation and risks of hyperglycaemia and compromised weight control [7].
  • The variability in available studies, potential confounding factors, and severe heterogeneity of conclusions emphasize the need for more high-quality evidence-based primary research to optimize perioperative management of patients taking GLP-1 RAs [8].
  • GLP-1 agonists have effects on bone health that are relevant to perioperative patients undergoing orthopedic surgery, with an emphasis on spine surgery [9].
  • GLP-1RA use suggests a potential benefit for optimizing high-risk patients who have obesity or diabetes undergoing total joint arthroplasty [10].

Effects on Surgery and Recovery

Perioperative Anesthesia and Gastric Emptying

  • Authors call for further high-quality studies to address the optimal perioperative care of patients on GLP-1RAs due to their increasing popularity in patients with obesity [3].
  • Available observational evidence suggests that extended GLP-1 RA withholding, 24-hour clear liquid diets, and pre-procedural gastric POCUS may be associated with reduced residual gastric content in selected patient populations [14].

Arthroplasty Outcomes

  • Arthroplasty surgeons will encounter an increasing number of patients on GLP-1 agonists, making it important to understand the implications of their use in the perioperative period [5].
  • Conflicting findings highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes in arthroplasty [4].
  • Findings suggest a potential benefit of GLP-1RA use for optimizing high-risk patients who have obesity or diabetes undergoing total joint arthroplasty [10].
  • While GLP-1 receptor agonists show potential to reduce postoperative complications in total joint arthroplasty, findings remain inconsistent, and further research is needed to clarify their impact on outcomes and establish perioperative management guidelines [11].
  • Preoperative glucagon-like peptide-1 receptor agonist use may be linked to reduced readmission risk following joint arthroplasty, without evidence of increased postoperative medical harm [12].
  • Semaglutide and other GLP-1 agonists may increase the number of eligible candidates for elective total joint arthroplasty by enabling weight loss and improving diabetic control [13].
  • Semaglutide and other GLP-1 agonists may potentially reduce postoperative complications such as sepsis and prosthetic joint infections [13].
  • Current observational data suggest that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty is not associated with a consistent increase in short-term revision rates [16].
  • Current observational data suggest that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty may be associated with a reduced risk of postoperative infection [16].

Other Orthopedic Procedures

  • Based on data from a systematic review and meta-analysis, GLP-1 agonist use should not be a contraindication for proceeding with total shoulder arthroplasty [6].
  • Perioperative GLP-1RA use was associated with a small yet statistically significant reduction in the odds of wound dehiscence following carpal tunnel release [15].
  • Perioperative GLP-1RA use did not increase the odds of any other 90-day postoperative complications following carpal tunnel release [15].

Bone Health

  • A narrative review explores the mechanisms of action of GLP-1 agonists, their effects on bone health, and the implications of their use in perioperative patients undergoing orthopedic surgery, with an emphasis on spine surgery [9].
  • Exenatide is the best option agent with regard to the risk of fracture [17].

Practical Considerations

Perioperative Anesthesia and Gastric Emptying

  • Delayed gastric emptying induced by GLP-1 RAs has implications for perioperative aspiration risk during anesthesia [1].

Medication Management

Arthroplasty Outcomes and Eligibility

  • Conflicting findings highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes [4].

Shoulder Surgery

Bone Health and Spine Surgery

Key Evidence

  • [L4] This review summarizes the pharmacological mechanisms and clinical implications of GLP-1 RA-induced delayed gastric emptying, evaluates current literature on perioperative aspiration risk, and emphasizes the importance of interdisciplinary collaboration between endocrinologists and anesthesiologists to ensure safe and individualized perioperative management. [1] (10.3904/kjim.2025.277)
  • [Paper] While efficacious, GLP-1 agonists may not produce sufficient weight loss to achieve body mass index cutoffs for total joint arthroplasty depending on individual patient factors, including starting bodyweight. [2] (10.2106/jbjs.rvw.23.00167)
  • [L4] Due to the increasing popularity of GLP-1RAs in patients with obesity, the authors call for further high-quality studies to address the optimal perioperative care of patients on GLP-1RAs. [3] (10.5114/ait/203167)
  • [L4] However, conflicting findings highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes. [4] (10.1016/j.arth.2025.07.015)
  • [L5] Arthroplasty surgeons will encounter an increasing number of patients on GLP-1 agonists, making it important to understand the implications of their use in the perioperative period. [5] (10.1016/j.arth.2023.12.002)
  • [L1] Based on this data, GLP-1 agonist use should not be a contraindication for proceeding with TSA. [6] (10.1016/j.jse.2025.12.005)
  • [L2] The variability in available studies, potential confounding factors, and the severe heterogeneity of conclusions all emphasize the need for more high-quality evidence-based primary research to optimize perioperative management of patients taking GLP-1 RAs. [8] (10.1186/s13741-026-00662-9)
  • [L4] This narrative review explores the mechanisms of action of GLP-1 agonists, their effects on bone health, and the implications of their use in perioperative patients undergoing orthopedic surgery, with an emphasis on spine surgery. [9] (10.1177/15563316261438492)
  • [L1] These findings suggest a potential benefit of GLP-1RA use for optimizing high-risk patients who have obesity or diabetes undergoing total joint arthroplasty. [10] (10.1016/j.arth.2025.09.054)
  • [L5] The paper concludes that while GLP-1 receptor agonists show potential to reduce postoperative complications in total joint arthroplasty, findings remain inconsistent, and further research is needed to clarify their impact on outcomes and establish perioperative management guidelines. [11] (10.1016/j.arth.2025.10.027)
  • [L1] Preoperative glucagon-like peptide-1 receptor agonist use may be linked to reduced readmission risk following joint arthroplasty, without evidence of increased postoperative medical harm. [12] (10.1016/j.arth.2025.11.036)
  • [L5] Semaglutide and other GLP-1 agonists may increase the number of eligible candidates for elective total joint arthroplasty by enabling weight loss and improving diabetic control, while also potentially reducing postoperative complications such as sepsis and prosthetic joint infections. [13] (10.1016/j.arth.2023.12.014)
  • [L4] Available observational evidence suggests that extended GLP-1 RA withholding, 24-hour clear liquid diets, and pre-procedural gastric POCUS may be associated with reduced residual gastric content in selected patient populations. [14] (10.7759/cureus.108216)
  • [L3] Perioperative GLP-1RA use was associated with a small yet statistically significant reduction in the odds of wound dehiscence following CTR and did not increase the odds of any other 90-day postoperative complications. [15] (10.1016/j.jhsg.2025.100746)
  • [L4] Current observational data suggest that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty is not associated with a consistent increase in short-term revision rates and may be associated with a reduced risk of postoperative infection. [16] (10.1186/s42836-026-00375-w)
  • [L1] Exenatide is the best option agent with regard to the risk of fracture. [17] (10.1007/s00198-018-4649-8)

References

[1] Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia. The Korean Journal of Internal Medicine. 2026. DOI: 10.3904/kjim.2025.277

[2] Glucagon-like Peptide-1 Agonists. JBJS Reviews. 2024. DOI: 10.2106/jbjs.rvw.23.00167

[3] GLP-1 agonists: a new hope for patients, a new challenge for anaesthetists. Anaesthesiology Intensive Therapy. 2025. DOI: 10.5114/ait/203167

[4] Impact of Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes in Arthroplasty: A Systematic Review. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.07.015

[5] The Impact of Glucagon-Like Peptide-1 Agonists on Hip and Knee Arthroplasty and Perioperative Considerations. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.002

[6] GLP-1 receptor agonist therapy is not associated with adverse events following shoulder surgery: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.12.005

[7] Periprocedural use of GLP-1 receptor agonists: ANZCA Clinical Practice Recommendations. ANZCA. 2025.

[8] Perioperative anesthesia management of GLP-1 receptor agonists: a systematic review of potential risks. Perioperative Medicine. 2026. DOI: 10.1186/s13741-026-00662-9

[9] GLP-1 Agonists in Orthopedic Surgery: A Narrative Review of Bone Health and Surgical Implications. HSS Journal. 2026. DOI: 10.1177/15563316261438492

[10] The Impact of Glucagon-Like Peptide-1 Receptor Agonist Use on Clinical Outcomes After Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of 346,899 Patients. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.09.054

[11] Glucagon-Like Peptide-1 Receptor Agonists: Have We Found the Holy Grail for Total Joint Arthroplasty?. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.10.027

[12] Glucagon-Like Peptide-1 Receptor Agonists, Readmission, and Postoperative Complications in Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.11.036

[13] Semaglutide and Other GLP-1 Agonists: A Boon for the Arthroplasty Industry?. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.014

[14] Peri-Procedural Fasting and Gastric Ultrasound Strategies in Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist Users: A Systematic Review With Qualitative Synthesis. Cureus. 2026. DOI: 10.7759/cureus.108216

[15] Impact of Perioperative Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes Following Carpal Tunnel Release. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100746

[16] Glucagon-like peptide-1 receptor agonists in total joint arthroplasty: a comprehensive systematic review of what orthopaedic surgeons should know. Arthroplasty. 2026. DOI: 10.1186/s42836-026-00375-w

[17] Glucagon-like peptide-1 receptor agonists and fracture risk: a network meta-analysis of randomized clinical trials. Osteoporosis International. 2018. DOI: 10.1007/s00198-018-4649-8

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Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.