Is it safe and effective for weight loss?

When Robin Langois, 58, was prescribed the weight loss drug Wegovy last year, she couldn’t afford the high price tag after her insurance wouldn’t cover it.

But she later discovered on TikTok that people could get what appeared to be the drug’s active ingredient, semaglutide, from compounding pharmacies for a fraction of the price.

Langois, of Tucson, Arizona, said she was hesitant at first because of safety concerns, but she eventually found a telehealth provider who could write her a prescription.

“I’m not 100% sure that’s what I’m getting,” Langois said. However, she noted that she has experienced satiety and weight loss, as well as nausea, a common side effect of the drug. “It’s working as it should,” she said.

Whether due to cost or ongoing shortages, people are seeking alternatives to the brand-name drugs Ozempic and Wegovy, both of which contain the active ingredient semaglutide.

Some people, like Langois, turn to compounding pharmacies for hard-to-get weight loss medications.

Novo Nordisk, the sole maker of Ozempic and Wegovy and the patent holder of semaglutide, said in a statement that it does not supply the ingredient to those pharmacies, prompting some experts to ask where the pharmacies get the drug — and whether it is semaglutide at all .

“That’s the million-dollar question,” said Dr. Fatima Cody, a doctor specializing in obesity at Massachusetts General Hospital in Boston who serves as an adviser to Novo Nordisk.

What are compounding pharmacies?

Compounding pharmacies mix and change drug ingredients to create medications tailored to specific patient needs, according to the Food and Drug Administration.

Compounded medicines are usually made using the active ingredients of medicines. In Ozempic’s and Wegovy’s case, it’s semaglutide.

But compounded drugs — while containing FDA-approved ingredients — are not themselves approved by the FDA, meaning they are not regulated, monitored or tested by the agency, said Benjamin Jolley, a pharmacist and owner of Jolley’s Compounding Pharmacy in Salt Lake City.

Hospitals will sometimes use a compounded medicine when a commercially available alternative is not ideal, according to the FDA. They can lower the dose of painkillers to prevent some side effects, for example, or remove preservatives or dyes that could cause an allergic reaction.

The FDA will also grant exemptions that allow pharmacists to make certain drugs if there is a shortage, said Jeremy Kahn, an agency spokesman.

Do compounding pharmacies offer real semaglutide? Is it safe?

Dr. Chris McGowan, who runs a weight loss clinic in Cary, North Carolina, has noticed that compounded versions of Wegovy and Ozempic are growing in popularity.

“What I hear from patients is, ‘Oh, hey, I heard about this semaglutide compound.’ Can I try it?’” he said.

Mary Morgan Mills, 32, of Raleigh, North Carolina, came to McGowan after taking what she was told was a compounded version of semaglutide for about a year.

The weekly injection, which she received at a wellness center, made her nauseous, and she only lost about 15 pounds while taking it.

“I felt confused,” she said, adding that she still had “bottles of it in my fridge.”

“I’ve always wanted to go and get it tested to see what it actually is, but I don’t know the process,” Mills said.

Latest news on weight loss medications

McGowan said compounding pharmacies, in many cases, are not completely transparent about how they source the drug.

Jolley, who does not offer semaglutide, said it is possible that pharmacists could give people semaglutide sodium, a cheaper and modified version of the compound intended for research use only. However, semaglutide sodium is not approved by the FDA, he said, which would make selling the product illegal.

Compounding pharmacists can also buy high doses of semaglutide from wholesalers and then separate it into smaller doses or mix it with other drug ingredients, he said.

Matt Buderer, a pharmacist and owner of Buderer Drug Company Compounding Pharmacy in Ohio, said that would essentially dilute the medicine, which he said doesn’t make sense because it would make the drug less effective.

If the compound the pharmacies are offering as semaglutide is not actually the drug, it is ultimately a safety issue because the ingredients they are using may not be thoroughly evaluated by the FDA, McGowan said.

“What I tell patients is to be very careful when considering any form of compounded semaglutide or compounded tirzepatid, which is another drug that we’re currently seeing offered in a compounded form,” he said. (Tirzepatide is a diabetes drug made by Eli Lilly that also has weight loss effects.)

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