This content originally appeared in everyday health. It was reissued with permission.
by Kaitlin Sullivan
Medical review Adam Gilden, MD, MSCE Courtesy of the American University of Lifestyle Medicine
Demand for Ozempic, Wegovy, Zepbound and Mounjaro has led to the rise of online companies selling what online companies claim to be the cheaper version of their weekly injection drug. However, regulations are vague and it is unclear whether these options are safe or effective.
Patients face ongoing obstacles to obtain prescription and insurance coverage. Without manufacturer coupons or insurance, Wegovy costs $1,350 a month, according to its producer Novo Nordisk. According to manufacturer Eli Lily, Zepbound is over $1,000.
Pharmaceutical companies are also nervous to produce enough of these drugs to keep up with demand, leading to shortages.
The result was the growth of the so-called combined pharmacy niche industry selling “homemade” versions of these weight loss drugs: combined semaglutide (as an alternative to Ozempic or Wegovi) and formulated tilzepatides (as a substitute for Mounjaro and Zepbound).
In early 2024, a warning by the US Food and Drug Administration (FDA) focused on the potential dangers of formulated semaglutide and cited reports of unexpected health problems in people using the drug.
It is a risk that many people willing to take to their quest to lose weight.
If insurance doesn’t cover Wegovy, despair could begin
Snee, 50, (full name for privacy) had always struggled to calm his mind when it came to food. “I feel like I’m carrying too much eating,” she says.
Obesity runs in her family. Her mother lost 100 pounds twice in her life, but she regained it.
Sunny gave birth to three children and slowly gained weight while raising her, reaching a body mass index of 45. Her doctors contradicted the weight loss pill, which combines bupropion (an antidepressant) with naltrexone (a drug used to treat opioids and alcohol intake disorders). The inconsistency is approximately $100 per month and is FDA approved for long-term use in weight management.
“By suppressing those desires and impulses in my brain, it helped me control my thoughts about food,” says Snee. “But it stopped working.”
When her doctor wrote her a prescription for Wegovy, a semaglutide drug, she was ready to try again. Semaglutide is a GLP-1 receptor agonist and is a drug that mimics a natural hormone called GLP-1, which is released in the gastrointestinal tract in response to feeding. GLP-1 allows the body to release insulin, lower blood sugar levels, and interact with the brain to suppress appetite and signal fullness.(1)
The FDA approved Wegovy in 2021 for at least one weight-related condition, such as obese adults, or overweight, with high blood pressure, type 2 diabetes, and high cholesterol.
At that moment, Snee hit a wall. Her insurance doesn’t cover Wegovy because she has no weight-related conditions in addition to obesity.
“I felt so defeated. I kept gaining weight. I felt like I was out of control.
Snee works in a hospital. This is where we heard about cheap alternatives to Wegovy. It can be obtained through the nurse who told Snee that he is reselling it from the pharmacy he prepares. Several coworkers had successfully taken the medication, so Snee decided to go for it and bought a month’s supply for under $300.
“I understand there is a risk, I know that it can be anything,” Snee says. “I feel desperate. I feel that gaining weight is bigger than me. I realized I need medicine to help me.”
Snee quickly began to lose weight and noticed that her appetite had decreased significantly.
“When I’m taking weight loss medication, I can feel the brain difference telling me I’m hungry. I’m telling me my actual stomach telling me I’m hungry. I eat out of anxiety and boredom, and I have many psychological reasons why I eat, but I can separate them with semaglutide,” she says.
Are complex semaglutide and tilzepatide legal?
Approximately 7,500 licensed pharmacies in the United States specialize in compound interest.(2) These pharmacies mix, modify or combine FDA-approved drugs with a variety of ingredients for people with specific needs, such as individuals who may be allergic to certain dyes in branded drugs.
In the US, the combined version is legal if there is a drug shortage. In May 2023, the FDA included both Ozempic and Wegovy on its drug shortage list, legalizing the combined version of the drug.
The FDA recognizes that combined drugs can meet important needs, but warns that “it poses a higher risk to patients than FDA approved drugs and is not subject to FDA indoor review reviews for safety, efficacy or quality.”(3)
Novo Nordisk says it doesn’t sell patented semaglutide for compound interest, and is questioning what exactly is in the compound version. However, the chemical formulas for semaglutide and tilzepatide have been published.
Although semaglutide in its common form is absent, combined drugs are often sold in that way. The company has filed at least 12 lawsuits against medical spas, weight loss or wellness clinics, concoctions of pharmacies selling suspicious compound or so-called generic versions of semaglutide.(4)
According to the FDA, the combined versions of Ozempic and Wegovy could exchange pure semaglutide for a salt-based form. This has not been shown to be safe and effective in clinical trials. The FDA has received reports of adverse effects from people taking combined semaglutide.
Pharmacies that sell complex semaglutides may contain vitamins such as B12 in their mixture, which is said to increase weight loss.(5)
Experts say complex semaglutide and tilzepatide are too dangerous
Juliana Simonetti, a community member of the University of Utah’s Comprehensive Weight Management Program in Salt Lake City, says it’s often “absolute crazy” for insurers to reject coverage of injectable weight loss medications for obese people. She understands what drives people to seek alternatives.
However, she said there is no way to ensure that the combined drug is being created, adding that anyone who purchases combined drugs from suspicious sources is at risk of using drugs that may not even be sterile.
“I’m very clear telling patients not to get complicated versions. I feel their pain and despair, but I’m telling them not to do so because these are dangerous practices,” she says.
Andrew Craftson, director of the weight navigation program for Michigan Medicine in Ann Arbor, believes heavily in the value of drugs like semaglutide, and understands why people are in a hurry to get their hands on them. He points out that obesity is highly condemned and treated.
“This sense of urgency drives people to make a hurry to make decisions,” he says. “They feel like this is there right now. I should have been on it yesterday.”
But without FDA monitoring, the combined version is far too risky, says Dr. Kraftson. “It’s problematic to have this inherent conflict of interest,” he says of providers who are willing to compromise safety in order to pursue profits.
Additionally, he doesn’t guarantee that people who buy cheap weight loss pills will remain healthy when they significantly reduce their calories, as they usually don’t get nutritional counseling.
“Food as a medicine is a key element here,” says Kraftson. “Everyone can lose weight at 800 calories a day in the form of the Twin Kies, but that doesn’t mean they should.”
Oral semaglutide and tilzepatide
Some online compounding pharmacies currently sell semaglutide and tilzepatide in pill or liquid form. These substances are said to use the same active ingredients found in Wegovy and Zepbound, and are not swallowed and instead dissolve under the tongue. This is called sublingual delivery.
Are sublingual GLP-1 pills and liquid suspensions legal? Tenil Davis of Pharmd, Chief Advocacy Director of Pharmadrics Alliance, is permitted to change the form of prescription drugs in patients if doctors point out that “over-the-counter medications are not appropriate.” For patients who are seriously terrified of needles or allergies to inactive ingredients in injectable solutions, sublingual administration provides a solution. However, there have never been any published studies of sublingual GLP-1. The safety and efficacy of such substances may be highly questionable.
Dr. Davis says at least one large combined pharmacy has conducted an in-house study showing that semaglutide salts can be absorbed into the oral cavity via soluble tablets or tinctures placed under the tongue. However, other experts are skeptical and warn that only small amounts of active ingredients are likely to be absorbed.
“I don’t think they’re effective,” says Dr. Simonetti. “You can’t take what’s infused and place it under your tongue to make it work the same way.”
Some combined drugs are more risky than others
Simonetti empathizes with patients desperately trying to access these weight loss medications.
“People are desperate and understand how decisions are rolling to choose these medications from the combined pharmacy,” she says.
If someone chooses to purchase compound semaglutide, Simonetti will provide some advice to ensure the best possible safety. First, she recommends checking the FDA’s list of licensed combined pharmacies.
“This is a good place to start. I don’t know what you’re still getting, but if you go with a company on this list, you’ll be under your skin lowers the risk of injecting bacteria,” she says.
The National Pharmacy Board also has a database that allows people to search for pharmacies on their websites to eliminate fraudulent things.
Find out the best online GLP-1 program recommendations, including Henry Meds, Found, Noom Med and more.
People should always ask the manufacturer for information on how many milligrams of active ingredients are in each dose. The exact nature of these ingredients may be a mystery, but knowing at least how much semaglutide-like substances are in each dose can help clinicians help patients with diet and medication management.
“There are a lot of combined drugs in the unit,” says Simonetti. “I don’t know how many milligrams there are in the unit, especially when mixing it with other ingredients.”
If you can talk to your doctor before reaching out to the pharmacy you are formulating, Davis recommends asking about the pharmacy you previously worked for and the trust. She also says people should call the pharmacy and ask for information about their quality programs and about tests performed on their fertility products. The pharmacy should be willing to provide a pure certificate that says the drug is pure and barren.
“If pharmacists hesitate to discuss these types of things, I would choose a different pharmacy,” she says.
Beware of illegal GLP-1 drugs
While the formulating pharmacies may appear to operate in the grey area of regulation, other online suppliers are undoubtedly engaged in illegal practices. A recent survey in the online market has identified over 100 websites claiming to sell semaglutide, which can be ordered without a prescription. Pharmacies cannot legally provide GLP-1 medications without a doctor’s prescription.
When researchers ordered Semaglutide from six of these websites, three suppliers never sent out the product at all and instead asked for more money. They were total scams. Three other providers sent out several medications containing semaglutide, but lab tests showed that the active ingredient was present in inaccurate concentrations. One of the samples is contaminated with endotoxin and may be toxic.(6)
Experts agree that using medicines from illegal sources is particularly dangerous, as the efficacy and safety of such medicines is completely unknown.
Take home
Online combined pharmacies are beginning to offer a variety of imitation GLP-1 medications for dizziness, but most experts are nervous about unbranded ozempics and similar products. The FDA does not evaluate the safety or efficacy of combined drugs, but it can take steps to reduce the risk of purchasing weight loss medication online.
Resources we trust
(TagstoTranslate) Compound Drugs (T)GLP-1 (T)Insulin (T)Intensive Control (T)Lily Diabetes (T)Novo Nordisk (T)Semaglutide (T)Tirzepatide (T)US Food and Drug Administration (FDA)
