Is this 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 because her insurance didn’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 cost.

Langois, of Tucson, Arizona, said she was initially hesitant because of safety concerns, but eventually found a telehealth provider to write her a prescription.

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

Either because of cost or because of continued shortages, people are looking for alternatives to the brand-name drugs Ozempic and Wegovy, both of which contain the active ingredient semaglutide.

Some people, like Langois, turn to pharmacies to compound hard-to-get weight loss drugs.

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

“This is the million-dollar question,” said Dr. Fatima Cody, an obesity physician 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 created using the active ingredients in medicines. In the case of Ozempic and Wegovy, it is semaglutide.

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

Hospitals will sometimes use a combination drug when a commercially available option isn’t ideal, according to the FDA. They may reduce the dose of painkillers to prevent certain side effects, for example, or remove preservatives or colorings that may 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 genuine semaglutide? Is it safe?

Dr. Chris McGowan, who runs a weight loss clinic in Cary, North Carolina, has noticed that the combination versions of Wegovy and Ozempic are becoming more popular.

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

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

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

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

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

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

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

Compounding pharmacists can also buy high doses of semaglutide from wholesalers and then split 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 drug, which he says makes no sense because it would make the drug less effective.

If what pharmacies are selling as semaglutide isn’t actually the drug, that’s ultimately a safety issue because the ingredients they’re using may not have been thoroughly evaluated by the FDA, McGowan said.

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

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