How to Vet a Compounded GLP-1 Provider: 8 Questions to Ask

Compounded drugs are not FDA approved, and the FDA does not review them for safety, effectiveness or quality before they are sold. On its page about unapproved GLP-1 drugs used for weight loss, the FDA describes several problems: adverse events after dosing errors, some requiring hospitalization; salt forms of semaglutide with no lawful basis for compounding; counterfeit and fraudulent products; and products falsely labeled "for research purposes" sold to people for injection.

The FDA also notes that state-licensed pharmacies that are not outsourcing facilities do not have to report adverse events to the agency, so problems are likely underreported. That puts more of the checking on you. The questions below are the ones we would want a family member to ask.

A prescription should follow a real medical evaluation by a licensed clinician who takes your history, checks for the conditions that rule these medicines out, and stays responsible for your follow-up. Ask who that person is, what their license is, and how you reach them if something goes wrong.

The FDA's advice is to get a prescription from your clinician and fill it at a state-licensed pharmacy, and to buy online only from state-licensed pharmacies. Ask for the pharmacy's name. A clinic that will not tell you where your medication comes from is a reason to keep looking.

The FDA has said that semaglutide sodium and semaglutide acetate are different active ingredients from the one in the approved products, and that it is not aware of any lawful basis for using them in compounding. Ask what form of the drug the pharmacy uses. Never buy a product labeled "for research purposes" or "not for human consumption."

The FDA has received reports of adverse events, some needing hospital care, after patients measured and injected the wrong dose of compounded semaglutide, and after some clinicians miscalculated doses. Ask who will show you how to measure and give your dose, and who you call if the label or instructions are unclear. The FDA also advises a new, sterile needle and syringe for every dose, and discarding a multi-dose vial 28 days after first use even if medication is left.

Monthly prices are hard to compare unless you know what sits outside them: consultations, follow-ups, dose changes, labs and check-in visits. Ask for every charge in your first month. The FDA lists prices that "seem too good to be true" as a warning sign for online sellers.

Ask how often you will be seen, who reviews side effects, and what to do after hours. Ask whether the clinic reports serious problems to the FDA's MedWatch program; the FDA encourages health care professionals, patients and compounders to report adverse events there, and you can report one yourself.

Some people should not take these medicines at all, including anyone with a personal or family history of medullary thyroid carcinoma or MEN 2, and the labels of the approved products say to stop them once a pregnancy is recognized. A careful provider screens for this and says no when the answer is no. Read when a compounded GLP-1 is not the right choice.

Weight change varies from person to person. A clinic that guarantees a number of pounds, a timeline, or results "like" a brand-name product is a reason for caution. Compounded versions were not studied in the trials of the approved products, so those results cannot be assumed to apply.

You can ask us every one of these questions, on the phone or at your consultation. Here is where we stand on the ones we can answer up front: