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 because her insurance didn’t cover it.

But he later noticed on TikTok that people were getting their hands on the drug’s active ingredient, semaglutide, at 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 to write her a prescription.

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

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

Some people, like Langois, turn to pharmacies for hard-to-find weight loss drugs.

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 question where the pharmacies are getting the drug — and whether it is semaglutide. at all.

“It’s 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 that are tailored to specific patient needs, according to the Food and Drug Administration.

Combined medicines are usually made from the active ingredients of medicines. In the case of Ozempic and Wegovy, it is semaglutide.

But compounded drugs — while they contain FDA-approved ingredients — are not FDA-approved themselves, meaning the agency doesn’t regulate, monitor or test them, said Benjamin Jolley, a pharmacist and owner of Jolley’s Compounding Pharmacy in Salt Lake City.

According to the FDA, hospitals sometimes use combinations when a commercially available option is not ideal. They can lower the dose of painkillers to prevent some side effects, for example, or remove preservatives or dyes that can cause an allergic reaction.

The FDA also grants waivers that allow pharmaceutical pharmacists to prepare certain drugs if they are in short supply, said agency spokesman Jeremy Kahn.

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 the combination versions of Wegovy and Ozempic are on the rise.

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

Mary Morgan Mills, 32, of Raleigh, North Carolina, came to McGowan after taking a mixed version of semaglutide for about a year.

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

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

“I’ve always wanted to go and test it to see what it really 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.

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

Compounding pharmacists could also buy large 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 dilute the medication, which he says doesn’t make sense because it would make the drug less effective.

If what pharmacies offer as semaglutide is not, in fact, a drug, that’s ultimately a safety issue because the FDA may not thoroughly evaluate the ingredients they’re using, McGowan said.

“I tell patients that they need to be very careful when considering any kind of semaglutide or tircepatide, which is another drug that’s currently offered in combination,” he said. (Tircepatide is a diabetes medication manufactured by Eli Lilly that also has weight loss effects.)

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