Compounded GLP-1 Drugs: 9 Questions to Ask Your Doctor

If you’re considering trying a compounded GLP-1 drug for weight loss, or want to continue taking one, here’s what to discuss with your doctor.

1. Am I a Good Candidate for GLP-1 Weight Loss Drugs?

The best way to find out if a drug like semaglutide or tirzepatide is the right fit for you is to talk to your doctor. They know more about your personal history and overall health goals than the clinician at a compounding pharmacy or online weight loss program.

“Providers should do a good history check and talk with the patient face-to-face, either virtually or in person, says Rhonda Bonilla, NP, a board-certified nurse practitioner at Sculpt, a wellness center in Pasco, Washington, that uses GLP-1s to aid weight loss.

• You have a body mass index of 30 or more.
• You have a body mass index of 27 or more with a weight-related complication, such as high blood pressure and high cholesterol.
• You haven’t lost weight after making lifestyle changes.
• You have a history of fluctuating weight.

2. Is There Still a Way to Find a Trustworthy Online Supplier?

Despite uncertain online availability for compounded GLP-1 meds, there are sellers that are more legitimate than others.

Some online suppliers operate illegally or unethically. Hayley Miller, MD, is the medical director of Nurx Weight Management in Missoula, Montana which only sells brand name weight loss medications. She says, “You should never get a compounded GLP-1 from a supplier that does not require a prescription or medical screening. No legitimate company will offer a prescription without asking you specific details about your health history.”

Dr. Miller recommends looking for the following:

• Ensure the pharmacy is licensed and that the provider follows standard telehealth practices, including verifying your identity and reviewing your complete medical history.
• Pharmacies should have a 503A or 503B designation to ensure they follow specific state and federal guidelines. “This helps to guarantee that the medications contain the active pharmaceutical ingredient sourced from an FDA registered manufacturer,” Miller says.
• Ask if the pharmacy has independent lab tests or certificates of analysis, and if the formulation is stable and tested for sterility and potency.

3. Should I Take an Alternative GLP-1 Formulation?

Since the FDA ruled there’s no longer a shortage of semaglutide and tirzepatide, compound pharmacies increasingly rely on custom doses and formulations, such as mixing the medication with vitamins or using new pills or tinctures. Ask your doctor if you have a true need for one of these alternatives, which may be a better fit for some people than the brand-name drugs.

“The commercial products come in predetermined doses that do not allow for customization,” says Bonilla. That means these alternatives can be smaller doses if that’s what your body requires. “Some patients need their dose escalated at smaller increments,” Bonilla says. “It is important to work with a knowledgeable health professional to ensure that your dosage fits your individual needs. GLP-1s are not a one size fits all.”

4. Should I Start a Drug Now if I May Lose Access Later?

There is no easy answer to this question, since the ongoing availability of compounded GLP-1s is uncertain. Consult with your doctor about the pros and cons of starting them now, so you can make the right decision together. People who discontinue GLP-1 drugs usually put the weight back on, and most experts believe that the medications need to be used indefinitely in order to deliver sustainable benefits.

“Ask whether your provider has a plan for long-term access, and if they’ll help transition you to an FDA-approved version if needed,” Miller says. You should also ask what your options for treatment will be if the compounded version you take is no longer available.

5. Can I Administer Compounded GLP-1 Drugs Myself?

“Since adverse events related to compounded medications are not reportable to the FDA, it’s difficult to determine if side effects occur more often,” Bonilla says. She suspects compounded medications lead to more dosing errors, both accidental and intentional, since some patients may try to lose weight faster by increasing their own dose outside of their providers’ guidelines.

6. Do I Need to Make Lifestyle Changes if I Take a GLP-1 Drug?

Talk to your doctor or a nutritionist about what your weekly menu and exercise schedule should look like when you’re taking these drugs.

“My clients eat at least 120 grams (g) of protein per day, strength-train two or three times per week, walk 10,000 steps per day, and drink at least 80 ounces of water with electrolytes daily,” says Bonilla.

These healthy changes can also help if you lose access to your GLP-1, as research has shown that a new diet or consistent exercise regimen can help offset weight gain people experience when they stop.

7. Are There Other Weight Loss Alternatives I Should Consider?

Though GLP-1s are white-hot now, they aren’t the only way to shed pounds and keep them off. If you’ve tried other weight loss plans in the past that haven’t worked, chat with your doctor about new strategies. There may be another medication to try, a healthy eating plan that’s easier for you to stick with, a form of exercise you’re excited about, or you may be a good candidate for weight loss surgery.

Miller says not talking about the alternatives is actually a red flag: “If your provider jumps to GLP-1s without discussing other strategies, they may be skipping crucial steps in your care plan.”

8. Will You Support My Decision to Start Taking a Compounded Weight Loss Drug?

Miller says your doctor should be able to advise you if you don’t tolerate or have difficulty accessing this medication, and help you create a plan for how often you should be checking in to monitor your weight loss.

9. Can We Convince My Insurance to Cover a Brand Name GLP-1?

Even if you’ve been denied coverage for a weight loss drug in the past, it’s possible that you still haven’t exhausted all your options to access the brand name GLP-1 medications. Your provider may be able to help you seek out patient affordability programs, appeal a denial, or see if you qualify for a GLP-1 under a different diagnosis.

“These medications are also approved by insurance for the treatment of diabetes, cardiovascular disease, and sleep apnea,” says Miller. If you have one of these additional conditions, your insurer may approve a new GLP-1 medication for those other health benefits. “A knowledgeable provider or care team can help you navigate that process.”

The Takeaway

• The FDA recently restricted the manufacturing of compounded GLP-1 weight loss drugs, which are based on the popular weight loss and diabetes drugs Ozempic, Mounjaro, Wegovy, and Zepbound. Despite this change, these off-brand alternatives are still available online in novel dosages or formulations, like pills or tinctures.
• Experts are wary of compounded GLP-1 drugs, which are not tested for safety or effectiveness, and the new FDA restrictions have only increased the uncertainty surrounding these less-expensive options.
• If you’re considering (or already using) these medications, it’s crucial to consult your doctor and involve them in your weight loss treatment to help keep you safe and maximize your ability to thrive.