Some health care providers say they’re starting to feel more comfortable prescribing compounded versions of the blockbuster weight loss drugs Wegovy and Zepbound, even as others have lingering concerns about the ingredients used in them.
It has been no secret that, even with a prescription in hand, the weight loss drugs can be hard to get hold of. They’re pricey — a month’s supply can cost more than $1,000 — and are often in shortage.
Compounded versions of semaglutide (the drug found in Wegovy) and tirzepatide (the drug in Zepbound), on the other hand, often come at lower prices and are much easier to get.
“Not only are physicians more OK with prescribing compounded GLP-1 medications, but they are also advocating for them,” said Dr. Shauna Levy, a specialist in obesity medicine and the medical director of the Tulane Bariatric Center in New Orleans, referring to the class of drugs that include Wegovy and Zepbound.
At Duke Health’s Hillsborough Primary Care Center in North Carolina, providers have been prescribing compounded versions of the drugs while the brand-name versions are in shortage.
Leanne Owens, a physician assistant at the practice, said she prescribed 10 of her patients compounded versions of the weight loss drugs after the state stopped covering the brand-name versions for state employees in April.
Initially, she said, she was nervous about prescribing compounded weight loss medications because she had never done it before. However, after she spoke with a compounding pharmacist at Duke, she felt reassured.
“Is this truly the medication? And is the recipe the same recipe that’s being used by the commercial drug manufacturers?” Owens recalled thinking. “Anything that is new that we are considering offering to a patient, we want to make sure that we have done our research.”
Owens isn’t alone — other members of the medical practice have also turned to compounded versions of weight loss drugs.
What is compounding?
People use compounded versions of drugs for a number of reasons. A compounding pharmacy can take a drug that comes only in tablets and reformulate it into a liquid for a patient who can’t swallow a pill, or it can make a version of a drug without a certain dye, for example, if a patient is allergic to it.
Compounding also comes into play during drug shortages: The Food and Drug Administration allows compounded versions that are “essentially a copy” of commercially available drugs under special circumstances such as those.
Semaglutide for weight loss has been in shortage since 2022, according to the FDA’s drug shortage database. Tirzepatide, which was approved for weight loss in the U.S. only in November, went into shortage in April and is currently in shortage, the agency says.
Both drugs are under patent, and Novo Nordisk and Lilly don’t supply the ingredients to outside groups, raising questions about what’s being sold to consumers.
Compounding pharmacists, however, typically purchase their ingredients from FDA-registered facilities that themselves can’t buy the active ingredients from the drugmakers.
The facilities can essentially replicate or produce copies of the active ingredients in demand, according to the FDA. Unlike for generic drugs, the agency doesn’t test or verify the ingredients, however; that’s up to the pharmacists. Experts say it’s important that doctors prescribe the drugs from compounding pharmacists they can trust. Patients should get prescriptions from their doctors and fill them at state-licensed pharmacies. Patients should also avoid ordering drugs online or buying them from med spas.
It’s also important for providers to advise patients about on how to measure doses accurately. Last month, the FDA reported that it had received reports of patients’ overdosing on compounded semaglutide, which some to be hospitalized. The dosing errors, the agency said, were due to patients’ measuring and giving themselves incorrect doses, as well as providers’ miscalculating the drugs’ dosage.
Matthew Brown, the pharmacy manager at the Duke Compounding Facility, said the center uses only state-licensed pharmacies that Duke has vetted to compound medications. The facility provides compounding pharmacy services for the university’s entire health system, including the Hillsborough Primary Care Center.
Brown said Duke prescribes compounded versions of the weight loss medications only when there are shortages. Once the shortages have ended, it will switch back to prescribing the brand-name drugs, he said.
Owens, the physician assistant, said she trusts that the compounded versions are the same medications, noting that patients are losing weight. She said she hasn’t seen an increase in side effects.
Elizabeth Kenly, 58, of Graham, North Carolina, was prescribed a compounded version of tirzepatide by a doctor at the Hillsborough practice in March after she had trouble finding Wegovy because it was in shortage. Since she started the compounded drug, she has lost 25 pounds and wants to lose another 25.
“I was a little nervous. I was like, ‘What is a compounded medication?’” Kenly said. “I felt really comfortable after talking to my doctor.”
For some, too many unknowns
Even though more doctors are open to prescribing the compounded weight loss drugs, Novo Nordisk and Eli Lilly staunchly oppose the practice.
Both have filed multiple lawsuits against compounding pharmacies, weight loss clinics and medical spas. In statements to NBC News, the drugmakers said the drugs lack the same oversight as FDA-approved medicines and pose risks to patients.
A spokesperson for Novo Nordisk described the compounding system as “not working as intended.”
“Novo Nordisk will continue to take legal action against compounding pharmacies and other entities engaged in unlawful marketing and sales of unapproved compounded ‘semaglutide’ drugs,” the spokesperson said.
Lilly spokesperson Antoinette Forbes said in a statement, “Poison control centers, regulators, and patient advocacy groups around the country are issuing warnings about the use of compounded anti-obesity products.”
Many doctors are still uncertain, as well.
“In theory, if you can get everything right, it can be a reasonable product. But the problem is that there are so many things that could go wrong,” said Dr. Scott Isaacs, president-elect of the American Association of Clinical Endocrinology. “Definitely there may be more doctors prescribing it, but from an organizational and professional perspective, there’s more and more warnings.”
“Not everybody is probably doing it like Duke,” Isaacs said.
Dr. Christopher McGowan, a gastroenterologist who runs a weight loss clinic in Cary, North Carolina, said he frequently hears about patients who have tried compounded weight loss drugs. However, he said, he would be “very hesitant” to prescribe them himself.
“In my opinion, there are still too many unknowns about compounded versions of semaglutide and tirzepatide,” McGowan said. “Regardless of whether a pharmacy is accredited or not, the actual compound is not monitored, regulated or tested by the FDA. For patients, there is no guarantee of what they are receiving and whether it is equivalent to a brand-name drug.”
Dr. Daniela Hurtado Andrade, an endocrinologist at the Mayo Clinic in Jacksonville, Florida, said she has begun to see more patients in her clinic who have already started on compounded versions of the drugs. However, when she sees them, she often suggests alternative weight loss drug options — such as combination treatments of phentermine and topiramate (sold together as the drug Qsymia) or naltrexone and bupropion (the drug Contrave) — if the brand-name drugs aren’t available.
“People are focused on the fact that the only options available for the treatment of overweight and obesity are the new injectable medications. This is absolutely not true,” Andrade said. “There are other anti-obesity medications that are also effective and are not as expensive.”
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