Some doctors resort to compounded versions of popular weight loss drugs

Some healthcare providers say they are starting to feel more comfortable prescribing prescription versions of the successful weight-loss drugs Wegovy and Zepbound, even as others continue to have concerns about the ingredients found in those drugs.

It's no secret that weight-loss drugs are hard to get, even with a prescription. They're expensive—a month's supply can cost more than $1,000—and they're often in short supply.

Compounded versions of semaglutide (the active ingredient in Wegovy) and tirzepatide (the active ingredient in Zepbound), on the other hand, are often cheaper and much easier to obtain.

“Doctors are not only prescribing compounded GLP-1 drugs more frequently, they are also endorsing them,” said Dr. Shauna Levy, an obesity medicine specialist and medical director of the Tulane Bariatric Center in New Orleans, referring to the class of drugs to which Wegovy and Zepbound belong.

At Duke Health's Hillsborough Primary Care Center in North Carolina, doctors are prescribing ready-to-use medications while brand-name products are in short supply.

Leanne Owens, a physician assistant at the practice, said she prescribed ready-to-use weight-loss drugs to 10 of her patients after the state stopped covering the brand-name versions for state employees in April.

At first, she says, she was nervous because she had never been prescribed self-compounded weight loss medication before. But after speaking with a pharmacist at Duke who makes compounded medications, she was reassured.

“Is this really the drug? And is the formula the same as the one used by the commercial drug manufacturers?” Owens recalled. “Anything new that we want to offer a patient, we want to make sure that we have done our research.”

Owens is not alone – other members of the medical practice also resort to over-the-counter versions of weight loss medications.

What is compounding?

People use compounded versions of medicines for a variety of reasons. A pharmacy that makes its own compounded medicines can convert a medicine that is only available in tablet form into a liquid so that it is palatable to a patient who cannot swallow tablets. Or it can make a version of a medicine without a particular coloring, for example if a patient is allergic to it.

The compounding technique is also used in cases of drug shortages: under special circumstances such as these, the US Food and Drug Administration allows the production of compounded versions that are “essentially a copy” of commercially available drugs.

According to the FDA's drug shortage database, semaglutide for weight loss has been in short supply since 2022. Tirzepatide, which was only approved for weight loss in the U.S. in November, was in short supply in April and is currently in short supply, the agency said.

Both drugs are under patent protection and Novo Nordisk and Lilly do not supply the ingredients to outside groups, raising questions about what is being sold to consumers.

However, pharmacists who manufacture their own drugs typically purchase their ingredients from FDA-registered facilities that cannot purchase the active ingredients themselves from the drug manufacturers.

According to the FDA, the facilities can essentially duplicate or create copies of the active ingredients in demand. However, unlike generic drugs, the agency does not test or verify the ingredients; that is the responsibility of pharmacists. Experts say it is important that doctors prescribe drugs from 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 that doctors explain to patients how to measure the dose accurately. Last month, the FDA reported that it had received reports of patients taking an overdose of semaglutide, which resulted in some patients being hospitalized. The dosing errors, the agency said, were due to patients measuring out incorrect doses and self-administering them, as well as doctors miscalculating the dosage of the drugs.

Matthew Brown, pharmacy manager at the Duke Compounding Facility, said the center only works with state-licensed pharmacies that have been vetted by Duke to manufacture medications. The facility provides pharmacy services to the entire university health system, including Hillsborough Primary Care Center.

Brown said Duke only prescribes compounded versions of the weight-loss drugs when there are shortages. Once the shortages are resolved, it will switch back to prescribing the brand-name drugs, he said.

Owens, the physician's assistant, said she trusts the mixed versions are the same medications and noted that patients lost 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 short supply. Since starting the compounded drug, she has lost 25 pounds and wants to lose another 25 pounds.

“I was a little nervous. I was like, 'What is a compounded drug?'” Kenly said. “After talking to my doctor, I felt really comfortable.”

Too many unknowns for some

Even though more and more doctors are willing to prescribe these compounded weight loss drugs, Novo Nordisk and Eli Lilly strongly oppose this practice.

Both have filed numerous lawsuits against pharmacies, weight-loss clinics and medical spas. In statements to NBC News, the drug companies said the drugs are not subject to the same scrutiny as FDA-approved drugs and that they pose risks to patients.

A Novo Nordisk spokesman described the compounding system as “not working as intended.”

“Novo Nordisk will continue to take legal action against pharmacies and other companies that illegally market and sell unapproved compounded 'semaglutide' medicines,” the spokesman said.

Lilly spokeswoman Antoinette Forbes said in a statement: “Poison control centers, regulators and patient advocacy groups across the country are issuing warnings about the use of compounded products to combat obesity.”

Many doctors are also still uncertain.

“In theory, it can be a reasonable product if you do everything right. But the problem is that so many things can go wrong,” said Dr. Scott Isaacs, president-elect of the American Association of Clinical Endocrinology. “It may be that more doctors are prescribing it, but from an organizational and professional perspective, there are more and more warning signs.”

“Probably not everyone does it like Duke,” Isaacs said.

Dr. Christopher McGowan, a gastroenterologist who runs a weight-loss clinic in Cary, North Carolina, said he often hears from patients who have tried compounded weight-loss drugs, but he himself would be “very hesitant” to try them, he said.

“In my opinion, there are still too many unknowns about the 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. There is no guarantee for patients about what they are getting 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's seeing an increasing number of patients at her clinic who have already started taking combinations of the drugs. But when she sees these patients, she often suggests alternative weight-loss medications — such as combination treatments of phentermine and topiramate (sold together as Qsymia) or naltrexone and bupropion (the drug Contrave) — if the brand-name drugs aren't available.

“People agree that the only treatments for overweight and obesity are the new injectable drugs. That is absolutely not true,” Andrade said. “There are other anti-obesity drugs that are also effective and not as expensive.”