NBC News
Some health professionals say they are starting to feel more comfortable prescribing compounded versions of the blockbuster slimming products Wegovy and Zepbound, although others remain concerned about the ingredients they contain.
It’s no secret that even with a prescription, weight-loss drugs are hard to come by. They’re expensive — a month’s supply can cost more than $1,000 — and often in short supply.
In contrast, compound versions of semaglutide (the drug in Wegovy) and tirzetide (the drug in Zepbound) are often cheaper and easier to obtain.
“Not only are physicians more likely to prescribe GLP-1-based drugs, they are more likely to advocate for 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 that includes Wegovy and Zepbound.
At Duke Health’s Hillsborough Primary Care Center in North Carolina, providers have been prescribing compounded versions of the drugs while brand-name versions are in short supply.
Leanne Owens, a physician assistant, said she prescribed compounded versions of the weight-loss drugs to 10 of her patients after the state stopped covering brand-name versions for state employees in April.
At first, she said, she was nervous about prescribing compounded weight-loss medications because she had never done it before. But after speaking with a compounding pharmacist at Duke, she felt more at ease.
“Is this really the drug? And is the prescription the same as the one used by commercial drug makers?” Owens recalls thinking. “Anything new that we’re considering offering to a patient, we want to make sure we’ve done our research.”
Owens is not alone: Other members of the medical practice have also turned to compounded versions of weight-loss drugs.
What is composition?
People use compounded versions of medications for a variety of reasons. A compounding pharmacy may take a medication that only comes in pill form and reformulate it into a liquid for a patient who can’t swallow a pill, or it may make a version of a medication without a certain dye, for example, if a patient is allergic to it.
Compounding also comes into play when there are drug shortages: The Food and Drug Administration (FDA) authorizes compounded versions that are “essentially a copy” of commercially available drugs in special circumstances like these.
Semaglutide for weight loss has been in short supply since 2022, according to the FDA’s drug shortage database. Tirzepatide, which was approved for weight loss in the United States only in November, entered into shortage in April and is currently in that status, the agency said.
Both drugs are patented, and Novo Nordisk and Lilly do not supply ingredients to outside groups, raising questions about what is being sold to consumers.
However, compounding pharmacists typically source their ingredients from FDA-registered facilities that cannot purchase active ingredients from manufacturers.
According to the agency, these centers can reproduce or produce copies of active ingredients on request. However, unlike with generic drugs, the agency does not check or verify the ingredients; that is the responsibility of pharmacists. Experts say it is important for doctors to prescribe drugs from compounding pharmacists they can trust. Patients should obtain prescriptions from their doctors and fill them at state-licensed pharmacies. Patients should also avoid ordering drugs online or buying them at spas.
It’s also important for providers to counsel patients on how to measure doses accurately. Last month, the FDA said it had received reports of patients overdosing on compounded semaglutide, leading to some being hospitalized. The agency said the dosing errors were due to patients measuring and administering incorrect doses to themselves, as providers miscalculated the dosage of the drugs.
Matthew Brown, director of pharmacy at the Duke Compounding Facility, said the facility only uses state-licensed and Duke-approved pharmacies to compound medications. The facility provides compounding pharmacy services for the entire university health system, including the Hillsborough Primary Care Center.
Brown said Duke prescribes compounded versions of weight-loss drugs only when there is a shortage. Once the shortage is over, it will revert to prescribing brand-name drugs, he said.
Owens, the physician assistant, said she is confident the compounded versions are the same drugs, and noted that patients are losing weight. She said she has not seen an increase in side effects.
Elizabeth Kenly, 58, of Graham, N.C., was prescribed a compounded version of tirzepatide by a Hillsborough doctor in March after she had trouble finding Wegovy because it was in short supply. Since starting the drug, she has lost 25 pounds and wants to lose another 25.
“I was a little nervous. I wondered what a compounded medication was,” Kenly recalled. “I felt very comfortable after talking to my doctor.”
For some, too many unknowns
Although more and more doctors are willing to prescribe compounded weight-loss drugs, Novo Nordisk and Eli Lilly strongly oppose this practice.
Both have filed multiple lawsuits against compounding pharmacies, weight-loss clinics and spas. In statements to NBC News, the drugmakers said the drugs lack the same oversight as FDA-approved medications and pose risks to patients.
A Novo Nordisk spokesman described the compounding system as “not working as intended.”
“Novo Nordisk will continue to pursue legal action against compounding pharmacies and other entities engaged in the illegal marketing and sale of unapproved compounded semaglutide medicines,” the spokesperson added.
Lilly spokeswoman Antoinette Forbes said in a statement: “Poison centers, regulatory agencies and patient advocacy groups across the country are issuing warnings about the use of compounded anti-obesity products.”
Many doctors also still have doubts.
“In theory, if you do 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. “There can definitely be more doctors prescribing it, but from an organizational and professional perspective, there are more and more warnings.”
“Probably not everyone is doing it like Duke,” Isaacs insisted.
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 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 compounding is not overseen, 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 Mayo Clinic in Jacksonville, Florida, said she has begun to see more patients in her clinic who have already started taking compounded versions of these drugs. But when she sees them, she often suggests 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 brand-name drugs aren’t available.
“People focus on the fact that the only options available for treating overweight and obesity are new injectable medications. This is absolutely false,” Andrade said. “There are other anti-obesity medications that are also effective and are not as expensive.”
