Compounded semaglutide side effects: A comprehensive guide
Achieve your weight loss goals safely with compounded semaglutide. We'll guide you through the common side effects and help you make informed decisions.
Key highlights
- Semaglutide is a glucagon-like peptide-1 receptor agonist that works on GLP-1 receptors in the body to manage blood glucose levels and lose weight by delaying gastric emptying and reducing appetite.
- Compounded semaglutide contains the same active ingredient as the brand name drugs, semaglutide. The medication is compounded by licensed pharmacies, licensed physicians, licensed pharmacists, or people under the supervision of a licensed pharmacist.
- Compounded semaglutide has the same side effects as brand-name semaglutide. Common side effects of compounded semaglutide include nausea, vomiting, constipation, diarrhea, and stomach pain. Serious side effects include kidney disease, gallbladder disease, pancreatitis, changes in vision, increased risk of hypoglycemia, and increased heartbeat.
- Always inform the compounding pharmacy of your allergies to avoid hypersensitivity reactions to any of the ingredients in the compounded semaglutide products.
- Consult your healthcare provider before starting compounded semaglutide, especially if you are pregnant, breastfeeding, or have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Semaglutide is a GLP-1 agonist drug that works on GLP-1 receptors and helps reduce weight and manage blood glucose levels by delaying gastric emptying. Compounded semaglutide contains the same active ingredient as the brand name drugs, Wegovy, Ozempic and Rybelsus.
Novo Nordisk’s Wegovy is FDA-approved for weight loss, whereas Ozempic and Rybelsus are FDA-approved drugs for type 2 diabetes management. The high demand for these drugs for weight loss often results in shortages, leading to the need for compounded semaglutide products.
Compounded semaglutide medications are compounded versions of the drug. They contain the same active ingredient (semaglutide) as the brand name drugs and the inactive ingredients may vary, depending on the pharmacy’s preparation process and patient needs.
Common side effects of compounded semaglutide include gastrointestinal-related side effects (nausea, vomiting, constipation, diarrhea, and stomach pain) that go away in a few days or weeks. In rare cases, some people may experience serious side effects like hypoglycemia, pancreatitis, gallbladder disease, kidney disease, and increased heart rate. When buying compounded semaglutide, make sure that the compounded drug does not have any ingredient you are allergic to as it may cause serious allergic reactions.
This article covers all the common and serious side effects of semaglutide, ways to manage these side effects and how to safely access compounded semaglutide.
What is semaglutide?
Semaglutide is a GLP-1 receptor agonist medication prescribed to individuals with type 2 diabetes, obesity, or overweight with at least one weight-related health condition. It is used for chronic weight management and managing blood glucose levels.
GLP-1 (glucagon-like peptide-1) receptor agonists are incretin mimetics that work by delaying gastric emptying and reducing glucagon release into the blood. This helps regulate blood sugar levels and reduces appetite which helps with weight loss.
Novo Nordisk manufactures two subcutaneous semaglutide injections and oral semaglutide. The U.S. Food and Drug Administration (FDA) approved Ozempic and Rybelsus for managing type 2 diabetes, and Wegovy was approved for chronic weight management in adults with obesity or overweight with at least one weight-related condition, such as high blood pressure, type 2 diabetes, or high cholesterol.
Wegovy and Ozempic are injected under the skin (subcutaneously) once weekly because of a half-life of 5 days. Your healthcare provider will typically start semaglutide treatment with a low dose to minimize gastrointestinal side effects and gradually increase the weekly dose. Talk to your doctor for medical advice if you experience any unusual side effects with compounded semaglutide.
Common side effects of semaglutide (Ozempic and Wegovy)
Ozempic, Rybelsus, and Wegovy are semaglutide drugs approved for specific uses, but share common side effects because of the same active ingredient. The common side effects of semaglutide injections include:
- Gastrointestinal issues: Gastrointestinal problems like nausea, vomiting, constipation, and diarrhea are the most common side effects of semaglutide. Most people starting semaglutide experience these side effects because of the changes in the digestive process. These side effects usually subside within a few days or weeks once your body adjusts to the weight loss drug.
- Fatigue and dizziness: Patients starting treatment with semaglutide have also reported headaches, dizziness, and fatigue. These side effects might occur as your body adjusts to the medicine. Constant nausea and vomiting might make you dizzy and fatigued.
- Hypoglycemia: Patients taking semaglutide injections are at an increased risk of hypoglycemia (low blood sugar), especially when used with insulin or insulin secretagogues. Mention the use of insulin or insulin secretagogue to your healthcare provider when starting semaglutide drugs to avoid severe hypoglycemia.
- Long-term risks: Other than the common adverse reactions, semaglutide medications like Ozempic and Wegovy might lead to long-term health problems, including acute gallbladder disease, acute pancreatitis, acute kidney injury, diabetic retinopathy, and an increased heart rate. These health conditions might take longer to treat, even after you stop taking semaglutide.
What is compounded semaglutide?
Compounded semaglutide is a custom-made medication made by compounding pharmacies. It contains the same active ingredient, semaglutide, as the brand-name drugs Wegovy, Ozempic, and Rybelsus.
There could be various reasons for using compounded semaglutide instead of Novo Nordisk’s Ozempic or Wegovy:
- Semaglutide is typically compounded to meet specific patient requirements. For example, if an individual is allergic to one or more excipients in brand-name semaglutide, the ingredient can be replaced with a suitable alternative in compounded semaglutide.
- Compounded medications may also provide additional benefits, such as adding vitamin B-12 while compounding semaglutide for patients susceptible to B-12 deficiency.
- The patient needs a custom dosage or form that is not commercially available.
- Given the rising popularity of Wegovy and Ozempic, patients may have challenges accessing the brand name drugs due to ongoing drug shortages.
What does compounded mean?
Compounding is the process of mixing, combining, or altering the ingredients to create a custom medication tailored to the needs of the patient. A licensed physician, a licensed pharmacist, or a person under the supervision of a licensed pharmacist can prepare compounded semaglutide. Compounded medications are suitable for patients with allergies or intolerance to specific ingredients in the brand-name drugs, and can be useful during drug shortages.
FDA regulates the manufacturing of mass-manufactured drugs, including brand-name semaglutide drugs. However, compounded medications do not undergo the same rigorous testing by the FDA. Preparation of compounded semaglutide and other drugs is primarily overseen by the State Boards of Pharmacy.
Compounded semaglutide side effects
Individuals taking compounded semaglutide may experience side effects similar to those of Wegovy, Ozempic, and Rybelsus. The GI-related side effects of semaglutide typically resolve quickly as the body gets used to the medication.
Common side effects
- Gastrointestinal side effects: GI-related side effects are the most commonly reported in patients taking semaglutide because of the drug’s GLP-1 action. Changes in gastrointestinal activity can lead to adverse effects like diarrhea, constipation, nausea, vomiting, stomach pain, heartburn, eructation (burping), gastroenteritis, gastritis, and GERD.
- Fatigue and weakness: Semaglutide works by suppressing your appetite, which may lead to fatigue (tiredness) and weakness in the initial weeks until your body adjusts to the lower calorie intake.
- Headache: Patients also report experiencing headaches, which may result from changes in the diet. Adjustment to the medication or dehydration due to prolonged vomiting or diarrhea can cause headaches.
- Injection site reactions: If you administer the subcutaneous injection at the same location every time, you might see redness, swelling, itching and pain at the site of injection. You can avoid injection site reactions by rotating the injection area on each administration.
Rare and serious side effects
Other than the common side effects of compounded semaglutide mentioned above, some users may experience other side effects, such as:
- Hypoglycemia (low blood sugar): Semaglutide not only decreases appetite but also lowers blood sugar levels in patients with diabetes, increasing the risk of hypoglycemia. You must be vigilant when taking semaglutide, especially with insulin or insulin secretagogues to avoid severe hypoglycemia. In case you experience dizziness, blurred vision, sweating, confusion or drowsiness, headache, fast heartbeat, light-headedness, fast heartbeat, shakiness, drowsiness, slurred speech, irritability, and mood changes could be signs of hypoglycemia. Keep fast-acting glucose sources like juices, candies, or sugar near you for instant medical intervention.
- Pancreatitis (inflammation of the pancreas): Studies have shown a relationship between pancreatitis and GLP-1 drugs used for type 2 diabetes management or weight loss. If you experience severe abdominal pain along with fever, report the symptoms to your healthcare provider immediately.
- Gallbladder problems: Individuals taking semaglutide are at a risk of gallbladder disease. Common symptoms of gallbladder disease include fever, pain in the upper stomach, jaundice (yellowing of the eyes or skin), or clay-colored stools.
- Acute kidney injury: Dehydration as a result of prolonged vomiting may lead to acute kidney disease and worsening of chronic renal failure, which may require hemodialysis. Patients with renal impairment taking compounded semaglutide may be at a higher risk of acute kidney injury, and those without known underlying renal disease may also experience kidney-related issues. Individuals experiencing symptoms of kidney disease must be reported to the doctor immediately for adequate treatment.
- Allergic reactions: If someone is allergic to the excipient or the active ingredient in Ozempic, Wegovy, or compounded semaglutide, they may experience allergic reactions. Compounded semaglutide can prevent severe allergic reactions by substituting a particular ingredient with a suitable alternative. Stop the medication and consult your doctor immediately in case you experience the symptoms of an allergic reaction, such as swelling of your face, lips, tongue, or throat, severe rash or itching, trouble breathing or swallowing, increased heartbeat, or dizziness.
- Thyroid C-cell tumors: Brand-name semaglutide medications come with a boxed warning for thyroid c-cell tumors. These tumors have not been reported in humans, but rodent studies have shown evidence of thyroid tumors, including thyroid cancer. Semaglutide is not recommended if you or any of your family members have ever had MTC or if you have MEN 2.
- Diabetic retinopathy: Users taking semaglutide have been seen to experience worsening diabetic retinopathy because of a sudden improvement in blood glucose levels. Studies show that 4.0% of semaglutide-taking patients experienced temporary worsening in diabetic retinopathy, compared to 2.7% of placebo patients. Patients with diabetic retinopathy must be vigilant of the condition when taking compounded semaglutide to avoid complications.
- Increased heart rate: Some individuals taking semaglutide have reported an increase in their heart rate. Reports show an increase of 1 to 4 beats per minute among adults using semaglutide. Pediatric patients (12 years and older) also showed a significant increase (20 bpm or more) in their heart rate. If you feel a sudden increase in your heartbeat or palpitations when resting, report these symptoms to your healthcare provider immediately. They might advise you to stop the medication in case of consistent symptoms.
- Suicidal behavior: Clinical trials have shown a tendency for suicidal behavior and ideation in patients taking semaglutide for weight management. Individuals (including pediatric patients) taking semaglutide must be monitored closely to ensure they do not become depressed or suicidal. Patients showing changes in mood and behavior, indicating depression or suicidal thoughts with a history of active suicide ideation may be advised to stop semaglutide.
- Pulmonary aspiration during general anesthesia or deep sedation: GLP-1 drugs like semaglutide influence your body’s gastric action and delay stomach emptying. As a result, your stomach might not be completely empty as expected after fasting for a specific period. Delayed gastric emptying as a result of semaglutide intake might interfere with preoperative fasting recommendations. Individuals taking semaglutide must inform their healthcare provider before a procedure or surgery requiring general anesthesia or deep sedation to avoid complications.
Why might compounded semaglutide cause side effects?
Compounded semaglutide typically has the same side effects as brand-name semaglutide drugs because it contains the same active ingredient. Users might experience other side effects if the medication is prepared with sub-standard ingredients, making it critical to get compounded semaglutide from a licensed compounding pharmacy only.
Differences in formulation
Some pharmacies preparing compounded semaglutide may use salt forms of semaglutide, including semaglutide acetate or semaglutide sodium. These may not show the same efficacy or safety as semaglutide used in Wegovy, Ozempic, or Rybelsus. Compounding facilities may also use low-quality excipients to reduce costs, increasing the risk of unknown adverse events.
Dosage and administration
Commercially prepared semaglutide injections are available in specific doses allowing the patient to administer only the prescribed amount. Compounded semaglutide comes in numerous dosage forms, and may contain a lower or a higher dose than prescribed by your doctor. The administration may not be as efficient as commercially manufactured subcutaneous pens, making it challenging to ensure accurate dosing with compounded semaglutide. Dosing errors can lead to underdosing or overdosing, potentially resulting in hypoglycemia and other side effects.
Quality control
Compounded semaglutide production is not directly reviewed by the FDA and the compounding process does not undergo the same rigorous quality testing as FDA-approved medications. Compounded semaglutide must be prepared by qualified and experienced pharmacists, but sometimes they might not follow the standard operating procedures, putting the patient’s health at risk. The potential for substandard quality control during compounding can result in adverse events. Always use a licensed compounding pharmacy that has a reputation for high-quality products.
Managing compounded semaglutide side effects
Most side effects of compounded semaglutide go away within a few weeks, but some might linger for longer. You should consult a healthcare professional before using compounded semaglutide to ensure it is medically appropriate and safe for you. Do not ignore any changes in your body when you start the medication and report any sudden reactions and side effects to your doctor. You can manage the common side effects of compounded semaglutide through lifestyle changes.
General strategies
- Hydration: Prolonged vomiting and diarrhea can cause dehydration, increasing your risk for kidney disease. Stay hydrated to alleviate the GI-related side effects of semaglutide and prevent severe dehydration.
- Diet: Doctors suggest taking bland, low-fat foods when using semaglutide to prevent nausea. Eating smaller meals, avoiding greasy foods, and not lying down after eating can also help manage nausea and vomiting. For people experiencing bloating, it is suggested to avoid gas-causing foods like beans, peas, whole wheat, corn, barley, and carbonated beverages.
- Lifestyle changes: Lifestyle changes such as light exercise can improve the digestive process and help reduce fatigue by increasing energy levels. Aerobic exercises can also boost metabolism and burn fat over time, contributing to weight loss when using semaglutide.
- Medication changes: Doctors typically start semaglutide treatment with a low dose to allow your body to adjust to the changes. If you still experience side effects of semaglutide after a few weeks, consult your doctor about changing the timing or dose of compounded semaglutide.
Nausea
If you experience nausea continuously with compounded semaglutide, these tips may help you manage it:
- Eat bland, low-fat foods, such as toast, rice, and crackers
- Eat foods that contain water, like soup
- Eat slowly
- Drink cold water
- Avoid fried and sweet foods
- Do not lie down after you eat
- Go out for fresh air
Vomiting
Vomiting is one of the most common side effects of semaglutide, leading to dehydration. In case you experience vomiting for a longer period, make sure to drink at least 2 liters of water daily to prevent dehydration. Prolonged vomiting may also be a sign of gastroparesis, pancreatitis, or gallbladder disease. Take an over-the-counter anti-emetic for instant relief and share your side effects with your healthcare provider for proper treatment.
Diarrhea
29.7% of participants in research studying the gastrointestinal tolerability in patients taking semaglutide experienced diarrhea. Long-term diarrhea has been seen to cause dehydration, which can lead to headaches and kidney disease. People experiencing diarrhea must increase their water intake, add psyllium husk to their diet, take an over-the-counter anti-diarrhea medication, and talk to their healthcare provider for proper treatment.
Stomach pain
Stomach pain resulting from compounded semaglutide usually settles with time as your body adjusts to the medication. Talk to your doctor about the use of over-the-counter antacids to prevent stomach aches when using semaglutide. Inform your healthcare provider of prolonged stomach pain as it could be a sign of an underlying issue, such as gallbladder disease or pancreatitis.
Fatigue
Reduced appetite and weight loss may cause fatigue and dizziness when using semaglutide. Do not compromise on nutrition when taking low-calorie foods and keep yourself hydrated if you feel lethargic. Light exercise and 8 hours of quality sleep every night can also help reduce fatigue.
Who should not use compounded semaglutide
Compounded semaglutide can be an excellent alternative for people who cannot access the brand name drugs during shortages or when a custom dosage strength or form is needed. However, the drug is not to be used if:
- You or any of your family has ever had medullary thyroid carcinoma (MTC)
- You have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
- You are allergic to semaglutide or any of the inactive ingredients
When taking compounded semaglutide, ask the compounding pharmacy for the inactive ingredients to avoid severe allergic reactions. If you’re allergic to semaglutide, talk to your doctor about an alternative medicine. Patients with a history of gastrointestinal issues are also not recommended GLP-1 drugs like semaglutide to avoid GI-related adverse effects. Individuals taking multiple medications for complex medical conditions should talk to their healthcare provider when starting semaglutide. Pregnant and breastfeeding women must consult a doctor before taking semaglutide
When to seek medical attention
Most of the common side effects of compounded semaglutide will typically resolve on their own over time. In case you experience unusual side effects, get immediate medical advice from your doctor to find out the cause of the symptoms for proper treatment.
People experiencing side effects that interfere with daily activities (vomiting, hypoglycemia, changes in vision, etc.) for a prolonged period should also report those side effects to their doctor. They might change the dose or administration time of the medication. In case of an allergic reaction, stop the medication immediately and call your healthcare professional.
Compounded semaglutide vs. FDA-approved semaglutide: Side effects comparison
Individuals taking compounded semaglutide are likely to experience gastrointestinal side effects when starting the medication or increasing the dose. They might also observe symptoms of gallbladder disease, kidney disease, and pancreatitis along with changes in vision and an increased heartbeat.
Compounded semaglutide might cause hypersensitivity reactions if you are allergic to the excipient or active ingredient in the preparation. Patients might also overdose or underdose compounded semaglutide considering the availability of varying dosage forms made in different pharmacies.
Factors influencing side effects
Other than the known common and serious side effects resulting from the drug’s GLP-1 action, some other factors may influence the side effects of semaglutide.
- Dosage and administration methods: Commercially manufactured semaglutide comes in subcutaneous pens that administer a specific dose for each use. Compounded semaglutide, on the other hand, is prepared in various dosage forms, which may contain more or less than the recommended weekly dose. Taking a higher or lower dose than prescribed can also worsen the side effects of semaglutide.
- Individual factors: Individual factors like hypersensitivity to the active or any of the inactive ingredients, complex medical diseases, and a family history of conditions such as MTC can cause serious side effects. It is crucial to mention your personal and family history to your doctor before taking compounded semaglutide to avoid adverse effects.
- Compounding facility: The compounding facility that makes the medication can influence the side effects as the preparation process and ingredients may vary. Always ensure that you source compounded semaglutide from a licensed compounding pharmacy or outsourcing facility to ensure the safety and efficacy of the drug.
How to safely access compounded semaglutide
The absence of direct FDA monitoring of compounding medications in state-licensed pharmacies makes it essential to ensure that you obtain the medication from a reputable compounding pharmacy with qualified professionals.
You can ask your healthcare provider to refer you to a credible compounding pharmacy that offers compounded semaglutide. Also, ensure that the pharmacy you choose is licensed in your state and complies with the FDA guidelines for compounding.
When buying compounded semaglutide, ask the pharmacist about the ingredients used in the preparation. The compounded drug should have a semaglutide base and should not contain any ingredients you are allergic to.
Alternatives to compounded semaglutide
Compounded semaglutide is typically more readily available than the brand-name drugs which are known to be affected by drug shortages.
However, if you want to buy brand-name semaglutide, you can consider buying Ozempic, Rybelsus, and Wegovy. Novo Nordisk offers Wegovy to patients without insurance for $499 per month through its direct-to-consumer platform, NovoCare Pharmacy.
You can also talk to your healthcare provider about using other GLP-1 receptor agonist drugs like liraglutide (Saxenda and Victoza by Novo Nordisk) and tirzepatide (Zepbound and Mounjaro by Eli Lilly). Zepbound and Saxenda are approved for weight management, and Mounjaro and Victoza are approved by the FDA for type 2 diabetes management.
GLP-1 medications should always be combined with a low-calorie diet, physical activity, adequate sleep, and stress management to ensure optimal results.
Frequently asked questions
What are the most common side effects of compounded semaglutide?
Gastrointestinal-related side effects like nausea, vomiting, constipation, diarrhea, and stomach pain are the most common side effects associated with compounded semaglutide use. These side effects usually subside over a few days or weeks as your body adjusts to the medication. Users might also see redness or swelling at the injection site. It is recommended to rotate the injection site to avoid injection site reactions.
What are the most serious side effects of compounded semaglutide?
Pancreatitis, gallbladder disease, and kidney disease are among the most serious side effects of compounded semaglutide. Users might also experience allergic reactions to the compounded medicine if they are allergic to one or more ingredients in the preparation. Semaglutide use in rodents has been associated with thyroid c-cell tumors, but no cases have been reported in humans.
Can compounded semaglutide cause serious health issues?
Compounded semaglutide may cause serious health issues in some people. Semaglutide can affect the kidneys, gallbladder, and pancreas. Users might also experience an increased heartbeat even after stopping the medication.
How can I reduce the risk of side effects from compounded semaglutide?
You can minimize the side effects of compounded semaglutide by ensuring that you buy the compounded medication from a licensed compounding facility that uses high-quality ingredients and follows the FDA’s regulations for compounding. Physical activity and staying hydrated when taking the medication may also help improve side effects like nausea, fatigue, headache, kidney disease, etc.
Is compounded semaglutide safe for long-term use?
Compounded semaglutide from trustworthy and licensed compounding pharmacies and outsourced facilities can be used long-term.
Eat small, bland meals, and avoid lying down immediately if you experience GI-related side effects. Report prolonged abdominal pain and vomiting to your healthcare provider immediately. People with a history of MEN or MTC should not use compounded semaglutide. Pregnant and breastfeeding women must talk to their doctor before starting semaglutide.
How do the side effects of compounded semaglutide compare to Ozempic?
Compounded semaglutide has the same side effects as Ozempic. If you experience any unusual side effects of compounded semaglutide, talk to your healthcare provider immediately.
Bottom line
Semaglutide is a glucagon-like peptide-1 agonist medication prescribed for type 2 diabetes and chronic weight management in individuals with obesity and overweight with one weight-related condition like blood pressure, cholesterol, and heart disease.
Compounded versions of semaglutide have the same active ingredient as the brand-name semaglutide products and cause similar side effects. Common side effects of compounded semaglutide include nausea, vomiting, constipation, diarrhea, and abdominal pain. Patients taking compounded semaglutide also report rare but serious side effects of the drug, such as kidney problems, gallbladder disease, pancreatitis, changes in vision, hypoglycemia, and risk of thyroid c-cell tumors. Some users may experience adverse events resulting from an allergic reaction to any of the ingredients in the preparation or the use of sub-standard ingredients by the compounding pharmacy.
Always consult your healthcare provider before starting semaglutide and make sure to buy compounded semaglutide from a legitimate compounding pharmacy. Report your side effects to your doctor immediately for adequate medical attention and treatment.
