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Compounded semaglutide side effects

Why compounded semaglutide may have different ingredients and different side effects than FDA-approved counterparts
Gerardo Sison medical writer headshot
By | Feb. 17, 2025
An injection: Compounded semaglutide side effects

Key takeaways

  • Compounded semaglutide lacks FDA approval, leading to risks like dosing errors, contamination, and unknown side effects. 

  • Side effects of semaglutide may include nausea, vomiting, constipation, gallbladder problems, and low blood sugar. 

  • The quality and effectiveness of compounded medications vary due to less rigorous safety checks than FDA-approved medications. 

  • Consult a healthcare provider before use, as compounded semaglutide may interact with other drugs or worsen existing health conditions.

In this article:

Many people are turning to compounded versions of semaglutide for various reasons, such as costs and shortages of approved medications like Ozempic and Wegovy. While compounding alternatives might seem appealing, they lack the testing and quality control of their approved counterparts. The side effects of compounded semaglutide can range from mild digestive issues to more severe complications, like low blood sugar (hypoglycemia) or gallbladder problems.

It’s a good idea to be aware of the potential risks and complications associated with compounded semaglutide. It’s not safe or effective, according to the Food and Drug Administration (FDA), and it may lead to serious health problems. Read on to learn more about the side effects and safety concerns surrounding this increasingly popular but controversial weight loss option.

Semaglutide vs. compounded semaglutide

Semaglutide is the active ingredient in three brand-name medications: Wegovy, Ozempic, and Rybelsus. Wegovy is approved for weight loss, while Ozempic and Rybelsus are approved to treat Type 2 diabetes. Although these medications are effective, the FDA has not yet approved generic versions, meaning people can only get a prescription for semaglutide under its brand name.

Compounded semaglutide is a custom-made version made by licensed compounding pharmacies. They use the same active ingredient as brand-name versions but might add different inactive ingredients. Therefore, compounded semaglutide is meant to work the same way and to be almost identical to the brand name semaglutide. However, it isn’t regulated as closely as drugs approved by the FDA. 

Compounded semaglutide has become commonly marketed by pharmacies due to shortages of brand-name semaglutide. In addition, many people may be attracted to compounded semaglutide because of the costs, especially if they don’t have insurance. Still, the quality of compounded medications can vary, and they might not work as well as FDA-approved semaglutide. 

Healthcare providers usually prefer to prescribe FDA-approved drugs when possible. They know exactly what’s in them and how they work. With compounded drugs, it’s harder to be sure.

Is compounded semaglutide safe?

The safety of compounded semaglutide products is not clear. The FDA does not check these drugs for safety or how well they work, as they’re often made in smaller pharmacies, not by big drug companies. 

Some risks of using compounded semaglutide include:

  • Unknown side effects
  • Wrong doses
  • Contamination
  • Risk of drug interactions
  • Mistakes in labeling
  • Allergenic or expired ingredients

It’s best to talk to a healthcare provider before trying compounded semaglutide. A healthcare provider can offer medical advice based on your overall health history.

In addition, getting compounded semaglutide from a local pharmacy with a prescription might be safer than ordering online. Telehealth providers may not know enough about a person’s health to prescribe it safely.

As drug shortages end, compounded versions might become harder to get. The FDA might also crack down on online pharmacies that sell them.

Compounded semaglutide side effects

Semaglutide, like other glucagon-like peptide-1 (GLP-1) receptor agonists, can cause a range of side effects. These effects may range from mild to severe, similar to those seen with FDA-approved versions. However, their frequency and intensity can vary.

Common compounded semaglutide side effects

The most common side effects of semaglutide, whether FDA-approved or compounded, are gastrointestinal. For example, nausea is common, especially when starting treatment or increasing doses. Many people also report vomiting, diarrhea, constipation, bloating, belching, gas, heartburn, and abdominal pain. Other potential side effects may include headaches, fatigue, dizziness, runny nose, or sore throat. Side effects of semaglutide usually get better over time as the body adjusts to the medication.

You may experience different side effects from compounded semaglutide than from FDA-approved semaglutide, whether due to dosing errors or added ingredients that compounding pharmacies sometimes add. For example, some compounding pharmacies add vitamin B12, vitamin B6, L-carnitine,  and nicotinamide adenine dinucleotide (NAD) into their semaglutide products. The FDA has not established whether it is safe to combine these ingredients with semaglutide. There have also been reports of some compounded versions being made with salt forms of semaglutide rather than the pure ingredient despite FDA warnings that semaglutide sodium and semaglutide acetate should not be used to compound semaglutide. 

Rare compounded semaglutide side effects

While less common, some side effects of compounded semaglutide can be serious or life-threatening. Serious side effects may be similar to those of FDA-approved versions and may include:

  • Pancreatitis: Inflammation of the pancreas can develop, leading to severe stomach pain that might spread to your back. If you experience persistent stomach pain, with or without vomiting, stop taking the medication and contact your healthcare provider immediately.
  • Gallbladder issues: Compounded semaglutide may contribute to gallbladder problems, such as gallstones, which might require surgery. Symptoms to watch for include upper abdominal pain, yellowing of your skin or eyes (known as jaundice), fever, or stools that look clay-colored.
  • Hypoglycemia: There is an increased risk of low blood sugar, particularly in those taking other diabetes medications like insulin or sulfonylureas. Be aware of symptoms like dizziness, sweating, shakiness, blurred vision, and confusion. You may need to check glucose levels regularly while on this treatment.
  • Kidney problems: People with preexisting kidney problems may experience worsened kidney function due to dehydration caused by diarrhea, nausea, or vomiting. 
  • Allergic reactions: Some people may have serious allergic reactions. If you notice swelling in your face, lips, or tongue, a severe rash, difficulty breathing, or a fast heartbeat, seek medical help immediately.
  • Vision changes: People taking semaglutide might notice changes in their vision, such as blurred eyesight. There can also be a risk of worsening eye problems related to diabetes, like diabetic retinopathy and problems with the central part of the retina (macula).
  • Increased heart rate: Semaglutide may lead to an elevated resting heart rate. You may experience prolonged feelings of a racing heart or chest pounding.
  • Mental health changes: Semaglutide may cause sudden changes in mood, behavior, or emotional state. Watch for signs of depression or suicidal thoughts. 

Since compounded semaglutide isn’t FDA approved, there might be unknown risks that the FDA isn’t aware of. The safety checks for these versions aren’t as strict as for regular medicines.

Compounded semaglutide overdose warnings

Taking too much compounded semaglutide can be dangerous. The FDA has even warned about potential dosing errors with compounded semaglutide injections, with some people having ended up in the hospital after accidental overdoses. These mistakes can happen since some versions require the patients to measure their own dose and pull it from a vial. In contrast, FDA-approved Ozemic and Wegovy come in premeasured autoinjectors, and Rybelsus is an oral tablet. There have also been reports of compounded semaglutide being mislabeled with unclear instructions.  

Overdose symptoms may include:

  • Severe nausea and vomiting 
  • Intense stomach pain 
  • Dangerously low blood sugar

It’s important to be careful with dose measurements if you take compounded semaglutide. Even small errors can lead to severe problems. Always consult a healthcare provider to double-check the correct dose you should be taking. 

Compounded semaglutide interactions

Semaglutide may interact with other medications. These interactions may change how other medications work or increase certain side effects. We know about these interactions because Novo Nordisk, the manufacturer of FDA-approved Wegovy, Ozempic, and Rybelsus, is required to report adverse events to the FDA. Since some compounding pharmacies may not be required to report adverse events, there is a lack of information on whether compounded semaglutide has the same interactions. 

Nonetheless, here are some potential semaglutide interactions to watch out for:

  • Antidiabetic medications: Compounded semaglutide can lower blood sugar levels, which may lead to hypoglycemia, especially when used with other diabetes medications. Combining semaglutide with insulin or medications that stimulate insulin release, such as sulfonylureas, increases this risk. The dosages of other antidiabetic medications may need to be adjusted when starting compounded semaglutide.
  • Oral medications: Semaglutide slows down how quickly food leaves the stomach, affecting how well other oral medications are absorbed. Although studies have shown that semaglutide does not significantly affect the absorption of all oral medications, it is still important to watch how these drugs work when taken together. Some people may find that their oral medications take longer to have an effect when used alongside semaglutide. 

In addition, drinking alcohol while taking semaglutide can increase the risk of low blood sugar. Alcohol may also cause gastrointestinal problems like nausea, vomiting, and an upset stomach, which may be worsened when combined with semaglutide. It’s recommended to limit alcohol and talk to a healthcare provider about safe drinking habits.

Always consult a healthcare provider about potential drug interactions. Provide them with a list of all medications you take, including prescription drugs, over-the-counter medications, and herbal supplements, before taking compounded semaglutide.

How to prevent side effects of compounded semaglutide

Although compounded semaglutide can cause side effects, there may be ways to potentially reduce them. These tips may help make treatment with compounded semaglutide more comfortable and effective.

Follow the prescribed dosage

Sticking to the right dose is key to avoiding problems. Don’t change the amount without talking to a healthcare provider first. Semaglutide is typically started at a low dose and increased slowly over time to give the body a chance to adjust. Use the medication exactly as directed. If it’s an injection, learn the proper technique. For pills, take them at the same time each day. You can keep track of doses with a calendar or phone app.

Take the medication with food to reduce nausea

Nausea is a common problem with semaglutide. Eating something when taking injectable semaglutide may help. Try a small snack or light meal. Avoid fatty or spicy foods that might upset the stomach. Some people find crackers or toast helpful, while others prefer fruit or yogurt. Experiment to see what works best. Keep in mind that oral semaglutide is typically taken 30 minutes before breakfast. 

Stay well-hydrated to prevent constipation

Drinking plenty of water may help prevent constipation. Water also supports healthy lifestyle changes and may help reduce feelings of hunger. Try carrying a water bottle as a reminder to drink regularly. Herbal tea and low-calorie beverages count, too. Avoid sugary drinks, which can add extra calories and hinder your weight loss goals.  

Increase dietary fiber intake 

Eating more fiber can help with digestive problems. It can support bowel movements and feed healthy gut bacteria. Good sources of fiber include apples, berries, broccoli, carrots, and whole-grain bread. Add fiber slowly to avoid gas or bloating, and drink extra water when increasing fiber intake.

Eat smaller, more frequent meals instead of large ones

Large meals can worsen nausea and bloating. Eating smaller amounts more often is easier on the stomach. Try having five to six small meals or snacks throughout the day instead of three big ones. Avoid eating late at night, as doing so may cause discomfort when lying down.

Consult a healthcare provider before starting treatment

A healthcare provider can assess if compounded semaglutide is safe and suitable for you. Discuss any health conditions or medications that might interact. Ask about potential adverse events and how to manage them. Regular check-ups can help you monitor progress and adjust your weight management plan as needed.

How to treat side effects of compounded semaglutide

Side effects of semaglutide and compounded semaglutide can develop at any time. Therefore, you should know how to manage these effects and when to seek medical help. 

For mild nausea, eating smaller meals and avoiding fatty foods can help. Staying hydrated is important for managing diarrhea. Over-the-counter medicines like antacids or anti-diarrhea medications may provide relief.

Cold compresses can ease injection site reactions. For constipation, increasing fiber intake and staying active often help. If these symptoms persist, talk to a healthcare provider.

Some side effects need quick medical attention. These include:

  • Severe stomach pain
  • Ongoing vomiting
  • Severe dehydration
  • Allergic reactions like rashes or trouble breathing
  • Symptoms of acute kidney injury, such as decreased urination

If these occur, seek immediate medical care. In rare cases, hospitalization might be needed for proper treatment and monitoring.

Safety measures while using compounded semaglutide

Some people may need to avoid compounded semaglutide, including the following:

  • Pregnant or breastfeeding women 
  • People with a history of thyroid cancer 
  • Anyone allergic to semaglutide or its ingredients

If you decide to use compounded GLP-1 receptor agonists to manage obesity or diabetes, you might want to keep the following in mind:

  • Buy from a reputable, licensed pharmacy. 
  • Ask for a list of the ingredients used.
  • Get clear dosing instructions. 
  • Watch for side effects. 
  • Keep in touch with a healthcare provider.

Regular check-ups are a must when taking any medication. A healthcare professional can track progress and adjust the dose if needed. They’ll also help you watch for any health issues that arise. Try keeping a log of how you feel throughout treatment. Doing so can make it easy to track symptoms and communicate them to your healthcare provider promptly.  

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