Update on Compounded GLP-1s
Update on Compounded GLP-1s
The landscape for compounded weight loss medicines is changing rapidly.
Some availability depends on the state you live in. You may have heard that a U.S. federal judge has denied an injunction that would have allowed compounding pharmacies to keep making copies of Eli Lilly’s weight-loss and diabetes drugs Zepbound and Mounjaro (generic name Tirzepatide) in the United States. This was based on Lilly saying the shortage of Zepbound and Mounjaro has ended which most experts say is not true. The Outsourcing Facility Association that filed the lawsuit said that the number of patients taking compounded GLP-1s as in the millions, so banning compounding pharmacies from providing these medicines will cause a shortage. This injunction does not current affect the Novo Nordisk’s drugs Ozempic or Wegovy (generic name Semaglutide), although it may in April 2025. Hundreds of Dr. Friedman’s patients have benefited from these compounded GLP-1s which are available in syringes allowing individual dosing that is not possible with the commercial medicines. Compounded GLP-1s do not require insurance pre-authorization and are much more affordable.
Compounding Pharmacies that Dr. Friedman works with:
Dr. Friedman works with several compounding pharmacies to provide affordable and safe GLP-1 drugs that have improved patients’ health and weight. Dr. Friedman has communicated with representatives from the three compounding pharmacies he works with University Compounding Pharmacy (UCP), Strive Pharmacy and Empower Pharmacy and each pharmacy with each companies’ availability below. Dr. Friedman’s philosophy is that compounded pharmacies are supplying “Tirzepatide” and “Semaglutide” and not “Ozempic”, “Wegovy”, “Zepbound” and “Mounjaro” and that they are supplying customized dosing that are not available with the fixed doses supplied by the pharmaceutical companies.
According to the Wall Street Journal, Hims & Hers referred to a March 2 social-media post by Chief Executive Andrew Dudum saying the firm would stop selling commercially available doses in mid-May but would keep providing compounded versions if they have been getting a personalized dosing regimen. Thus, the personalized dosing regimen of GLP-1s (syringes that allow patients to adjust dosing) may allow them to continue to supply these compounds.
Legal Status as of April 1, 2025
Eli Lilly is suing two pharmacies for compounding Zepbound and Mounjaro, claiming the companies are skirting the Food and Drug Administration’s ban on the practice and luring people away from Lilly’s medicines. In lawsuits filed Tuesday in Delaware and New Jersey, Lilly alleges the two companies — Strive Pharmacy and Empower Pharmacy — are falsely marketing their products as personalized versions of the drugs that have been clinically tested and are made using stringent safety standards. Lilly argues these claims are turning people toward compounded drugs and away from its FDA-approved treatments.
Tirzepatide versus Semaglutide
Overall, Dr. Friedman prefers Tirzepatide over Semaglutide as it gives more weight loss and less side effects but is currently available in CA only in the sublingual form. Dr. Friedman’s top recommendations are in red.
Siblingual Tirzepatide at UCP – is an excellent choice. Patients pay UCP. Tirzepatide injections have been discontinued but they have sublingual (under the tongue) Tirzepatide (10 mg/mL). One can start with 2.5 mg (0.25 mL) twice a week for 2 weeks, then go up to 5 mg (0.5 mL) twice a week for 4 weeks and then go up to 10 mg under the tongue twice a week, which is the final recommended dose. The price for 10 mL (lasts about 2 months) is $199. The 20 mL is $299. It needs to be refrigerated and can be used for 90 days after opening the bottle. It comes with a syringe that can withdraw the liquid from the vial and put under the tongue, where it should be held for 1 minute and then swallowed. It is best to take with a “dry” mouth and not to drink/eat for 30 minutes after administration. Because the sublingual product is new, its weight-loss properties compared to injectable Tirzepatide are not known.
Compounded Semaglutide/ B12 FIVE is available from UCP until April 22, 2025, and is available in 44 states including Califormia. A 5 mg vial that last about 2 months is $299.
Strive Pharmacy Strive Pharmacy, which compounds Semaglutide (brand name Ozempic, Wegovy), and Tirzepatide (brand name Mounjaro, Zepbound) is a 503B compounding pharmacy that offers GLP-1RAs to patients at a low price in 31 states including California. For Strive pharmacy, patients pay Dr. Friedman directly. There are several options available at Strive Pharmacy, with the common 3 options seen in this table:
The Empower compounding pharmacy ships to all states but CA, WI and IA. Patients pay Empower directly.
Semaglutide / Cyanocobalamin Injection
1/0.5 mg/mL 1 mL $94.68
1/0.5 mg/mL 2.5 mL $118.96
5/0.5 mg/mL 1 mL $132.18
5/0.5 mg/mL 2.5 mL $219.49
Tirzepatide / Niacinamide Injection
8/2 mg/mL 2.5 mL $188.20
17/2 mg/mL 2 mL $308.53
17/2 mg/mL 4 mL $559.21
Zepbound Glass Vials For those patients who insist on non-compounded preparations, Zepbound Glass Vials from Lilly Direct are an option. The cost for the 4 of the 10 mg vials is $499 for the first vial and $499 if renewed within 45 days or $699 if renewed after 45 days. Patients need to register on LillyDirect.lilly.com and purchase syringes for a small fee. Each vial is 0.5 ml, so the concentration is 2 mg/0.1 ml. Although the company discourages using the vial for multi-dosing (it doesn’t contain a preservative), one option would be to inject 1 mg (0.05 mL) weekly for 2 weeks, 2 mg (0.1 mL) weekly for 2 weeks, then 4 mg (0.2 ml) weekly. The box of 4 vials would last about 10 weeks.
Because of the different options for compounded GLP-1s, Dr. Friedman is advising his patients to make a 10-minute followup appointment to discuss options. For more information, please read about compounded GLP-1s, and listen to listen Dr. Friedman’s original GoodHormoneHealth Webinar on November 17, 2024 on compounded Tirzepatide vs Semaglutide for patients with endocrine problems https://www.youtube.com/watch?v=u9VbPDsJcPE, https://www.facebook.com/goodhormonehealth, https://www.goodhormonehealth.com/webinars or on your podcast channel.
Dr. Friedman discussed the updated situation for compounded GLP-1s at his most recent GoodHormoneHealth Webinar on Sunday March 23rd at 6:00 PM after his talk on “How can Blue Zones and Maimonides’ principles be applied to lead a healthy life for patients with endocrine problems?” It is available on YouTube, https://www.goodhormonehealth.com/webinars/ or https://www.facebook.com/goodhormonehealth.