Comprehensive Guide to Compounded Semaglutide

Author: Darshan Patel, MD Weight loss Apr 22, 2024 5   min read

Obesity is a significant global health challenge, associated with a range of chronic conditions including diabetes, hypertension, and heart diseases. In response to the escalating incidence of obesity, the U.S. Food and Drug Administration (FDA) has approved various pharmacological agents for weight management. Among these, Semaglutide, marketed under names such as Ozempic, Wegovy, and Rybelsus, stands out as a GLP-1 receptor agonist that has shown considerable promise in weight management. It functions by mimicking the hormone GLP-1, which regulates appetite and food intake through actions in the brain. This guide explores the unique aspect of compounded semaglutide, discussing its efficacy, affordability, adverse effects, and more.

  • Ozempic: Primarily prescribed for diabetes management.
  • Rybelsus: The oral form of semaglutide is also targeted at diabetes management.
  • Wegovy: Specifically sanctioned for weight loss.

Compounded semaglutide is not a mass-produced drug but is custom-made in pharmacies to cater to individual patient needs, varying in dosage and formulation based on medical prescriptions.

Preparation of Compounded Semaglutide

Pharmacists craft doses and formulations tailored to specific prescriptions, aiding patients with unique dosage needs or those who have allergies or adverse reactions to conventional drug ingredients. This bespoke approach helps in enhancing therapeutic outcomes by ensuring optimal dosing and minimizing potential side effects, making it a critical option for patients with particular health requirements. Learn more here: Compounded GLP-1 Medications

The price of compounded semaglutide can vary, generally averaging around $250 – $500 monthly, influenced by factors such as dosage requirements and pharmacy pricing models.

Semaglutide has been demonstrated to be a highly effective option for weight loss, particularly in comparison with other GLP-1 receptor agonists. Its efficacy is driven by its potent and sustained action on the GLP-1 receptor, which plays a pivotal role in regulating appetite and caloric intake.

Semaglutide vs. Liraglutide (Ozempic vs Victoza / Wegovy vs. Saxenda):

In a comprehensive study reported in the New England Journal of Medicine, participants treated with semaglutide lost significantly more weight compared to those on liraglutide. Specifically, participants on semaglutide lost an average of 15.3% of their body weight, compared to 6.4% with liraglutide over the same period. This notable difference underscores semaglutide’s enhanced potency in promoting weight loss.

Reference: Wilding, J.P.H., Batterham, R.L., Calanna, S., Davies, M., Van Gaal, L.F., Lingvay, I., … & Wadden, T.A. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989-1002.

Semaglutide vs. Dulaglutide (Ozempic vs. Trulicity):

In studies comparing semaglutide with dulaglutide, semaglutide showed a greater degree of weight loss. Patients on semaglutide achieved an average weight loss of about 13.0% of their body weight, whereas those on dulaglutide lost around 7.8%. This demonstrates semaglutide’s superior effectiveness in managing weight alongside diabetes.

Reference: Ludvik, B., Giorgino, F., Jódar, E., Frias, J.P., Fernández Landó, L., Brown, K., … & García-Pérez, L.E. (2021). Once-weekly semaglutide versus once-weekly dulaglutide in metformin-treated patients with type 2 diabetes (SUSTAIN 7): a randomis

Semaglutide vs. Exenatide (Wegovy vs. Byetta/Bydureon):

When compared to exenatide, semaglutide again shows a more robust effect on weight reduction. Participants using semaglutide experienced a weight loss of approximately 12.7%, significantly higher than the 9.2% loss seen with exenatide weekly. This points to semaglutide’s effective action in both glucose control and weight management.

Reference: Pratley, R., Aroda, V.R., Lingvay, I., Lüdemann, J., Andreassen, C., Navarria, A., … & Garber, A. (2018). Semaglutide versus exenatide once weekly in patients with type 2 diabetes (SUSTAIN 3): a 56-week, open-label, randomized clinical trial.

Semaglutide vs. Tirzepatide (Ozempic vs Mounjaro / Wegovy vs. Zepbound):

Tirzepatide, a newer agent that stimulates both the GIP and GLP-1 receptors, has shown even more impressive results in weight loss than semaglutide, based on recent studies. For example, in the SURPASS-2 trial, patients treated with tirzepatide showed an average weight loss ranging from 16% to 22.5% of their body weight at the highest dose (15 mg), compared to 13.9% with the highest dose of semaglutide (2.4 mg). These figures underscore tirzepatide’s potential as a more powerful tool for weight reduction due to its dual incretin effect.

Reference: Jastreboff, A.M., Aronne, L.J., Ahmad, N.N., Wharton, S., Connery, L.E., Alves, B., … & Rubino, D.M. (2022). Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine, 387(3), 205-216

These specific figures provide a clear, quantitative understanding of semaglutide’s effectiveness in weight loss compared to other GLP-1 receptor agonists, reinforcing its position as a potent therapeutic option for patients aiming to manage obesity and type 2 diabetes.

  1. For Diabetes: Starts at 0.25 mg weekly, increasing to 1.0 mg.
  2. For Obesity: Begins at 0.25 mg weekly, with a maintenance dose of up to 2.4 mg.

Semaglutide operates through a multifaceted mechanism that primarily targets metabolic pathways influenced by the glucagon-like peptide-1 (GLP-1) hormone. Its action begins at the receptor level of GLP-1, which is extensively expressed in several key areas, including the pancreas and the central nervous system.

Enhancement of Insulin Secretion: Semaglutide binds to the GLP-1 receptors on pancreatic beta cells, which stimulates insulin release in a glucose-dependent manner. This means that insulin is released only when blood glucose levels are elevated, thereby reducing the risk of hypoglycemia—a common concern with some diabetes medications.

Suppression of Glucagon Release: Concurrently, semaglutide inhibits the secretion of glucagon from pancreatic alpha cells. Since glucagon typically raises blood glucose levels by promoting glucose production in the liver, its suppression helps in reducing hepatic glucose output, further aiding in the control of blood glucose levels.

Delay in Gastric Emptying: By slowing down gastric emptying, semaglutide prolongs the absorption of nutrients, including glucose, into the bloodstream. This action helps in reducing postprandial (after-meal) blood glucose spikes, an essential factor in managing both diabetes and weight.

These combined effects of semaglutide contribute significantly to its effectiveness in managing type 2 diabetes and aiding in weight loss. Extensive studies and clinical trials have substantiated these mechanisms, highlighting the therapeutic potential of GLP-1 receptor agonists in metabolic disorders.

For more detailed insights into the pharmacodynamic properties of semaglutide and its clinical applications, the following articles provide comprehensive information:

While semaglutide has shown significant efficacy in managing type 2 diabetes and aiding in weight loss, it is also associated with a range of potential adverse effects. Understanding these side effects is crucial for both patients and healthcare providers to manage expectations and treatment plans effectively.

Gastrointestinal Issues: The most commonly reported side effects of semaglutide are gastrointestinal in nature, including nausea, vomiting, diarrhea, abdominal pain, and constipation. These symptoms are thought to arise from the drug’s action on gastric emptying and digestive motility. Studies suggest that these side effects are often transient and can diminish over time as the body adjusts to the medication.

Pancreatitis: There is a concern about an increased risk of pancreatitis associated with GLP-1 receptor agonists like semaglutide. Patients are advised to report any severe abdominal pain promptly as this could be a sign of pancreatitis.

Thyroid C-cell Tumors: In animal studies, GLP-1 receptor agonists have been linked to thyroid C-cell tumors. While it is unclear if this risk directly translates to humans, it is a noted area of concern, and semaglutide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or in those who have Multiple Endocrine Neoplasia syndrome type 2.

Hypoglycemia: When combined with other antidiabetic medications, particularly sulfonylureas or insulin, semaglutide can increase the risk of hypoglycemia. Careful dose adjustments and monitoring are required when semaglutide is used in combination with these therapies.

Changes in Vision: There have been reports of changes in vision or retinopathy worsening in patients using semaglutide. This effect may be linked to rapid improvements in glucose control that can temporarily worsen retinal disease, particularly in patients with pre-existing retinopathy.

For further detailed information on the adverse effects of semaglutide, the following references provide comprehensive data. 



Compounded semaglutide provides a personalized strategy in the battle against obesity, delivering significant advantages in weight and diabetes management. By understanding its workings, potential side effects, and the specifics of compounded formulations, patients and healthcare providers can make informed decisions about its use, tailoring treatment plans to maximize benefits while minimizing risks.

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