Some medical professionals say they are beginning to feel more comfortable prescribing combination versions of the hit weight-loss drugs Wegoby and Zepbound, while others remain concerned about the ingredients they contain.
Even with a prescription, weight-loss drugs are notoriously hard to come by: They’re expensive — a month’s supply can cost more than $1,000 — and they’re often in short supply.
Meanwhile, combined versions of semaglutide (the drug in Wegovy) and tirzepatide (the drug in Zepbound) are often cheaper and much easier to obtain.
“Doctors are not only becoming more willing to prescribe combined GLP-1 drugs, they’re recommending them,” Dr. Shauna Levy, medical director of the Tulane Obesity Center in New Orleans and an expert in obesity medicine, said of the group of drugs that includes Wegobee and Zepbound.
At Duke Health’s Hillsboro Primary Care Center in North Carolina, doctors are prescribing compounded versions of drugs amid a shortage of brand-name drugs.
Leanne Owens, a physician assistant at the clinic, said she prescribed compounded versions of weight-loss drugs to 10 patients after the state stopped covering brand-name weight-loss drugs for state employees in April.
She said she was initially apprehensive because she had never prescribed a combination drug for weight loss before, but after speaking with a compounding pharmacist at Duke, she felt reassured.
“Is this really a drug? And is the formulation the same as the formulation used by the over-the-counter drug manufacturers?,” Owens recalls thinking. “Anything new that we’re considering offering to patients, we want to make sure we’ve done our research.”
Owens isn’t alone: Other medical professionals have also turned to combination versions of weight-loss drugs.
What is Compound Interest?
Compounded medications are used for a variety of reasons: A compounding pharmacy may compound a medication that only comes in tablet form into a liquid for a patient who cannot swallow a tablet, or compound a medication without a dye, for example if a patient is allergic to a particular dye.
Compounding can also be useful during drug shortages: The Food and Drug Administration allows compounded versions that are “essentially copies” of over-the-counter drugs in those special circumstances.
There has been a shortage of semaglutide for weight loss since 2022. FDA Drug Shortage DatabaseTirzepatide, which was just approved in the United States in November as a weight-loss drug, became in short supply in April, There is currently a shortage, according to officials..
Both drugs are patented and Novo Nordisk and Lilly do not supply ingredients to outside parties, raising questions about what is being sold to consumers.
However, compounding pharmacists typically purchase ingredients from FDA-registered facilities, but these facilities themselves cannot purchase active ingredients from pharmaceutical companies.
According to the FDA, these facilities can essentially duplicate or copy active ingredients that are in demand. However, unlike generic drugs, the FDA does not test or verify the ingredients, which is the responsibility of the pharmacist. Experts say it’s important for doctors to prescribe medications from a compounding pharmacist they trust. Patients should get a prescription from their doctor and pick it up at a state-licensed pharmacy. Patients should also avoid ordering medications online or buying them at medical spas.
It is also important for healthcare professionals to advise patients on how to accurately measure the dose. The FDA reported The agency said it had received reports of patients overdosing on their prescribed semaglutide, some of whom were hospitalized. The administration errors were caused by patients measuring out the wrong amount and by healthcare professionals miscalculating the dosage of the drug, the agency said.
Matthew Brown, pharmacy manager for the Duke pharmacy facility, which provides pharmacy services to the university’s entire health system, including Hillsboro Primary Care Center, said the center uses only state-licensed pharmacies that Duke has vetted to compound medications.
Brown said Duke only prescribes compounded versions of weight-loss drugs during shortages, and will go back to prescribing brand-name drugs once the shortages are resolved.
Owens, a physician assistant, said he believes the compounded version is the same drug, noting that patients have lost weight, and he hasn’t seen an increase in side effects.
Elizabeth Kenley, 58, of Graham, North Carolina, said that in March, a doctor at a Hillsboro clinic prescribed the tirzepatide compound because Wegoby was in short supply and difficult to get. Since starting the compound, she has lost 25 pounds and hopes to lose another 25.
“I was a little nervous. I was like, ‘What is a compounded drug?'” Kenley said. “After I spoke with the doctor, I felt really at ease.”
For some, there are too many unknowns
Despite an increasing number of doctors being willing to prescribe combination weight-loss drugs, Novo Nordisk and Eli Lilly remain staunchly opposed to the practice.
The two companies have filed multiple lawsuits against compounding pharmacies, weight loss clinics and medical spas. In statements to NBC News, the drug companies said the drugs are not subject to the same oversight as FDA-approved drugs and pose risks to patients.
A Novo Nordisk spokesman said the compounding system was “not working as intended.”
“Novo Nordisk will continue to pursue legal action against compounding pharmacies and other entities involved in the illegal marketing and sale of the unapproved compound medicine semaglutide,” the spokesman said.
“Poison control centers, regulatory agencies and patient advocacy groups across the country have issued warnings about the use of combination anti-obesity products,” Lilly spokeswoman Antoinette Forbes said in a statement.
Many doctors still aren’t sure.
“In theory, if you do everything right, this could be a reasonable product. But the problem is, there’s a very real possibility that something could go wrong,” said Dr. Scott Isaacs, president-elect of the American College of Clinical Endocrinologists. “Yes, more doctors may be prescribing this, but from an organizational and professional standpoint, there are more and more red flags.”
“Maybe not everyone is doing what Duke is doing,” Isaacs said.
Dr. Christopher McGowan, a gastroenterologist who runs a weight-loss clinic in Cary, North Carolina, said he often hears from patients who have tried combination weight-loss drugs but are “very hesitant” to prescribe them himself.
“In my opinion, there are still too many unknowns about the combination of semaglutide and tirzepatide,” McGowan says. “Whether a pharmacy is licensed or not, the actual combination is not monitored, regulated, or tested by the FDA. For patients, there is no guarantee of what they will receive or whether it will be equivalent to the brand-name medication.”
Dr. Daniela Hurtado-Andrade, an endocrinologist at the Mayo Clinic in Jacksonville, Fla., said she is seeing more patients in her clinic who have already started taking combination drugs, but when she sees them, she often suggests alternative weight-loss options, such as phentermine and topiramate (sold as Qsymia) or naltrexone and bupropion (sold as Contrave), if the brand-name medications aren’t available.
“People are focusing on the idea that the only option for treating overweight and obesity is the new injectable drugs, but this is completely wrong,” Andrade said. “There are other anti-obesity drugs that are just as effective and less expensive.”
