It seems too good to be true: a weight loss drug that works just like name-brand GLP-1s (Ozempic, Wegovy, Mounjaro) but for a fraction of the cost.
And, according to some experts, it is.
Compounded semaglutide — the active ingredient in the blockbuster drugs mixed with other additives — is produced by compounding pharmacies and is non-FDA approved.
And, with demand growing, scrutiny is increasing due to the risk of severe and potentially fatal health conditions linked to using these unregulated drugs.
The FDA has repeatedly warned the millions of Americans currently taking approved GLP-1 medications for weight loss to steer clear of non-approved concoctions from compounding pharmacies.
And this month, Maziar Mike Doustdar, CEO of Novo Nordisk, which makes Ozempic and Wegovy, cautioned against using the compounded drugs, claiming that 1.5 million Americans currently take ‘unsafe, knock-off versions of our products.’
Compounded GLP-1 medications have become exceedingly popular after the brand-name prescriptions experienced a protracted shortage starting in 2022. With list prices soaring above $1,300 per month and spotty insurance coverage for weight loss-related issues, many patients turned to compounding pharmacies, which offered what appeared to be the same drug for around $200.
That is what initially piqued the interest of Jamie Evan Bichelman, who tried compounded semaglutide from a pharmacy in Las Vegas.
The clinical psychology expert, now based in Massachusetts, told the Daily Mail that he couldn’t afford name-brand GLP-1s at the time.
Compounded versions of blockbuster drugs like Ozempic and Wegovy – made by mixing the active ingredient for weight loss with other additives – are now facing scrutiny
Jamie Evan Bichelman (pictured) told the Daily Mail that he couldn’t afford name-brand GLP-1s at the time
He was working as a freelance and contract worker, forced to pay out of pocket for health insurance that he described as ‘extremely limiting and overall very poor.’ As a result, his doctor informed him that any prescriptions for weight loss medication would likely be denied.
His doctor’s solution? A compounding pharmacy.
Bichelman claimed: ‘He sounded extremely confident in their products, said that he writes prescriptions for his patients there all of the time, and that semaglutide compounded with [amino acid] L-Carnitine would “torch the weight off in no time”.’
But after months of taking the medication and forking over a total of around $1,000, Bichelman says he experienced ‘nothing but disastrous effects.’
‘Monday through Friday would look very much the same: feeling nauseated, experiencing constant headaches, my appetite was still massive and unending, which was quite the feeling when combined with the constant nausea, and it wasn’t until Saturday or Sunday when the effects would lessen and I’d find some reprieve,’ he told the Daily Mail.
‘It obviously impacts your ability to focus at work, or in social settings, and you’re constantly feeling turmoil inside because you’re wildly hungry — and wildly nauseous.’
Bichelman now uses the brand-name Zepbound, with the active ingredient tirzepatide, and said the difference is night and day in terms of both effectiveness and how his body tolerates it. Despite some side effects the first week of taking the drug, he now reports a reduction in ‘food noise’ and can eat moderate, healthy portions with discipline.
His experience has made him ‘strongly encourage [people] to avoid the compounding pharmacies,’ he said.
Compounding pharmacies are not typical retail chains like CVS or Duane Reade. They are usually small, independent operations where pharmacists custom-mix medications for individual patients.
In the case of GLP-1s, these pharmacies concoct versions of weight loss drugs by mixing the active ingredients, like semaglutide or tirzepatide, with additives such as Vitamin B12. These untested combinations are fundamentally different from the rigorously studied, FDA-approved formulas.
Dr Betsy Dovec, a weight-loss specialist and bariatric surgeon, told the Daily Mail: ‘The potential downsides are very real and deserve careful attention. Compounded versions are not FDA-approved and are not identical to brand-name pens, which means there can be variability in formulation, handling, and dosing.’
Namely, she emphasized that one of the key risks is ingredient sourcing, ‘particularly products marketed as “semaglutide” that may use alternative salt forms, which are not the same active ingredient as the FDA-approved medication and raise legitimate safety and efficacy concerns,’ she said.
‘There is also a higher risk of dosing errors when patients are using multi-dose vials and syringes rather than prefilled pens, especially if they are not carefully counseled.’
Dr Betsy Dovec, a weight-loss specialist and bariatric surgeon, told the Daily Mail: ‘The potential downsides are very real and deserve careful attention’
She added that sterility, cold-chain shipping and pharmacy quality standards matter enormously, and this is where the difference between a reputable pharmacy and a questionable one becomes critical.
Dovec continued: ‘The problem is not compounding itself, but inconsistency and lack of oversight in parts of the market.’
Compounding pharmacies operate in a distinct regulatory space that falls between traditional pharmaceutical manufacturing and standard pharmacy practice.
While drug makers must secure rigorous FDA approval, compounding pharmacies are mainly regulated by state boards.
The FDA does oversee large-scale ‘outsourcing facilities,’ but traditional compounders creating custom prescriptions do not need FDA approval for each formulation.
This creates a patchwork system where safety hinges on state oversight and a pharmacy’s own standards, not on uniform federal approval for every compounded product.
But now, people can also subscribe to deliveries of weekly injectables for as little as $99 per month via direct-to-consumer telehealth platforms, which operates under their own distinct regulatory framework.
While state pharmacy boards oversee the dispensing facilities and the FDA regulates drug safety, the role of the telehealth intermediary, including its marketing practices, clinical claims and remote prescribing protocols, often falls into murky oversight space.
In September 2025, the FDA launched a sweeping crackdown, issuing over 100 warnings to compounders and telehealth companies, including Hims and Hers. The Daily Mail contacted Hims and Hers for comment and did not receive a response.
The agency targeted ‘false and misleading’ advertisements that presented compounded semaglutide and tirzepatide as identical to their FDA-approved counterparts, an unlawful sale of unapproved drugs.
Dr Meena Malhotra, a double board-certified physician who specializes in weight loss, hormone balancing and diabetes
The FDA has warned the public about the dangers of compounded ‘knock-off’ weight-loss drugs, citing reports of severe injuries and deaths in its MedWatch database.
MedWatch logs, which compile reports from providers, patients and manufacturers, show around ten deaths linked to compounded semaglutide since 2023. These reports do not confirm the drug caused the fatalities, as the FDA has not yet completed investigations to establish a definitive causal link. They also do not list the providers.
The FDA’s latest warning in September noted 605 adverse event reports for compounded semaglutide and 545 for compounded tirzepatide as of July.
However, the agency warned that adverse events are likely underreported because most compounding pharmacies are not required to submit them.
Compounded semaglutide has been directly linked to emergency room visits for severe complications, including pancreatitis and gallbladder injury.
Dr Dovec said: ‘In our practice, we do not administer compounded semaglutide or tirzepatide directly in the office.
‘However, when a compounded option is appropriate, we prescribe it and have it shipped directly to the patient from a vetted pharmacy, with clear instructions and close medical supervision.’
While official figures do not separate compounded from brand-name versions, semaglutide users overall accounted for nearly 25,000 emergency room visits between 2022 and 2023, one study estimates.
FDA data links some semaglutide hospitalizations to critical dosing errors by both patients and prescribers. Beyond side effects, life-threatening sepsis, acute toxicity or overdose could occur.
The most common side effects of GLP-1s, whether FDA-approved or compounded, include nausea, abdominal pain, diarrhea and constipation, which affect between 40 and 70 percent of people taking them.
Dr Meena Malhotra, a double board-certified physician who specializes in weight loss, hormone balancing and diabetes, told the Daily Mail: ‘With branded GLP-1s, we know exactly what the patient is getting. With compounded versions, variability in formulation and dosing can lead to more GI symptoms or responses that don’t always line up with the dose.
‘These are powerful medications, and formulation and oversight really matter.’
