Drugs like Wegovy and Ozempic and Mounjaro and Zepbound have been making headlines—not only as weight-loss medications but also for their potential to treat diabetes, cardiovascular disease and chronic obesity. Researchers are even exploring their use for sleep apnea, Alzheimer’s disease and substance abuse. 

As of mid-2024, roughly 1 in 8 Americans had tried one of these medications. Their popularity has caused supply shortages, even though they cost upward of $1,000 a month and are not universally covered by insurance. Coverage often depends on the patient’s specific diagnosis.

The high demand and steep costs have fueled the rise of “compounded” versions—often marketed as cheaper alternatives and sold through telehealth services, compounding pharmacies and medi-spas. These versions are sometimes promoted as having the “same active ingredient” as the brand-name drugs. However, according to the Health Research Group (HRG) at the advocacy organization Public Citizen, these claims can be misleading and potentially dangerous.

Semaglutide is the active ingredient in Wegovy and Ozempic, while tirzepatide is found in Mounjaro and Zepbound. Both belong to a class of drugs known as GLP-1 receptor agonists. While the FDA regulates brand-name drugs for safety, quality and consistency, it does not apply the same standards to compounded versions. In other words, there are no approved “generic” versions of these drugs. 

In fact, the FDA has expressed concerns about off-brand formulations that may contain unsafe ingredients. HRG adds that there are also counterfeit versions of these drugs that can be purchased online without a prescription, which is illegal and risky.

Proper administration is another concern. Wegovy, Mounjaro and Zepbound are sold in single-use, prefilled pens designed for once-weekly injections. Ozempic comes in a multi-dose pen. Even with these standardized devices, patients—especially those unfamiliar with self-injection—can find dosing confusing. The problem is worse with compounded drugs, which may come in vials or syringes labeled in unfamiliar units like milliliters, milligrams or “units.” This increases the risk of dosing errors.

The FDA has received reports of serious adverse events linked to compounded versions, including nausea, vomiting, abdominal pain, fainting, headaches, pancreatitis and gallstones. Some cases required medical intervention or hospitalization. Overdoses can lead to dehydration and hypoglycemia—especially for those also taking insulin or other diabetes medications.

Approximately 8% of U.S. adults age 65 and older have used GLP-1 drugs for chronic conditions like diabetes or heart disease. Fewer—around 1%—have used them solely for weight loss, likely due to Medicare and other insurers typically not covering the drugs for that purpose. (Coverage policies remain under discussion.)

Healthline.com notes that GLP-1 medications haven’t been well studied in older adults, who are more likely to have multiple health conditions and take several medications. This increases their risk for side effects—especially with compounded drugs that lack FDA oversight.

So what should older adults do? According to VeryWellHealth.com, “If you are 65 or older and are thinking about taking [a GLP-1 drug], consider speaking with a trusted healthcare provider about your individual risks and how you can start this medication safely.”

As for compounded alternatives, HRG strongly advises against them. 

“Do not use compounded injectable semaglutide or tirzepatide products,” they warn. “In addition to safety concerns, compounded drugs have no advantage in meeting the medical needs of patients who may be prescribed GLP-1 drugs.”

YOU MAY ALSO LIKE:

Effective strategies for managing obesity after 60

Explore strategies for seniors to manage obesity and achieve a healthy weight. Learn about the impact of obesity on health and available treatments for older adults. Read More » 

Combat obesity: Order off the kids' menu

Everyone knows this country has an obesity problem. Rates have increased significantly since 1999-2000 when 13.9 percent of children and 30.... Read More »