The Risk of Taking Compound GLP-1s

Posted on August 20, 2026 by Patrick Hercules

Over the past few years, GLP-1 medications, such as semaglutide and tirzepatide, have become a popular way to help people lose weight.

However, some patients and healthcare providers have turned to compounded versions of semaglutide and tirzepatide called compounded GLP-1 antagonists.

Glucagon-like peptide-1 or GLP-1 antagonists are a class of medications that mainly manage blood sugar levels in people with Type 2 diabetes. In 2024, nearly one in three Americans taking a GLP-1 drug said they were getting it from a compounding pharmacy.

Compounded GLP-1 antagonists are custom-mixed weight loss medications made by certain pharmacies, not drug companies, and use the same active ingredients as the brand names, but they don’t have approval from the U.S. Food and Drug Administration (FDA) for safety or effectiveness, and some compounded GLP-1 drugs have additional ingredients or alternate chemical forms of the active drugs.

This is why the FDA has warned against taking compounded versions of semaglutide and tirzepatide, as they don’t undergo regulatory testing for safety, quality, or effectiveness. They also issued a warning about a spike in overdoses and adverse side effects largely attributed to dosing errors with these drugs, due to them coming with syringes for people to draw the medications themselves, unlike brand-name GLP-1 injections that come in prefilled pens.

In 2024, the FDA raised concerns about the increased risk of dosing errors, improper storage, and fraudulently labeled GLP-1s from compounding pharmacies. Consequently, hundreds of people reported serious problems, including dangerous dosing mistakes, where patients got five to twenty times more than the proper dose.

By April of 2025, the FDA had logged over 520 reports linked to compounded semaglutide and 480 for compounded tirzepatide.

Additionally, U.S. poison centers have seen a nearly 1,500% increase in calls related to overdose or side effects of injectable weight-loss drugs since 2019. What’s more, as of April 30th, 2025, poison centers have managed 3,633 GLP-1 agonist-related exposure cases and 22,966 cases from 2019-2025.

The common side effects of GLP-1 antagonist poisoning include:

Nausea and vomiting
Constipation and diarrhea
Abdominal pain

Other symptoms and side effects to watch out for include:

Signs of severe dehydration such as fainting and confusion or not urinating for eight hours.
Pancreatitis, which usually feels like sharp pain in your upper abdomen and back.
Gastrointestinal symptoms that don’t improve when you eat smaller meals or take anti-nausea medications.
Gastrointestinal symptoms that grow worse rather than easing the longer you’re on the drug.

However, there are instances when it might be appropriate for a person to take a compounded drug, such as when a patient’s medical need can’t be met by an FDA-approved drug, or the FDA-approved drug is not commercially available.

If taking a compounded GLP-1 is your only option, it is important to confirm if it is coming from a 503B-registered outsourcing facility, rather than an unregistered seller, and that you remain under close medical supervision while using it.

Other clues that your compounded prescription may not be legitimate:

It does not require a prescription.
The pharmacy is not located within the U.S.
The medication arrives in packaging that is damaged, open, labeled in a foreign language, or has no expiration date.
Unusual delivery methods. Delivery methods other than injections and oral pills, such as sublingual drops and dissolving tablets, have not been tested in clinical trials.
Vague or proprietary ingredient lists. Products marketed as “personalized” blends with added vitamins or other ingredients, without a clear clinical rationale, are often designed to promote those additions to sidestep regulations rather than to benefit the patient.

If you need help locating a licensed online pharmacy, you can use the FDA’s BeSafeRx program. For more information about the Bariatric Surgery Services at Flushing Hospital or procedures performed by our doctors, please call 718-408-6977 or 718-670-8908.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

GLP-1 Microdosing

Posted on May 27, 2026 by Patrick Hercules

Glucagon-like peptide-1 or GLP-1 antagonists are, however, a class of medications that mainly manage blood sugar levels in people with Type 2 diabetes. Medications, such as semaglutide and tirzepatide, have become popular over the past few years to help people lose weight.

Recently, however, some people have been microdosing GLP-1 medications as their preferred way to take these medications. Microdosing means taking much smaller doses than those approved by the Food and Drug Administration (FDA).

People may microdose GLP-1 medications for many reasons, including:

They have hit their target weight goal

They have concerns about the cost of the medications

They are sensitive to the side effects of the medications

They want to just suppress their appetite

They are worried about the supply of the medications

Microdosing GLP-1 medications can come with real risks, including:

Inaccurate doses

Reduced effectiveness

Unpredictable outcomes

Possibility of regaining weight

No data on the long-term effects of microdosing

Minimal oversight

Large clinical trials have confirmed that the standard GLP-1 doses work well when helping people lose weight and manage Type 2 diabetes. What’s more, precise doses have proven benefits for heart, liver, and kidney health. Taking very low doses may not provide the same results.

Additionally, smaller GLP-1 doses may help reduce symptoms such as nausea or an upset stomach. However, microdosing may prevent you from reaching the effective dose needed to make significant changes in your body weight or blood sugar levels. In many cases, the side effects of GLP-1 treatment are temporary. GLP-1 dosage schedules are intended to increase doses gradually to help balance their benefits and potential side effects.

GLP-1 medications affect people differently. Some people may see substantial benefits even at lower doses. However, other people may not see their benefits at full doses.

Before you consider microdosing GLP-1 medications, it is important to speak with a healthcare provider who is knowledgeable about these treatments. Here are some things to consider:

If the GLP-1 medication is off-label, it is an unproven treatment

The health benefits for those who don’t have Type 2 diabetes or a high body mass index (BMI) are unproven

Taking smaller doses doesn’t make them risk-free

As an alternative to taking GLP-1 medications, here are some proven ways to support metabolic and overall health naturally:

Exercising regularly

Eating a healthy, balanced diet

Managing stress

Getting enough restful sleep

Eating certain foods and taking supplements

For more information about the Bariatric Surgery Services at Flushing Hospital or procedures performed by our doctors, please call 718-408-6977 or 718-670-8908.

What to Know About Protein Intake While on Weight Loss Medication

Posted on August 20, 2025 by Patrick Hercules

GLP-1 antagonists are a class of medications that mainly manage blood sugar levels in people with Type 2 diabetes. Some GLP-1 antagonists can also help treat obesity.

When a person starts to lose weight on a GLP-1 weight loss medication, it can happen very fast. However, as they lose fat, they could also be losing essential lean muscle mass, which can harm their metabolism and blood sugar levels. This will ultimately work against weight loss efforts and can even negatively affect bone health.

Protein is the building block of muscle. Getting enough is crucial for preventing muscle loss, especially when consuming fewer calories. When you consume enough protein, you are more likely to retain and even build muscle. However, when you don’t have enough protein, your body will cannibalize some of your muscle mass for energy.

A 2024 review study that made diet recommendations for GLP-1 patients based on the latest research recommends at least 60 grams of protein a day. It is suggested to aim for 20 to 40 grams of protein at every meal.

Most people who are on GLP-1 medications experience at least one side effect. The side effects are worse just after starting and in the days after increasing the dose. Fortunately, there are ways to combat those side effects, including:

Make every meal count
Schedule your meals
Make protein a priority
Aim for 64 ounces of fluid a day, plus electrolytes
Avoid fatty and greasy foods
Steer clear of sugary foods, alcohol, and refined carbs
Maintain muscle with resistance training
Eat smaller portions more frequently
Add fiber to your diet
Talk to your doctor if you are having side effects

For more information about the Bariatric Surgery Services at Flushing Hospital or procedures performed by our doctors, please call 718-408-6977 or 718-670-8908.