Dr. Friedman’s Weight Loss Guide
The Changing Landscape for Compounded GLP-1s
The landscape for compounded weight loss medications is evolving rapidly. The most common class of weightloss medicines are GLP-1 receptor agonists, that are commonly called GLP-1s. GLP-1s are made by two pharmaceutical companies, Eli Lilly and Novo Nordisk and are often very expensive, comes in a fixed dose that does not allow for individualized dosing and are often not covered by insurance. A compounding pharmacy prepares customized medications for individual patients that are not commercially available. Compounding pharmacies can individualize the dosing and add different compounds that reduce side effects. Their price is often a fraction of the cost from commercial pharmacies. Availability of compounded GLP-1s depends on the state you live in. You may have heard that a U.S. federal judge has denied an injunction that would have allowed compounding pharmacies to keep making copies of Eli Lilly’s weight-loss and diabetes drugs Zepbound and Mounjaro (generic name Tirzepatide) in the United States. This was based on Lilly saying the Drug Shortage Designation of Zepbound and Mounjaro has ended, which most experts say is not true.
The Outsourcing Facility Association that filed the original lawsuit said that the number of patients taking compounded GLP-1s is in the millions, so banning compounding pharmacies from providing these medicines will cause a severe shortage and have a major consequence for millions of patients, including denying patients affordable drugs available in individualized dosing. Banning these compounded medications will not allow providers who use these compounded medicines as part of the their treaatment regimens. In spite of lawsuits, compounded GLP-1s are still available for individualized dosing. Hundreds of Dr. Friedman’s patients have benefited from these compounded GLP-1s, which are available in syringes, allowing individual dosing that is not possible with the commercial medicines. Compounded drugs, such as GLP-1s, do not require insurance pre-authorization and can be a much more affordable option.
Dr. Friedman does not directly dispense these compounds.
Compounding Pharmacies that Dr. Friedman works with for Safe GLP-1 Weight Loss Drugs
Dr. Friedman works with several compounding pharmacies to provide affordable and safe, GLP-1 drugs that have improved patients’ health and weight. Dr. Friedman has communicated with representatives from the three compounding pharmacies he works with: University Compounding Pharmacy (UCP), Strive Pharmacy and Empower Pharmacy and their availability is listed below. Dr. Friedman’s philosophy is that compounded pharmacies are supplying “Tirzepatide” and “Semaglutide” and not “Ozempic”, “Wegovy”, “Zepbound” and “Mounjaro” and that they are supplying customized dosing that are not available with the fixed doses supplied by the pharmaceutical companies.
Additional Note: Tirzepatide Vs Semaglutide
Overall, Dr. Friedman prefers the compounded versions of Tirzepatide over Semaglutide as Tirzepatide gives more weight loss and less side effects, but is currently available in CA only in the sublingual form. Many patients find sublingual Tirzepatide to be quite effective at appetite suppression and weight loss, while others find it less effective than subcutaneous injections. Dr. Friedman’s top recommendations are in red.
Sublingual Tirzepatide at UCP
Sublingual Tirzepatide is an excellent choice. Patients pay UCP. Tirzepatide injections have been discontinued but they have sublingual (under the tongue) Tirzepatide (10 mg/mL). Recent information from UCP has recommended daily dosing for optimal weight loss. Recommended dose is 0.5mL (5 mg) under the tongue daily. After 4 weeks, increase to 1mL (10 mg daily which is the final recommended dose.. Patients pay UCP directly. It needs to be refrigerated and can be used for 90 days after opening the bottle. It comes with a syringe that can withdraw the liquid from the vial and put it under the tongue, where it should be held for 10 minutes and then swallowed. It is best to take with a “dry” mouth and not to drink/eat for 30 minutes before or after administration. Because the sublingual product is new, its weight-loss properties compared to injectable Tirzepatide are not known.
Strive Pharmacy
Strive Pharmacy, which compounds Semaglutide (brand name Ozempic, Wegovy), and Tirzepatide (brand name Mounjaro, Zepbound) is a 503B compounding pharmacy that offers GLP-1RAs to patients at a low price in 31 states including California-see https://catalog.strivepharmacy.com, but note that pricing Dr. Friedman charges will be different. For Strive pharmacy, patients pay Dr. Friedman directly. There are several options available at Strive Pharmacy, with the common 4 options seen in this table:
| Strive | How to order | Mg per vial | Use for which dose | Theoretical doses per vial* |
| Semaglutide/Glycine/B12 | 5mg/5mg/1mg/mL 1 ml vial | 5 mg | 0.25 mg weekly for 4 weeks, then 0.5 mg weekly for 4 weeks, then 1 mg weekly for 7 weeks | 8 |
| Semaglutide/Glycine/B12 | 5mg/5mg/1mg/mL 2 ml vial | 10 mg | 0.25 mg weekly for 4 weeks, then 0.5 mg weekly for 4 weeks, then 1 mg weekly for 7 weeks | 15 |
| Tirzepatide/Glycine/B12
(starter dose) |
10mg/5mg/500mcg/mL 1 ml vial | 10 mg | 1 mg (0.1 ml) weekly for 2 weeks, then 2 mg (0.2 ml) weekly for 4 weeks, then 4 mg (0.4 ml) weekly | 5 |
| Tirzepatide/Glycine/B12 | 10mg/5mg/500mcg/mL 2 ml vial | 20 mg | 1 mg (0.1 ml) weekly for 2 weeks, then 2 mg (0.2 ml) weekly for 4 weeks, then 4 mg (0.4 ml) weekly | 9 |
Empower Compounding Pharmacy
The Empower compounding pharmacy ships to all states but CA, WI and IA. Patients pay Empower directly.
Semaglutide / Cyanocobalamin Injection
Tirzepatide / Niacinamide Injection
Lilly Direct and Zepbound Glass Vials
For those patients who insist on non-compounded preparations, Zepbound Glass Vials from Lilly Direct are an option..
Patients need to register on LillyDirect.lilly.com and purchase syringes for a small fee. Each vial is 0.5 ml, so the concentration is 2 mg/0.1 ml. Although the company discourages using the vial for multi-dosing (it doesn’t contain a preservative), one option would be to inject 1 mg (0.05 mL) weekly for 2 weeks, 2 mg (0.1 mL) weekly for 2 weeks, then 4 mg (0.2 ml) weekly. The box of 4 vials would last about 10 weeks.
Frequently Asked Questions
Is Glycine/B12 helpful in compounded GLP-1s?
B12 may afford advantages: it has been studied for ameliorating nausea triggered by GLP-1 RAs. B12 may also optimize metabolic functioning, making it an adjunct in weight management goals. The glycine may help prevent loss of lean muscle mass in the context of caloric restriction.
What about loss of muscle mass with compounded GLP-1s?
Loss of muscle mass may occur on GLP-1s. Dr. Friedman does not recommend GLP-1s in patients with low muscle mass to begin with. He recommends making sure you have adequate protein intake, including plant-based protein. He also recommends increasing exercise, especially using the large muscles in arms and legs. He also recommends measuring a bioavailable and total testosterone lab every 3 months and going on compounded testosterone cream if bioavailable testosterone is less than 2.5 ng/dL.
Book a Consultation with Dr. Friedman to Discuss Compounded Medications OptionsOptions
Because of the different options for compounded GLP-1s, Dr. Friedman is advising his patients to make a 10-minute followup appointment to discuss options. Compounding pharmacies do not give automatic refills; if you are on GLP-1s, make a 10 min appointment to discuss refills at least every 3 months. It is helpful to get labs before your appointment, including bioavailable and total testosterone. For more information, please read about compounded GLP-1s, and listen to listen Dr. Friedman’s original GoodHormoneHealth Webinar on November 17, 2024 on compounded Tirzepatide vs Semaglutide for patients with endocrine problems https://www.youtube.com/watch?v=u9VbPDsJcPE, https://www.facebook.com/goodhormonehealth, https://www.goodhormonehealth.com/webinars or on your podcast channel.
Want to Know More? Listen to Dr. Friedman’s Recent Discussion on GLP-1s
Dr. Friedman discussed the updated healthcare situation for compounded GLP-1s at his most recent GoodHormoneHealth Webinar on Sunday March 23rd at 6:00 PM after his talk on “How can Blue Zones and Maimonides’ principles be applied to lead a healthy life for patients with endocrine problems?” It is available on YouTube at or https://youtu.be/6q_zxNqu2uc
https://www.goodhormonehealth.com/webinars/ or
https://www.facebook.com/goodhormonehealth
Protect access to compounded medications — make your voice heard. Sign the Petition!
For more information go to Dr. Friedman’s website https://www.goodhormonehealth.com or contact his office at mail@goodhormonehealth.com.