If you’ve been using compounded Semaglutide or Tirzepatide for weight loss, you may have recently heard that these medications will no longer be available. The FDA has announced that brand-name versions (Wegovy, Zepbound, Ozempic, and Mounjaro) are no longer in shortage, meaning compounding pharmacies can no longer legally produce these medications for general use.

This sudden change leaves many patients wondering: What now?

If you’re concerned about losing access to your weight loss medication and regaining weight, don’t panic. There are still effective alternatives to help you maintain and continue your weight loss journey.

What Can You Do If You Can’t Access Compounded GLP-1 Medications?

Can Some Patients Still Access Compounded GLP-1 Medications?

Although compounded Semaglutide and Tirzepatide will soon be restricted, there are still certain circumstances where patients may qualify for compounded versions, particularly if they have specific medical needs that prevent them from using the brand-name versions.

A. Patients Who Have Not Tolerated Brand-Name Medications

Some patients experience significant side effects with FDA-approved versions, such as:
✔ Severe nausea or vomiting
✔ Extreme fatigue or headaches
✔ Gastrointestinal intolerance

In such cases, a custom-compounded formulation (e.g., lower initial dosing, slower titration) may help improve tolerance.

B. Patients Requiring Special Dosing Adjustments

✔ Some patients require microdosing (e.g., lower than 0.25 mg semaglutide) for gradual adjustment.
✔ Others may need intermediate doses due to sensitivity.

Custom-compounded versions allow for more flexible dosing adjustments, which may be necessary for patients who struggle with standard dosing schedules.

C. Patients with Certain Vitamin Deficiencies (e.g., B12 Deficiency)

Some compounding pharmacies fortify Semaglutide or Tirzepatide with vitamin B12, which may be beneficial for:
✔ Patients who have low B12 levels or are at risk for deficiencies.
✔ Individuals who experience fatigue or neurological symptoms on GLP-1 medications.
✔ Patients who prefer a single injection instead of separate B12 supplementation.

🔹 What to do next? If you believe you may qualify for a medically necessary compounded version, consult with a weight loss specialist or endocrinologist to determine if you meet the criteria and to explore legitimate compounding options.

FDA-Approved Alternative Weight Loss Medications

If compounded medications are not an option, several FDA-approved medications can help maintain or continue weight loss progress.

A. Other GLP-1 and GIP/GLP-1 Medications

If your insurance does not cover Wegovy or Zepbound, check if it covers alternative GLP-1 medications:

🔹 Saxenda (Liraglutide) – Daily GLP-1 Injection

✔ FDA-approved for weight loss (unlike Trulicity).
✔ Dosing: Daily injection (not weekly like Wegovy).
✔ Weight Loss Results:

• 8-10% total body weight loss over 56 weeks when combined with lifestyle changes.

🔹 Trulicity (Dulaglutide) – Weekly GLP-1 Injection

✔ Not FDA-approved for weight loss, but patients using it for diabetes often experience weight reduction.
✔ Weight Loss Results:

• 3-5% of total body weight loss over 36-52 weeks.

🔹 Ozempic (Semaglutide) – Weekly GLP-1 Injection for Diabetes

✔ FDA-approved for type 2 diabetes but also leads to weight loss.
✔ Same active ingredient as Wegovy, but available at lower doses.
✔ Weight Loss Results:

• In clinical trials, patients lost 10-15% of their body weight when using higher doses (1 mg or 2 mg weekly).

🔹 Best for: Patients with diabetes who need weight loss support but do not have access to Wegovy.

🔹 Mounjaro (Tirzepatide) – Weekly GIP/GLP-1 Injection for Diabetes

✔ FDA-approved for type 2 diabetes but also leads to significant weight loss.
✔ Works differently from other GLP-1s by activating both GLP-1 and GIP receptors, enhancing weight loss effects.
✔ Weight Loss Results:

• In clinical trials, patients lost 15-22.5% of body weight, making it one of the most effective medications for obesity.

🔹 Best for: Patients with diabetes and obesity who need an alternative to Zepbound.

B. Non-GLP-1 Weight Loss Medications

If GLP-1 medications like Wegovy, Zepbound, Ozempic, or Mounjaro are not accessible, several FDA-approved non-GLP-1 medications can also support weight loss. These medications work through different mechanisms to help control appetite, reduce cravings, or alter fat absorption.

1. Phentermine (Adipex-P, Lomaira) – Appetite Suppressant

✔ How it works: Phentermine is a stimulant that suppresses appetite by activating the central nervous system, increasing norepinephrine levels to reduce hunger signals.
✔ Dosing:

• Adipex-P: 15-37.5 mg once daily in the morning.
• Lomaira: Lower-dose option (8 mg) taken up to 3 times a day before meals.
  ✔ Weight Loss Results:
• Clinical studies show an average weight loss of 5-7% of total body weight over 3-6 months.
• Most effective when combined with a structured diet and exercise plan.
  ✔ Who it’s best for:
• Patients who struggle with hunger and portion control.
• Those looking for a short-term weight loss boost (since it is FDA-approved for short-term use only).
  ✔ Side Effects:
• Increased heart rate, elevated blood pressure, dry mouth, insomnia, nervousness.
• Not recommended for patients with heart disease, high blood pressure, or anxiety disorders.

💡 Phentermine is a widely used appetite suppressant, but it is typically prescribed for short-term use due to potential stimulant-related side effects.

2. Phentermine-Topiramate (Qsymia) – Appetite Suppressant + Metabolism Booster

✔ How it works: Qsymia is a combination of phentermine (a stimulant that suppresses appetite) and topiramate (a medication used for migraines and seizures that also affects appetite and cravings).
✔ Dosing: Taken once daily in the morning to prevent insomnia.
✔ Weight Loss Results:

• Clinical studies show an average weight loss of 6-9% of total body weight over 1 year.
• More effective than phentermine alone, which leads to about 5-7% weight loss.
  ✔ Who it’s best for:
• Patients who struggle with hunger and cravings.
• Those who need a cost-effective alternative to GLP-1s.
  ✔ Side Effects:
• Dry mouth, insomnia, tingling sensations, dizziness, and potential birth defects (should NOT be used in pregnancy).

💡 Qsymia is one of the most effective non-GLP-1 medications and maybe a strong alternative for those who cannot tolerate injectable treatments.

3. Bupropion-Naltrexone (Contrave) – Reduces Hunger and Cravings

✔ How it works: Contrave is a combination of bupropion (an antidepressant that affects dopamine levels and reduces hunger) and naltrexone (a medication used for addiction treatment that also decreases food cravings).
✔ Dosing: Taken twice daily, starting with 1 tablet and increasing gradually.
✔ Weight Loss Results:

• Clinical studies show an average weight loss of 4-12% of total body weight over 1 year.
  ✔ Who it’s best for:
• Patients who struggle with emotional eating, food cravings, and binge eating.
• Those who also suffer from mild depression (since bupropion is an antidepressant).
  ✔ Side Effects:
• Nausea, constipation, dizziness, and can raise blood pressure (should not be used in patients with uncontrolled hypertension).

💡 Contrave is ideal for patients who struggle with cravings and emotional eating but should be avoided in those with high blood pressure or seizure disorders.

4. Orlistat (Alli, Xenical) – Blocks Fat Absorption

✔ How it works: Orlistat inhibits the enzyme lipase, preventing the digestion and absorption of dietary fat. This means a portion of consumed fat passes through the digestive system undigested, reducing calorie intake.
✔ Dosing:

• Xenical (prescription version): 120 mg three times daily with meals.
• Alli (over-the-counter version): 60 mg three times daily with meals.
  ✔ Weight Loss Results:
• Clinical studies show an average weight loss of 3-5% of total body weight over 1 year.
• Less effective than GLP-1 medications but can be useful as an add-on therapy.
  ✔ Who it’s best for:
• Patients who consume a high-fat diet and need to reduce calorie absorption.
  ✔ Side Effects:
• Oily stools, diarrhea, bloating, gas, and urgency (due to undigested fat in the intestines).
• Can reduce absorption of fat-soluble vitamins (A, D, E, K), so supplementation may be needed.

💡 Orlistat is a good option for patients who want a non-stimulant, non-appetite-suppressing medication, but the GI side effects can be difficult to tolerate.

5. Metformin – Off-Label Use for Weight Loss

✔ How it works: Metformin is an insulin-sensitizing medication primarily used for type 2 diabetes, but it can also help with weight loss by:

• Reducing insulin resistance (a common issue in people with obesity).
• Decreasing hunger and cravings.
• Slightly increasing calorie burning.
  ✔ Dosing:
• Usually started at 500 mg once daily, then gradually increased to 1000-2000 mg per day.
  ✔ Weight Loss Results:
• Clinical studies show an average weight loss of 2-5% of total body weight over 6-12 months.
• Less effective than GLP-1 medications but can be useful for patients with insulin resistance, PCOS, or prediabetes.
  ✔ Who it’s best for:
• Patients with insulin resistance, prediabetes, or PCOS.
• Those who want a non-stimulant option for weight management.
  ✔ Side Effects:
• GI symptoms (nausea, diarrhea, bloating), especially when first starting.
• Can cause B12 deficiency with long-term use (monitor levels).

💡 Metformin is a great option for patients with insulin resistance but may not be as effective for those without metabolic issues.

Choosing the Right Non-GLP-1 Medication

3. Protein Shake Meal Replacement Strategy (A Temporary Alternative)

A structured meal replacement plan using high-protein shakes can help control hunger and prevent weight regain. This plan is implemented under medical supervision and monitoring with regular visits with the weight loss experts and the dietitians at The Silhouette Clinic.

✔ Replace 1-2 meals per day with a high-protein shake.
✔ Eat one whole-food meal rich in lean protein, fiber, and healthy fats.
✔ Choose a shake with at least 20-30g of protein, low sugar, and added fiber.

🔹 Best Protein Shake Options:

• New Direction Advanced
• Numetra
• Biocare

💡 This strategy mimics the appetite-suppressing effects of GLP-1 medications and helps maintain weight loss while transitioning to another treatment plan.

4. Endoscopic Weight Loss Procedures: Effective Non-Surgical Options

If you’re struggling with significant weight regain or want to continue your weight loss journey, endoscopic weight loss procedures offer minimally invasive, highly effective solutions.

A. Endoscopic Sleeve Gastroplasty (ESG) – A Non-Surgical Stomach Reduction

✔ Shrinks the stomach by 70% using internal sutures (no surgery, no cutting).
✔ Average weight loss: 15-20% of total body weight in 12 months.

🔹 Best for: Patients who need a long-term weight loss solution but don’t want surgery.

B. Gastric Balloons – Temporary, Non-Surgical Weight Loss Option

✔ A fluid- or gas-filled balloon is placed in the stomach to reduce food intake.
✔ Completely reversible (removed after 4-12 months).
✔ Average weight loss: 10-15% of total body weight in 6 months.

🔹 Best for: Patients who need short-term weight loss or a jumpstart before committing to a permanent procedure.

C. Bariatric Revision Procedures – For Weight Regain After Surgery

✔ If you had a gastric sleeve or gastric bypass and regained weight, an endoscopic revision can help restore your original weight loss.
✔ Average additional weight loss: 10-15% of total body weight in 6-12 months.

🔹 Best for: Patients who previously had weight loss surgery but have started regaining weight.

You’re Not Alone in This Journey

Losing access to compounded GLP-1 medications is frustrating, but you still have many options to maintain your weight loss progress.

✔ Some patients may still qualify for compounded versions under certain conditions.
✔ Alternative weight loss medications may work for you.
✔ Protein shake meal replacement strategies can help control appetite.
✔ Lifestyle & diet adjustments with expert support can prevent weight regain.
✔ Endoscopic weight loss procedures offer highly effective, non-surgical solutions.

💬 Need help figuring out your next steps? Schedule a consultation with our weight loss specialists today. Let’s build a plan to keep you on track—no matter what changes come your way.