{"id":10885,"date":"2025-04-11T13:43:15","date_gmt":"2025-04-11T13:43:15","guid":{"rendered":"https:\/\/www.europesays.com\/uk\/10885\/"},"modified":"2025-04-11T13:43:15","modified_gmt":"2025-04-11T13:43:15","slug":"the-era-of-compounded-glp-1-drugs-is-over-what-now","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/uk\/10885\/","title":{"rendered":"The Era of Compounded GLP-1 Drugs Is Over. What Now?"},"content":{"rendered":"

Now that the US Food and Drug Administration has removed both tirzepatide and semaglutide from its Drug Shortages List, the widespread compounding of these drugs is ending<\/a>. Tirzepatide\u2019s deadline has already passed, while physicians and pharmacies have until April 22 for semaglutide. An estimated 2 million Americans have been using these more affordable copycats every month<\/a>.<\/p>\n

Even with direct<\/a>-to-consumer<\/a> discounts, monthly doses of brand-name versions cost hundreds more than compounded ones, putting them beyond the reach of many people. This means a significant number of compounded glucagon-like peptide 1 (GLP-1) users will be forced to go cold turkey \u2014 but studies consistently show weight regain<\/a> when patients stop taking them abruptly. So how can you help your patients?<\/p>\n

Forced Off GLP-1s<\/strong><\/p>\n

While published research into best practices for discontinuing the use of GLP-1s is scant, accessibility and price issues have already forced physicians and patients to devise workarounds. Not everyone was willing to rely on the compounded versions, after all. And some who succeeded on a brand name were reluctant to spend that much money every month for the rest of their lives.<\/p>\n

As a result, anecdotal information already exists about tactics like stretching out the time between injections, tapering the dosage, and adding strength training to patients\u2019 exercise routines.<\/p>\n

\"photoJennifer Manne-Goehler, MD<\/p>\n

\u201cAnecdotally, some doctors and patients are being forced into this,\u201d said Jennifer Manne-Goehler, MD, a researcher at Harvard Medical School, Boston, and the lead author of a paper in JAMA Internal Medicine<\/a> that looked at what we know about off-ramping these drugs.<\/p>\n

\u201cI get messages from people saying, \u2018Do you think microdosing is okay?\u2019 or, \u2018I had a patient who ran out, or they couldn\u2019t get more tirzepatide, so they started taking it every other week,\u2019\u201d she said.<\/p>\n

So far, success seems to be dependent on the individual patient\u2019s level of motivation and their ability to commit to lifestyle changes. Regular communication with the patient goes a long way toward determining what might work.<\/p>\n

\u201cSubjectively, patients know when things are working for them or not,\u201d said Jeremy Korman, MD, medical director of the Cedars Sinai Marina Weight Management Center in Marina del Rey, California. \u201cThat\u2019s a way, without any concrete algorithm, that I work with my patients who\u2019ve reached a target weight. We start using those subjective measures of hunger and cravings and tapering in that way, whether it\u2019s tapering on time interval or tapering on dose.\u201d<\/p>\n

Slow Tapering May Work<\/strong><\/p>\n

Last year, researchers presented findings on a slow tapering method<\/a> at the European Congress on Obesity. When participants reached their goal weight, their dosage was gradually reduced over an average of 9 weeks while they continued with coaching on diet and exercise. Data was available for 85 participants \u2014 6 months after tapering to zero, and their weight remained stable.<\/p>\n

\u201cBecause they\u2019ve engaged in some of the lifestyle changes, when they eventually taper off, they keep the weight off without semaglutide,\u201d lead researcher Henrik Gudbergsen, MD, told Medscape Medical News<\/a> at the time. \u201cI think there\u2019s a strong linkage between the initial phase of using this medication with lifestyle changes and actually being capable of keeping the kilos off once they\u2019ve stopped.\u201d<\/p>\n

Given the small number of participants, more research is necessary. But those initial results are promising, Korman said.<\/p>\n

\u201cThe European study, tapering over 9 weeks, is very interesting,\u201d Korman said. \u201cThe original studies just stopped the medication, and all the weight came back. We still have to be a little skeptical, even if we taper properly, that it\u2019s going to be as durable as we hope. It could be, but it\u2019s very early on.\u201d<\/p>\n

Of course, the end of mass-produced compounded GLP-1s is less than 9 weeks away. But in Reddit<\/a> discussions among compounded tirzepatide users, many said they have stockpiled a supply, enough to last for months. A slow taper could work for them. For those without a ready supply, a short-term prescription for a brand-name GLP-1 might do the trick.<\/p>\n

Turn to Older Generation Weight-Loss Drugs<\/strong><\/p>\n

Another option that shows potential is simply migrating from a GLP-1 to an older generation, generic version of an anti-obesity medication. A study in the December issue of Obesity<\/a> followed patients on this protocol. Out of an initial group of 105 participants, 40 used a GLP-1 medication for 12 months to reach a body mass index of less than 30, then transitioned to generic phentermine, phentermine\/topiramate, topiramate, metformin, bupropion, and\/or naltrexone. They maintained their initial weight loss for up to 2 years when the study ended.<\/p>\n

\"photoGitanjali Srivastava, MD<\/p>\n

Gitanjali Srivastava, MD, medical director at Vanderbilt Obesity Medicine in Nashville, Tennessee, co-authored the study. She compared this approach to cancer treatment: If a patient comes in with an aggressive tumor, the oncologist might use expensive therapies to decrease the size of the tumor burden. Once that\u2019s achieved, the oncologist can move the patient to less intense, less costly therapies.<\/p>\n

\u201cIn the same way, when we think about obesity as a disease process, patients with severe obesity have a very high disease burden,\u201d she said. \u201cWith GLP-1 medications, you\u2019re shrinking the size of that disease burden, then exposing them to the older generation armoire.\u201d<\/p>\n

She\u2019s been using this approach in her practice for several years.<\/p>\n

\u201cEven though the GLP-1 drug classes have created hype, I don\u2019t think we should forget some of these older-generation medications that are less expensive, that patients still do really well on and respond very favorably to, if there are no contraindications,\u201d she said. \u201cFor instance, metformin is free at Publix. Topiramate is just a few dollars. A combination of phentermine and topiramate, which is sold under the brand name Qsymia, you can get for less than $20 a month.\u201d<\/p>\n

Discoveries Still to Come<\/strong><\/p>\n

With so many patients being forced off compounded GLP-1s at once, we\u2019re likely to learn a lot about what helps \u2014 and what does not \u2014 to maintain a substantial weight loss. One thing will almost certainly be a crucial factor: Guiding patients toward a healthier lifestyle in general.<\/p>\n

\u201cRegardless of what treatment we give a patient, even with surgery, our weight loss outcomes and the durability of them depend on lifestyle modification,\u201d Korman said. \u201cThat has to be the foundational concept. If we\u2019re just going to rely on the meds, and we\u2019re not going to commit to that, nothing is going to work.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"Now that the US Food and Drug Administration has removed both tirzepatide and semaglutide from its Drug Shortages…\n","protected":false},"author":2,"featured_media":10886,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4315],"tags":[7435,7434,372,7436,1154,7432,7433,7431,6979,6980,105,7437,7438,4326,7429,445,7430,16,15,734,1530],"class_list":{"0":"post-10885","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-medication","8":"tag-bmi","9":"tag-body-mass-index","10":"tag-diet","11":"tag-drug-cots","12":"tag-exercise","13":"tag-generic-drug","14":"tag-generic-medication","15":"tag-generics","16":"tag-glp-1-receptor-agonists","17":"tag-glucagon-like-peptide-1-receptor-agonists","18":"tag-health","19":"tag-health-care-access","20":"tag-health-services-accessibility","21":"tag-medication","22":"tag-obese","23":"tag-obesity","24":"tag-physical-activity","25":"tag-uk","26":"tag-united-kingdom","27":"tag-weight-loss","28":"tag-weight-management"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@uk\/114319629126493727","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/10885","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/comments?post=10885"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/10885\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media\/10886"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media?parent=10885"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/categories?post=10885"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/tags?post=10885"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}