Compounded Semaglutide and Tirzepatide Online: FDA Red Flags to Check

Weight often shifts around the middle in the menopause years, and GLP-1 medicines such as semaglutide and tirzepatide have drawn a lot of interest. Brand-name versions are expensive, so many telehealth companies sell compounded versions for less. Here is what the FDA¹ says about these products and the checks to make before you pay.

What “compounded” means here

Compounded drugs aren’t FDA¹ approved. The FDA doesn’t review them for safety, effectiveness or quality before they’re sold.¹ The FDA says compounded drugs should only be used when a patient’s medical needs can’t be met by an FDA-approved drug, and that patients should get a prescription from their doctor and fill it at a state-licensed pharmacy.¹

Telehealth red flags

The FDA¹ lists these warning signs. Be wary if a company:¹

• Claims its compounded drug is the same as an FDA¹-approved drug
• Offers deep discounts or prices that seem too good to be true
• Doesn’t require a screening and prescription by a licensed doctor
• Has no licensed doctor available to answer questions after you get the medicine
• Sends medicine that looks different from what was pictured, or arrives with broken packaging or no instructions
• Has spelling errors on the label, a wrong pharmacy address, or a pharmacy name you suspect is fake

The FDA’s¹ BeSafeRx campaign has resources for buying prescription medicines online safely.¹ Our article on online menopause clinics has more questions to ask any telehealth service.

Check the ingredient

• Salt forms. The FDA¹ says some compounders sell semaglutide sodium or semaglutide acetate. These are different active ingredients from the ones in approved drugs, and the FDA says it isn’t aware of any lawful basis for using them in compounding.¹
• Ingredients that can’t be compounded. Retatrutide and cagrilintide can’t be used in compounding under federal law, and they haven’t been found safe and effective for any condition.¹
• Fake labels. The FDA¹ has found compounded semaglutide and tirzepatide with false labels, including pharmacies that don’t exist or that didn’t make the product.¹

Dosing mistakes

The FDA¹ has received reports of adverse events, some requiring hospitalization, that may be linked to dosing errors with compounded semaglutide. Some patients measured the wrong dose themselves, and some health care professionals miscalculated doses.¹ Reported symptoms included nausea, vomiting, diarrhea, belly pain and constipation.¹

Before your first dose, ask your prescriber or the pharmacy to walk you through exactly how to measure it, and confirm the dose in both milligrams and syringe units.

Vials, needles and shipping

• Throw out a multi-dose vial 28 days after first use, even if medicine is left and even if the compounder’s instructions say otherwise.¹
• Use a new sterile needle and syringe for every dose.¹
• Don’t use a shipment that arrives warm or without enough ice packs.¹

Reports are probably undercounted

As of May 31, 2026, the FDA¹ had received 990 adverse event reports linked to compounded semaglutide and more than 730 linked to compounded tirzepatide. Federal law doesn’t require most compounding pharmacies to report adverse events, so the FDA says they’re likely underreported.¹ The FDA has also warned about counterfeit versions of brand-name semaglutide sold in the U.S.¹

Try: “I’m thinking about a GLP-1 medicine for weight gain since menopause. Is a brand-name version right for me, and if cost is a problem, how do I know a compounded version is from a licensed pharmacy and dosed correctly?”

My Body Changed. Now What? includes a Visit Brief. Use it to list your weight changes, other medicines and questions about cost and safety for your appointment. See the book.