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 Semaglutides Weight Loss in Miami: Once a Week Injection

Compound Semaglutides weight loss is the same spectacular weight loss as their brand equivalents-Oozempic, Wegovy, and Mounjaro at 20% of the cost.  In addition, compounded semaglutides offer the opportunity to tailor the medication to individual needs and tolerances. This includes individualization of dosage, combination with other medications for increased efficiency, and most importantly reduced costs and  side effects. Semaglutides are a group of new medications in a class of medications called glucagon-like peptides 1(GLP-1) agonists.

Semaglutides Are Derived from Older Drugs with Potent Weight Loss Effects and Proven Safety

Compounded Semaglutides are not new drug but rather a repurposed one; the same active ingredient, marketed as Ozempic has been on the market since 2017 as a treatment for type 2 diabetes. use of the drug as a once-weekly injection designed to lower blood sugar lead to the observation of significant weight loss in diabetics that historically have been a group of individuals with great difficulty losing weight. Increasing the weekly dosages from 0.5 mg to 1 and then 2 mg/week led to greater weight loss and the eventual approval of Wegovy. Wegovy is just a higher dose of  Ozempic. These medications were found to produce weight loss even greater than seen with most anti-obesity medications approaching the weight loss after gastric bypass surgery. This can be as much as  25 to 30% of starting body weight.

Compounded semaglutide, like brand name semaglutides(Wegovy, Ozempic)  are extremely safe. Marketed as Ozempic,  the semaglutide has been on the market since 2017 and taken by millions of diabetics and obese people all over the world. In addition, it has been carefully evaluated  in over 100 studies done in the US, South America, Europe and Japan without any evidence of problems. Other than mild to moderate GI side effects there are few side effects.

What is the Cost of Compounded Semaglutides?

Compounded Semaglutide cost much less than the brand equivalents of Ozempic, Wegovy and Mounjaro. The latter drugs cost hundreds to thousands of dollars per month. The costs of compounded semaglutides are low because you are not paying for expensive injection pens, large manufacturing facilities, distribution networks or even pharmacies. The compound Semaglutide drugs are sent directly by the compounding pharmacy to the patient or physician. Typical costs are less than $200/ month with starting doses about $130/month for four weekly injections.  Compound Semaglutide costs are dependent upon dosage( unlike Semaglutide pens where the costs of all doses are the same), the shipping  and any additive. See table below for costs.

Semaglutides Unprecedented Weight Loss is Due to Action on Receptors All over the Body

Surge in Insulin and Reduction in Glucagon with Semaglutide’s Action on Pancreas

Semaglutides  both  the Compound Semaglutide from a compounding pharmacy or from the brand versions are derived from the incretin hormones GLP-1 and GIP (in the case of Mounjaro) which are made normally in specific cells in the small intestine. After eating a meal they begin a chain reaction by first increasing insulin and lowering glucagon (the hormone responsible for eating). The surge in insulin and reduction in glucagon has the effect of delaying gastric emptying which sends signals to the brain of fullness.

Semaglutides Act on Appetite Centers of Brain,  on Muscles and on the Liver

In addition, Semaglutides work by binding to the GLP-1 receptors in the skeletal muscle, liver, and pancreas, and most important in the brain appetite centers. This reduces cravings, especially for sweet and fatty foods. This helps the individual whose goal is to lose weight quickly and safely. It’s proven to be a powerful and long-lasting appetite suppressor without all of the complications of the stimulating older medications. In addition, the marked improvement in blood sugar makes the semaglutides a great choice for overweight diabetics. Weight loss is  often 25 to 30% of the starting weight over just a few months.  The weight loss with compounded semaglutides  is the result of the following mechanisms:

1. Decrease appetite and craving
2. Increase in satiety and delayed gastric emptying
3. Changes in food preferences- away from fatty foods and carbohydrates
4. Reduced energy intake

Compounded Semaglutides vs. Ozempic/Wegovy and Mounjaro

Ozempic, Wegovy, and Mounjaro(the brand Semaglutides)  are new medications sold only by their brand names and are very expensive with discounted prices ranging from $850 per month for Ozempic to $1600/per month for Wegovy. The response to the very successful weight loss results (12% to 27%) weight loss from the baseline starting weight in 6 months or less) has led to the development of compounded semaglutides.  These drugs have almost identical weight loss and blood sugar control as their originals. They are identical to Ozempic-Wegovy except for the addition of minor components such as Vitamin B 6, Vitamin B 12, or L-Carnitine.

Compounded Semaglutides are Slightly Different than Mounjaro(Tirzepatide)

Compound Semaglutides( similar to Ozempic and Wegovy)  are different from Mounjaro (Tirzepatide) because Mounjaro has a second hormone, GIP which makes it slightly more effective.

Semaglutide Compounding Pharmacy:  Produce 6  Compound Semaglutide Medications:

Some of the Common Compounded Semaglutide  Equal to  Ozempic and Wegovy

These are the most common compounded Semaglutides that are based a single GLP-2 peptide:

1.Semaglutide-Vitamin B 12.
2. Semaglutide-Vit B 6,
3.Semaglutide-L Carnitine
4. Semaglutide -2.
5, Semaglutide-NAD+.

The combinations with Vitamin B 12 and L-Carnitine seem to be the most popular. I have treated individuals with both of these preparations. My limited experience  shows little weight loss difference.  The Vitamin B 12 preparation has a little less GI side effects.

Compounded Tirzepatide -Compounded version of Mounjaro

This is the compounded version of the Semaglutide containing both GLP-1 and GIP agonist peptides similar to Mounjaro. This is very new as of December 2022 and there is little reported experience.

Why Substitute Compounded Semaglutides for Ozempic, Wegovy, or Mounjaro? ….. It’s The Cost, Availability, and Reduction in Side Effects, as well as the Improved Efficacy Due to the Individualization of Dosage.

Ozempic, Wegovy, and Mounjaro the Brand Semaglutides Medications Are Very Expensive
Semaglutide Brands are very expensive medications. Ozempic, on the market for 6 years costs $1070/month, while Wegovy, one of the most recent ones may be as high as $1619. Mounjaro falls in between at about $1174/month. Unfortunately, the weight loss is related to the dose, the higher the dose the greater the weight loss. The greatest weight loss with the Ozempic, Wegovy, and the Compounded semaglutides occurs at doses of 2.4 mg per week. For Mounjaro the greatest weight loss is at the 15 mg dose per week. This becomes expensive if it’s needed for months. Insurance covers only a minority of obese people (depends solely on their contract, not on their weight.) Ozempic is covered more easily but only in uncontrolled diabetics. Here is a table of the Semaglutides both compounded and brand and their discounted prices per month.

Compounded Semaglutide is Less Expensive than Brand Products
Compounded Semaglutide cost less than the Brand equivalent. The cost is variable  and depends on the compounding pharmacy, the particular preparation, the dosage, and even the shipping charges. Unlike the brand Semaglutides  where the prices are not dependent on the dose, Compound Semaglutide is purchased in bulk and the price depends on the amount of medication. In addition, most individuals purchase their Brand Semaglutides from a local pharmacy and do not pay shipping costs. Compounded Semaglutides are usually purchased online and shipping charges can be expensive because the medications must be kept cold and shipped in thermal containers. Shipping charges can vary from $45 to $75 per order.

Ozempic/Wegovy and Mounjaro are Sold in Pre-filled Pens by the Month: Preparations Have Fixed Monthly Doses that Cannot Be Individualized
Wegovy and Mounjaro are sold in pre-filled- pre-dosed pens that are used once and discarded. All of them are sold by the month with 4 pens per box. While this is very convenient it increases the cost and decreases the efficiency. The patient purchases a box of 4 pens for the month and cannot change the dosage of the pre-filled pen once purchased. This means the patient may end up taking too much or too little medication over the 4-week injection period. Here is the Mounjaro pen. Other than locking and unlocking the injection mechanism, there is no control of dosage-It’s all or none…. and it’s all or none for a whole month!

Mounjaro auto-inject pen.

Semaglutide Compound Pharmacy Prepares in Bulk and Has Variable Doses that can be Individualized over the Month:
Unlike the brand semaglutides, the compounding pharmacy ships the medication in a multiple-dose vial. Insulin syringes are used to obtain the medication from the bottle and inject the medication permitting individualization of each dose throughout the month. This makes the weight faster with fewer side effects since the dose can be increased or decreased each week.

Compounded Semaglutides can be Combined with other Medications to Increase Weight Loss and Decreased Side Effects at the time of Injection.
Unlike the fixed dose of the brand Semaglutides, other medications can be combined into the injection that may increase weight loss and even reduce side effects. This is reviewed under the compound preparations.

Compounded Semaglutides are More Available than the Brands
Due to the marked weight loss observed with these medications in the past 6 months, there have been shortages and difficulty with production. As of this writing, Wegovy has been off the market for 6 months due to these problems. Ozempic has been hard to find, even for diabetics who have taken the medication for years. Compounded Semaglutides are much different. They do not require expensive auto-injectors, international distribution (Wegovy/Ozempic are sold by a Danish Company), and can be produced by multiple compound pharmacies all over the US. There are currently 7500 licensed compounding pharmacies in the US out of a total of 56,000 community pharmacies.

Compound Semaglutides Use for Weight Loss: Comparison with Ozempic/Wegovy & Mounjaro

Compound Semaglutide Weight Loss is varies depending on the starting weight, age, and gender of the individual. Weight loss usually begins with the 0.5 mg/week injection and increases with increasing doses. Here is a graph with 1 mg and 2 mg per week doses showing average pounds lost per week on the left axis and % weight loss from baseline on the right axis. Notice the weight loss at 12 weeks accounted for about 2/3 of total weight loss and by 24 weeks was almost equal to weight loss at 40 weeks. The average weight loss percent from baseline by 40 weeks for 1 mg of Semaglutide/L-Carnitine was 12.6 % of baseline weight and 16.8% with 2 mg. These results are almost the same as seen with Ozempic/Wegovy but lower than seen with Mounjaro.

Compound Semaglutides Dosing Is individual for Each Patient

Initial Dosing of Compound Semaglutides: Issues to Consider
Compounded Semaglutides have the same starting doses as Ozempic/Wegovy: 0.25 or 0.5 mg with a maximal dose of 2.0 mg/week. Each dose is given as a subcutaneous injection once a week. Depending on the weight loss and the presence of side effects, the subsequent weekly doses can be adjusted upward or downward. This unique dosing with compound semaglutide results in greater weight loss and fewer side effects than found with the brand versions. This also reduces costs even more. Weight loss increases as the doses are increased beginning at 0.5 mg/week in some people and after only 2- 3-4 weeks when the “steady state is achieved.” Many individuals lose large amounts of weight at only 0.5 mg/week. We have split the dose into two equal injections during the same week to reduce side effects. Below find the initial and treatment doses of the average individual starting Compound Semaglutide treatment.

The Day of Week When the Semaglutide is taken  Can Effect the Weight Loss

I have observed faster weight loss when the medication is taken on Friday night or Saturday Morning. Saturday injections produce more weight loss as compared to weekday injections because:
1. Most of the GI side effects of nausea, vomiting, and diarrhea are confined to the weekend limiting excess eating that often occurs.
2. It prevents loss of the workday due to side effects.
3 The injection is more effective in the first few days and most people normally eat more on the weekend than the weekday.

Semaglutide-Ozempic/Wegovy and Mounjaro Previous Use Determines Dosage

Semaglutide dosing and subsequent weight loss is also based on the previous use of any of these medications. Patients taking large doses in the past, 10 mg to 15 mg per week of Mounjaro or 1.5 mg per week or more of Wegovy or Ozempic should be started on higher doses of the Compound Semaglutides.

Compound Semaglutides should be Used Carefully or Avoided

Older patients or those having a history of the gastrointestinal disease should be started on very low doses. Even half  doses of the lowest 0.25 mg  or 0.125 mg/week can be used. Low doses should be used in patients with a history of GERD, colitis, and gallbladder disease. Although semaglutides have not been shown to cause pancreatitis, people with a previous history of pancreatitis should avoid these medications.

In addition, you should not take these medications with a history of diabetic retinopathy, medullary thyroid cancer, or multiple endocrine neoplasia type 2.

Compound Semaglutides: Switching Between Ozempic/Wegovy or Mounjaro(Tirzepatide)

When switching from Ozempic/Wegovy to any one of the 5  compounded Semaglutides the same doses are used. Mounjaro, however, is slightly different because of the added GIP hormone. Doses of Mounjaro range from 2.5 and 0.5 mg to 7.5, 10, 12.5, and 15 mg per week. Switching from Mounjaro to Semaglutides is more difficult. I suggest those taking 2.5 or 5 mg of Mounjaro take 0.5 mg of Semaglutide per week. Individuals taking 7.5 or 10 mg of Mounjaro should take 1 to 1.5 mg of Semaglutide and those taking 12-15 mg of Mounjaro take 1.75 to 2.0 mg of Semaglutide per week.

Compound Semaglutide Side Effects:

Compound Semaglutides have side effects similar to the brand-Ozempic/Wegovy and Mounjaro, but often less. Side effects are mostly gastrointestinal: Only 5% of patients in the clinical studies withdrew because of side effects. This is extremely low. Most occur early and during the first few days after the injection, especially when escalating the dose. The most common side effects are gastrointestinal with nausea being the main complaint. Weight loss and side effects with the Compounded Semaglutides are not different than that found with the brand version.

Nausea: this is the most common side effect. It usually occurs during the first 1-2 days after the injection. It may be associated with some mild vomiting. Lowering the dose or delaying the escalation of the dose often solves this problem. More than 50% of patients have minimal to no nausea. Only about 25% of patients experience significant nausea. Zofran 4 or 8 mg or Compazine suppositories are used.

Vomiting: usually, in the beginning, is often associated with skipping meals and then eating a large meal or eating too fast. You can take Zofran 4 mg or Compazine.

Diarrhea: less common, usually intermittent, possible by changes in food or the effect of semaglutide on the lining of the GI tract. Treat with Imodium, if persistent.

Constipation: very common and again intermittent, may or may not be related to medications, where there has been a significant reduction in food and especially in fats and oil. Treat with Miralax, and Metamucil capsules.

Heartburn: reflux is very common when taking these medications. It’s due to the delay in stomach emptying. Treatment with Omeprazole (Prilosec) daily in the morning) or Pepcid AC at any time, if needed.

Fatigue, lack of energy: this occurs when skipping meals normally but is significantly increased with these drugs which are designed to lower blood sugar in diabetics. In non-diabetics, there is some lowering also. Semaglutide administration itself in some people produces fatigue and weakness.