Avoid Mishaps During Semaglutide and Tirzepatide Shortages

Sky-high demand is leading to shortages of semaglutide (Wegovy) and tirzepatide (Zepbound) for weight loss.

Help prevent mishaps with alternatives...as supply issues persist.

Switching to a different GLP-1 agonist is usually considered first.

But be ready for prior auths. Most other GLP-1 agonists won’t be covered unless patients have type 2 diabetes or some heart risks.

In this case, anticipate that patients may switch to a comparable dose of a GLP-1 agonist...given at the same interval.

For example, a patient using semaglutide 0.5 mg or tirzepatide 2.5 mg weekly may switch to dulaglutide (Trulicity) 1.5 mg weekly.

Stay alert for prescribers sending e-Rxs for different strengths of the same med...such as Rybelsus 3 mg and 7 mg. This might be done because patients start on a low dose...and increase slowly to limit side effects.

But issuing multiple Rxs can cause confusion about which strength to dispense...and increase the risk of patients getting the wrong dose.

Ensure patients are notified about Rx changes...such as by putting a note on the will-call bag...and clarify meds and doses at pickup.

Using a compounded GLP-1 agonist may be an option during a shortage.

But encourage using a licensed US pharmacy...ideally accredited in compounding...to help ensure safety and quality.

Steer patients away from questionable sources...online sellers that don’t require an Rx, spas that tout “generic” GLP-1s, etc.

Patients can also ask to see a certificate of analysis...to confirm the active ingredient in the compound is semaglutide. Some products are being made with semaglutide sodium or other salts...which are “research grade” chemicals that aren’t for drug use.

Switching to an oral med such as phentermine/topiramate (Qsymia) or naltrexone/bupropion (Contrave) may be another choice. See our resource, Weight Loss Products, for dosing, costs, etc.

Also listen for questions about berberine supplements...which people are calling “nature’s Ozempic.”  There’s not enough evidence to say whether it helps with weight loss...and it has many possible interactions.

Dig into our resource, Managing Drug Shortages, for more strategies on handling shortages...including what to say to patients.

Key References

  • Grunvald E, Shah R, Hernaez R, et al; AGA Clinical Guidelines Committee. AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity. Gastroenterology. 2022 Nov;163(5):1198-1225.
  • American Diabetes Association Professional Practice Committee. 8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S145-S157.
  • Whitley HP, Trujillo JM, Neumiller JJ. Special Report: Potential Strategies for Addressing GLP-1 and Dual GLP-1/GIP Receptor Agonist Shortages. Clin Diabetes. 2023 Summer;41(3):467-473.
  • Alliance for Pharmacy Compounding. Statement on Rules Governing Compounding, What FDA Guidance Says About Permissibility of Compounding “Essentially a Copy” of an FDA-approved Drug – and What Those Have to do With Semaglutide. October 11, 2023. https://a4pc.org/files/APC-Compounding-Semaglutide-Media-Brief-REVISED-October-10-2023.pdf (Accessed June 17, 2024).
  • FDA. Medications Containing Semaglutide for Type 2 Diabetes or Weight Loss. January 10, 2024. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss (Accessed June 17, 2024).
  • Obesity Action Coalition. Leading Obesity Expert Organizations Release Statement to Patients on Compounded GLP-1 Alternatives. https://www.obesityaction.org/wp-content/uploads/GLP-1-Compounded-Alternative-Statement_Final_Logos-1.pdf  (Accessed June 17, 2024).
  • Conte C, Hall KD, Klein S. Is Weight Loss-Induced Muscle Mass Loss Clinically Relevant? JAMA. 2024 Jun 3. doi: 10.1001/jama.2024.6586.
Pharmacy Technician's Letter. July 2024, No. 400710

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