Compounded Semaglutide: What to Know About Overdose Risks of Ozempic Alternative

Three hours after Becky Cheairs injected herself with the first dose of compounded semaglutide, she started to vomit. Crouched over the toilet, reeling from nausea, she thought there was no way she would make it on the R.V. trip from Arkansas to San Antonio she had planned that weekend.

She was right: She spent the next day throwing up at least once an hour.

Like many others, Ms. Cheairs, 66, had taken the drug to lose weight. But she hadn’t taken the brand-name products Ozempic or Wegovy, which come in pens pre-filled with a specific dose. Instead, the medication she was prescribed through a telehealth service came with a vial and a bag of syringes to draw the drug out herself.

Ms. Cheairs’ husband asked how much she had taken, then read the instructions. He was shocked: Ms. Cheairs had accidentally given herself five times the amount she was supposed to take.

Accidents like this are becoming more common. There have been 159 calls to national poison control centers so far this year involving compounded GLP-1s, the class of medications that includes semaglutide. In 2023, there were only 32.

The vast majority of these calls are from people who took too much medication, said Kait Brown, the clinical managing director at America’s Poison Centers. The problem has become so concerning that the Food and Drug Administration issued a warning last month about people overdosing on compounded semaglutide. Some patients have been hospitalized, developed pancreatitis or gallstones, or have fainted or become dehydrated. Some patients had taken 10 or even 20 times more than the intended dose.

The demand for Ozempic and similar drugs has pushed compounded medications, once a somewhat niche corner of health care, into the mainstream. There isn’t solid data on how many people take compounded GLP-1s. But some estimates have suggested millions of Americans may be seeking them out, often, because they are looking for a cheaper option or can’t find the brand-name drug in stock.

When the F.D.A. lists a medication as “currently in shortage,” as semaglutide injections are, compounding pharmacies can purchase active ingredients from registered facilities and make their own versions. But the F.D.A. does not review, approve or test compounded drugs, and has warned about the risks that come with less oversight.

Many patients inject themselves with compounded drugs without incident. The Times spoke to several people who said they received clear instructions and found it easy to administer the right dose and gradually increase it over time.

But some have struggled to figure out how much of the syringe to fill, or to make sense of instructions that describe doses in different measurements. Some use “units”; others use milligrams or milliliters. Joseph Lambson, the director of the New Mexico Poison and Drug Information Center, said patients taking compounded semaglutide report receiving varying levels of counseling from pharmacists on how to dose and administer medication. He knew of at least one patient who had taken too high a dose and who said she had received no guidance at all.

“It’s imperative for physicians and other prescribers and for compounding pharmacists to make sure that patients are properly counseled” about how to administer the drugs, said Tenille Davis, a compounding pharmacist in Arizona and the chief advocacy officer at the Alliance for Pharmacy Compounding.

“We’ve talked to patients, just anecdotally, that are sent a box with tons of information and QR codes for videos,” Dr. Davis said. “And in some cases, patients aren’t reading or watching those videos and instead are going to Facebook and Reddit.”

Online, patients turn to calculators, YouTube tutorials and Reddit threads, posting photos of syringes with pleas for help: How many milligrams equal a unit? How many units go into each dose? Some also post about doubling doses, trying to lose weight faster.

Joyce Juntunen, 53, has found it stressful to calculate each dose of her compounded semaglutide on her own. Ms. Juntunen had been taking brand-name Wegovy prescribed by a telehealth service for several months when the company began offering compounded semaglutide instead. After the switch, the instructions on the label sometimes contradicted what the company told her over the phone.

“I would read the box like 47 times just to make sure I was doing it right,” she said.

Ms. Cheairs said that even though she ordered compounded semaglutide from the same pharmacy every month, the vials would sometimes show up with slightly different formulations, or different units of measurement.

Getting the dose wrong is “such an easy mistake to make, especially for a lay person,” she said.

Her symptoms lasted two and a half days. She considered never taking another dose.

“I said, ‘This scared the hell out of me, I’m not going to do this again,’” she said. “But I was like, damn, I want to lose that weight.”