What Is Actually in a Compounded Semaglutide or Tirzepatide Vial?
A compounded GLP-1 vial holds four kinds of things: the active drug, sterile water, a couple of inactive ingredients that keep the solution stable and safe to inject, and, on most labels you will see, one added ingredient. That added ingredient is why one offer reads semaglutide/B12 and the next reads tirzepatide + glycine.
Here is the short version. The additive is real and it is disclosed. It is also not the part that makes the medication work. What determines your dose is the active ingredient and its concentration, and those are printed on the same label most people skip past.
Educational information, not a substitute for personalized medical advice.
One thing to be clear about up front: compounded semaglutide and tirzepatide are not FDA approved. Compounded drugs do not go through FDA review for safety, effectiveness, or quality before they are sold, and the FDA's position is that they should be used only in patients whose medical needs cannot be met by an FDA-approved drug. Source: FDA's Concerns with Unapproved GLP-1 Drugs Used for Weight Loss
What is in the vial
Strip a compounded GLP-1 injectable down and you get a short list.
| Component | What it is doing |
|---|---|
| Active ingredient | The medicine itself: semaglutide or tirzepatide |
| Water for injection | The solvent everything is dissolved in |
| A salt, usually sodium chloride | Matches the solution to body fluids so the injection is tolerable |
| A buffer, usually a phosphate salt | Holds pH near neutral so the peptide stays stable |
| A preservative | Only in containers meant for more than one dose |
| An optional added ingredient | The "additive" you see on the offer: B12, glycine, and others |
The branded products are built the same way, and their labels are public, which makes them a useful reference point. Each milliliter of Wegovy contains semaglutide plus disodium phosphate dihydrate, sodium chloride, and water for injection. Each single-dose Zepbound pen or vial contains tirzepatide plus sodium chloride, sodium phosphate dibasic heptahydrate, and water for injection. Sources: Wegovy prescribing information; Zepbound prescribing information
The preservative line is worth pausing on, because it explains a difference patients notice. The single-dose Wegovy syringe carries no preservative. The multi-dose Wegovy FlexTouch pen adds phenol, and Zepbound's multi-dose vial and KwikPen add benzyl alcohol, glycerin, and phenol. A container you puncture more than once needs something that keeps microbes from growing between doses. Most compounded GLP-1 vials are multi-dose, so they carry a preservative for the same reason.
One more thing that belongs in the vial and sometimes is not: plain semaglutide. The FDA has said that salt forms such as semaglutide sodium and semaglutide acetate are different active ingredients from the one in the approved drugs, and that it is not aware of any lawful basis for using them in compounding. That is a fair question to ask any pharmacy.
The additive is the part that varies
Every additive currently offered across the compounding pharmacies in Temi's catalog is a vitamin, an amino acid, or a vitamin-like nutrient, with one exception noted at the bottom of the table.
| Additive | What it is | Where it appears |
|---|---|---|
| Cyanocobalamin or methylcobalamin (vitamin B12) | Two forms of B12, which supports energy metabolism, red blood cell production, and nerve health | Compounded semaglutide and tirzepatide injections, and some oral dissolving tablets |
| Glycine | An amino acid, which supports muscle maintenance, relaxation, and recovery | Compounded semaglutide and tirzepatide injections |
| Niacinamide | A form of vitamin B3, which supports energy metabolism and skin health | Compounded tirzepatide injections |
| L-carnitine | A vitamin-like compound, which supports energy and fat metabolism | Compounded tirzepatide injections |
| Pyridoxine HCl (vitamin B6) | A B vitamin, which supports energy metabolism and overall wellness. Typically 10 mg per tablet | Compounded semaglutide oral dissolving tablets |
| None | No added ingredient at all | Available for both compounded semaglutide and compounded tirzepatide injections |
| Naltrexone | Not a vitamin. A prescription medicine in its own right, with its own risks and interactions | Compounded semaglutide oral dissolving tablets only |
Those middle-column descriptions are how each ingredient is described on its own. None of them is a finding about what it does inside a GLP-1 vial.
That last row is the one to read twice. A vitamin riding along in the vial is a different kind of thing from a second prescription drug in the tablet. Naltrexone changes what the prescription is, so it belongs in a conversation with your clinician rather than in a price comparison.
Why there is an additive at all
The honest answer is regulatory, not clinical.
A 503A pharmacy compounds a patient-specific medication after receiving a prescription, and federal law limits how much it can compound a product that is essentially a copy of a commercially available drug. The FDA considers a compounded product essentially a copy when it has the same active ingredient in the same, similar, or easily substitutable strength, and the commercial product can be given by the same route, "unless a prescriber determines and documents the compounded drug product contains a change that produces a significant difference from the commercially available drug product for an identified individual patient." Source: FDA clarifies policies for compounders
Adding an ingredient is one kind of change a prescriber can document. But the FDA has also been explicit that adding one does not settle the question by itself. Its own worked example is semaglutide combined with vitamin B12: the agency says it may still consider that combination essentially a copy when the route is the same and both amounts land within 10 percent of the commercially available strengths.
So the additive exists inside a real regulatory frame. It is not a marketing garnish, and it is also not evidence that the formulation is better.
What the additive does not change
It does not change your GLP-1 dose. If your prescription is 2.5 mg of tirzepatide weekly, you take 2.5 mg of tirzepatide whether the vial also holds L-carnitine, niacinamide, or nothing. At Temi, the additive is not treated as part of the clinical decision. The prescription is written for the GLP-1 and its dose, and the additive comes with whichever product you select.
It is not backed by trials of the combination. There are no published randomized trials showing that compounded semaglutide with B12 produces more weight loss, or less nausea, than compounded semaglutide alone. Absence of evidence is not proof it does nothing, but it does mean nobody should be selling you the additive as a benefit.
The amounts are small relative to the studies people cite. The largest meta-analysis of L-carnitine and weight, covering 37 randomized trials and 2,292 participants, found a modest average reduction of about 1.2 kg, with the dose-response analysis pointing to roughly 2,000 mg taken by mouth every day. The L-carnitine in a weekly GLP-1 injection is a small fraction of that. Source: Talenezhad et al., Clinical Nutrition ESPEN, 2020
B12 helps if you are low on B12. The adult recommended intake is 2.4 mcg per day. The National Institutes of Health notes that B12 is often promoted as an energy enhancer, but that "supplementation appears to have no beneficial effect on performance in the absence of a nutritional deficit." If you suspect a deficiency, that is worth testing and treating on its own terms rather than inferring from a vial label. Source: NIH Office of Dietary Supplements, Vitamin B12
The two numbers that matter more than the additive
Concentration and total milligrams are the numbers that decide how much liquid you draw into the syringe, and they are the ones most likely to hurt you if you read them wrong.
Compounded semaglutide across Temi's catalog runs from 0.8 mg/mL to 10 mg/mL. Compounded tirzepatide runs from 5 mg/mL to 17 mg/mL. Two vials with the same headline number can be very different products:
- A 5 mg semaglutide vial at 5 mg/mL holds 1 mL. A 1 mg dose is 0.2 mL.
- A 5 mg semaglutide vial at 2.5 mg/mL holds 2 mL. The same 1 mg dose is 0.4 mL.
Same total milligrams, same prescription, double the volume in the syringe. The FDA has issued a specific alert about exactly this: it received reports of adverse events, some requiring hospitalization, from dosing errors with compounded injectable semaglutide, driven by confusion between milliliters, milligrams, and "units," and by the fact that a single compounder may offer multiple concentrations. In most of the reports, patients drew up five to twenty times the intended dose. Source: FDA alert on dosing errors with compounded injectable semaglutide
If you switch pharmacies or vial sizes, treat the new label as a new medication and confirm the volume with your care team before the first injection.
Two dates, not one
Vials carry two separate clocks, and patients often collapse them into one.
The beyond-use date is how long the sealed vial is good for. Across Temi's compounded catalog it ranges from 28 to 90 days depending on the pharmacy and the formulation.
The in-use window starts when you first puncture the stopper. For a multi-dose container the standard is 28 days from first entry unless the manufacturer specifies otherwise. That is why a vial holding far more medication than 28 days of dosing is not a bargain: the extra milligrams get discarded. Source: CDC injection safety guidance for health care providers
Why the same drug looks different at every pharmacy
There is no standard compounded formula. Each 503A pharmacy sets its own concentration, its own vial volumes, its own inactive ingredients, and its own beyond-use dating, then documents how its preparation differs from the commercial product. That is why one pharmacy sells tirzepatide at 17 mg/mL in a 2 mL vial and another sells it at 10 mg/mL in a 4 mL vial, and why the additive column is a different word at each one.
None of that variation is hidden. It is just rarely published side by side, which is how a shopper ends up comparing two numbers that are not measuring the same thing.
How Temi shows it
On the compounded semaglutide and compounded tirzepatide pages, each offer card in the pharmacy picker names its pharmacy and prints either the additive or No additives. The concentration, vial size, and beyond-use date sit in the product details below. If you want a vial with nothing added, that is a filter, not a special request.
FAQ
Is compounded semaglutide with B12 FDA approved?
No. No compounded semaglutide is FDA approved, with or without B12. Compounded preparations do not undergo FDA premarket review for safety, effectiveness, or quality, and the FDA's position is that they are for patients whose medical needs cannot be met by an FDA-approved drug.
Does semaglutide with B12 work better than semaglutide alone?
There is no published trial evidence that it does. Anyone telling you otherwise is ahead of the data.
What does "semaglutide 6 mg / pyridoxine HCl 10 mg" mean on a tablet label?
It is a compounded oral dissolving tablet containing 6 mg of semaglutide and 10 mg of pyridoxine, which is vitamin B6, per tablet. These tablets are usually dispensed in 30-count packs, so the total semaglutide in the pack is 180 mg. The tablet ladder in Temi's catalog runs 2, 4, 6, 12, and 24 mg per tablet, all paired with the same 10 mg of pyridoxine.
Is there a semaglutide and L-carnitine vial?
Not in Temi's catalog. L-carnitine shows up in compounded tirzepatide, including a 1 mL vial presentation, which is probably the source of the confusion. If you are searching for a semaglutide and L-carnitine combination specifically, the honest answer is that the L-carnitine vials here are tirzepatide.
Can I get a compounded GLP-1 with no additives?
Yes. Additive-free compounded semaglutide and tirzepatide injections are both in the catalog, and you can select them directly.
Key takeaways
- A compounded GLP-1 vial is mostly unremarkable. Active drug, water, a salt, a buffer, a preservative if the container is multi-dose, and sometimes one added ingredient.
- The additive is disclosed, not decisive. B12, glycine, niacinamide, L-carnitine, and pyridoxine are the ones you will see. None of them changes the GLP-1 dose you take.
- The regulatory reason is not a clinical claim. An added ingredient can be part of a documented difference from the commercial product, and the FDA has said adding B12 does not by itself settle that question.
- Concentration is the number that can hurt you. The same total milligrams at half the concentration means double the volume in the syringe, and the FDA has documented hospitalizations from that exact confusion.
- Watch both dates. The sealed beyond-use date and the 28-day window after first puncture are different clocks.
- Compounded GLP-1s are not FDA approved, and the FDA's position is that they are for patients whose medical needs cannot be met by an approved drug.
Sources
- U.S. Food and Drug Administration. FDA's Concerns with Unapproved GLP-1 Drugs Used for Weight Loss. Link
- U.S. Food and Drug Administration. FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize. Link
- U.S. Food and Drug Administration. FDA alerts health care providers, compounders and patients of dosing errors associated with compounded injectable semaglutide products. Link
- U.S. Food and Drug Administration. Pharmacy Compounding of Human Drug Products Under Section 503A of the Federal Food, Drug, and Cosmetic Act: Guidance. PDF
- Novo Nordisk. Wegovy (semaglutide) injection prescribing information. DailyMed
- Eli Lilly and Company. Zepbound (tirzepatide) injection prescribing information. DailyMed
- Talenezhad N, Mohammadi M, Ramezani-Jolfaie N, Mozaffari-Khosravi H, Salehi-Abargouei A. Effects of l-carnitine supplementation on weight loss and body composition: a systematic review and meta-analysis of 37 randomized controlled clinical trials with dose-response analysis. Clinical Nutrition ESPEN. 2020;37:9-23. PubMed
- National Institutes of Health, Office of Dietary Supplements. Vitamin B12 fact sheet for health professionals. Link
- Centers for Disease Control and Prevention. Injection safety: clinical safety considerations for health care providers. Link
- Temi. Compounded semaglutide injectable.
- Temi. Compounded tirzepatide injectable.
- Temi. How Temi works.
- Temi. Online GLP-1 intake.
If you are weighing compounded options and want a clinician to review whether treatment fits your history, you can start the online intake. Submitting it starts a review; it is not a guarantee that anything will be prescribed.
Temi is making access to healthcare more seamless. Questions about a formulation you were offered? Your Temi care team is here to help. usetemi.com