Compounded semaglutide vs. Wegovy: what actually differs

Wegovy is no longer one product. Its label now covers a weekly pen stepping from 0.25 mg to a 2.4 mg maintenance dose, Wegovy HD at 7.2 mg for adults who have tolerated 2.4 mg for at least four weeks, and a Wegovy pill taken daily up to 25 mg. The approved uses have widened too: long-term weight reduction in adults and in adolescents from 12, cardiovascular risk reduction in adults with established heart disease and obesity or overweight, and, under accelerated approval, a liver condition called MASH with moderate to advanced fibrosis.

Compounded semaglutide carries none of those indications. It is a pharmacy preparation, usually a multi-dose vial and insulin syringe, made for your prescription at a concentration the pharmacy sets. Your prescriber writes the dose ladder; nothing on the vial tells you where the approved doses stop.

There is no trial of compounded semaglutide against Wegovy. What exists is a growing stack of Wegovy trials, each run on the approved product:

• STEP 1 (NEJM 2021): 2.4 mg weekly, mean weight change −14.9% against −2.4% on placebo over 68 weeks, in adults without diabetes.
• SELECT (NEJM 2023): 20% lower risk of major cardiovascular events in adults with established heart disease and overweight or obesity.
• STEP UP (Lancet Diabetes & Endocrinology 2025): 7.2 mg produced −18.7% against −15.6% on 2.4 mg and −3.9% on placebo over 72 weeks.
• OASIS 4 (NEJM 2025): the 25 mg pill produced −13.6% against −2.2% on placebo over 64 weeks.

None of those numbers transfers to a compounded vial, and in February 2026 FDA said sellers may not claim compounded products are clinically proven to produce results. Wegovy HD also raises a practical point: above 2.4 mg, the only approved reference is the 7.2 mg dose, and FDA has received adverse event reports from people prescribed compounded semaglutide at doses beyond the approved label.

Wegovy's label and trials describe the pattern: gastrointestinal effects dominate and peak during dose increases. In STEP UP, gastrointestinal adverse events affected 70.8% of people on 7.2 mg, 61.2% on 2.4 mg and 42.8% on placebo. The higher dose also brought something new: dysaesthesia, an altered or painful skin sensation, in 22.9% on 7.2 mg against 6.0% on 2.4 mg. In OASIS 4, gastrointestinal events affected 74.0% on the 25 mg pill against 42.2% on placebo.

Warnings for every form include pancreatitis, gallbladder disease, kidney injury from dehydration, and the rodent thyroid C-cell tumour boxed warning. The compounded vial adds its own risks: a units mistake at a high concentration can overshoot a step, and FDA recommends discarding a multi-dose vial 28 days after first use.

Choose Wegovy if you have established heart disease, since the cardiovascular indication is backed by SELECT; if you want the option of 7.2 mg later; if you prefer a pill; or if your insurance covers it. The self-pay gap has also narrowed: NovoCare Pharmacy lists $199 a month for the first two pen fills, then $349 for doses up to 2.4 mg and $399 for Wegovy HD, with the pill from $149 (NovoCare Pharmacy, checked 28 Sep 2026).

Compounded semaglutide remains an option when even those prices do not work and you accept the trade: no approved indication, a dose you measure yourself, and quality you verify through the pharmacy rather than a label. Temi's starting price is shown in the table below.

Neither suits anyone with a personal or family history of medullary thyroid carcinoma or MEN 2, or anyone pregnant or planning to be within two months.