How to inject compounded semaglutide from a vial

Compounded semaglutide is not FDA-approved. The FDA does not review compounded drugs for safety, effectiveness or quality before they are sold, and it has received reports of dosing errors, some needing hospitalization, from patients and clinicians miscalculating doses. It also warns that some compounders use salt forms, semaglutide sodium or acetate, which it calls different active ingredients. Before your first dose, confirm with your prescriber and pharmacy: the vial's concentration in mg/mL, your dose in mg, the matching unit mark on your syringe, the beyond-use date and storage temperature. Tell your prescriber about thyroid cancer history or MEN 2, pancreatitis, and diabetes medicines.

Compounded semaglutide is given once weekly on the same day, at any time. There is no FDA label, so your prescriber sets the steps. Ask whether yours follows the approved Wegovy injection schedule, which is 0.25 mg for weeks 1 to 4, 0.5 mg for weeks 5 to 8, 1 mg for weeks 9 to 12, 1.7 mg for weeks 13 to 16, then 1.7 or 2.4 mg maintenance. The FDA has received adverse event reports from people given doses beyond the approved labels or faster titration. Keep at least 2 days between doses if you move your injection day.

Inject into the fat just under the skin of the abdomen, the front of the thigh or the back of the upper arm, the same sites the approved semaglutide labels list. On the stomach, keep 2 inches from the belly button. Rotate every week, both between regions and within one region, leaving an inch or more between spots. Skip skin that is bruised, tender, scarred, hard or broken. Keeping a simple site log with your dose record helps you rotate without having to remember which spot you used.

There is no single rule, because storage depends on each pharmacy's formulation; follow the vial label. Compounded semaglutide vials are typically labeled for refrigeration at 36°F to 46°F, protected from light, away from the freezer section, and never frozen. Pay attention to the beyond-use date, which the pharmacy sets and may be shorter than a branded pen's shelf life. Shipping matters too: open deliveries promptly. If a package arrives warm or the cold packs have fully thawed, refrigerate the vial but do not use it until the pharmacy confirms it is safe.

Compounded semaglutide has no FDA missed-dose rule, so ask your prescriber which to follow. The approved labels give two versions. Wegovy's: if the next dose is more than 2 days away, inject as soon as possible; if it is less than 2 days away, skip it and resume on your usual day. Ozempic's allows up to 5 days. Wegovy's label adds that after 2 or more missed weeks, restart at a lower dose.

The FDA has received reports of dosing errors with compounded semaglutide caused by miscalculating or mismeasuring doses. Typical slips include reading mL as units or reusing an old conversion with a new concentration. The FDA lists nausea, vomiting, diarrhea, abdominal pain and constipation among reported symptoms, some needing medical care. If you have taken too much, call your prescriber or the Poison Help line at 1-800-222-1222. Go to an emergency room if you cannot keep fluids down or feel faint.

Do not reuse a unit count from a previous vial without checking the concentration. Never use a syringe with different markings from the one your conversion is based on, such as a 3 mL syringe instead of a U-100 insulin syringe. Never share vials, syringes or needles. Do not combine compounded semaglutide with another GLP-1 medicine. Keep alcohol modest while doses rise, and avoid driving if you feel dizzy or faint. Tell anyone sedating you for a procedure that you take semaglutide.