GLP-1 Medications: In-Depth Comparison + Why We Often Recommend Compounded Options

GLP-1 Medications: In-Depth Comparison + Why We Often Recommend Compounded Options

Introduction

GLP-1 receptor agonists (GLP-1 RAs) have revolutionized how we treat type 2 diabetes and obesity. In this article, we compare every currently FDA-approved option in the U.S.—covering dosing, effectiveness, side effects—and explain why, in many cases, compounded semaglutide (when done right) can be the smarter route for access, cost, and flexibility under medical supervision.

Table of Contents (for navigation)

  1. FDA-Approved GLP-1s in the U.S.

  2. Side-by-Side: Key Differences

  3. What Are Compounded GLP-1s? (Advantages & Risks)

  4. How We Use Compounded Formulations at REJUV

  5. FAQs

  6. Summary & Next Steps

1. FDA-Approved GLP-1s in the U.S.

Semaglutide

  • Ozempic (weekly injection, diabetes)

  • Wegovy (weekly, obesity/weight loss)

  • Rybelsus (oral daily tablet)

Dulaglutide

  • Trulicity (weekly injection, diabetes)

Liraglutide

  • Victoza (daily, diabetes)

  • Saxenda (daily, weight loss)

Exenatide

  • Byetta (twice daily injection)

  • Bydureon BCise (weekly extended release)

Lixisenatide

  • Adlyxin (daily injection)

patients on semaglutide weekly exercise

2. Side-by-Side: Clinical Considerations

AttributeWeekly Agents (Semaglutide, Dulaglutide, Exenatide ER)Daily / Twice-Daily Agents (Liraglutide, Exenatide IR, Lixisenatide)Convenience & Adherence High — fewer injections to missLower — daily or twice daily schedules Weight Loss Potential Semaglutide typically wins Usually more modest weight loss Gastrointestinal Side EffectsCommon, especially during up-titrationSame class risks, often more noticeable with frequent dosing Clinical Experience / Track RecordS emaglutide is newer but well studied; dulaglutide has stable historyLiraglutide has long safety data Best Use Cases Most patients aiming for strong weight loss with fewer injectionsPatients who need milder dosing or have specific clinical profiles

Key points:

  • Among weekly agents, semaglutide (Ozempic/Wegovy) generally leads for weight reduction.

  • Dulaglutide is a strong alternative when semaglutide is not an option due to tolerability or drug interactions.

  • Older agents (exenatide, lixisenatide) are still viable in niche cases but often overshadowed by newer, more potent GLP-1s.

  • Daily injections (liraglutide) may suit patients whose insurance covers them, but adherence tends to drop with more frequent dosing.

3. What Are Compounded GLP-1s?

Definition

A compounded GLP-1 is a version of the medication (e.g. semaglutide) that is prepared by a compounding pharmacy rather than manufactured by a large pharmaceutical company. These pharmacies mix or dilute the active ingredients under sterile conditions to create the desired strength, format (e.g. vial, prefilled syringe), or dosage.

Why They Matter (Advantages)

  1. Improved Access & Affordability
    Brand-name GLP-1s often come with high out-of-pocket costs or insurance restrictions. Compounded versions can greatly reduce cost, making treatment possible for many otherwise excluded patients.

  2. Flexible Dosing & Titratability
    You aren’t limited to fixed brand doses. A compounding partner can provide intermediate strengths or custom titration steps to minimize side effects.

  3. Clinic-Centered Continuity
    With control over the compounding partner and patient education, your clinic can manage transitions, monitor outcomes closely, and reduce pharmacy surprises (out-of-stock, substitution, etc.).

Risks & Safeguards

  • Not FDA-approved: Compounded medications are not evaluated by the FDA like brand drugs.

  • Quality & sterility variances: Only trust reputable 503A/503B pharmacies that validate sterility, ingredient sourcing, and lot testing.

  • Ingredient integrity matters: Semaglutide must use the base form. The FDA warns against using salt forms (e.g. semaglutide sodium or acetate) because they differ chemically and lack evidence of equivalence.

  • Packaging / labeling mistakes: Clear instructions and error-proof packaging are vital to avoid dosing errors.

  • Legal/regulatory compliance: Since shortages have eased, compounding of GLP-1s is subject to newer FDA enforcement policies. Always confirm your compounding partner is up to date on compliance.

compounded glp1 vs brand chart with tape measure

4. How REJUV Implements Compounded GLP-1s Safely and Effectively

  1. Clinic Assessment & Screening
    Before prescribing, we complete labs, history, and risk evaluation (thyroid, GI, pancreatitis risk, etc.).

  2. Choice Based on Patient Context

    • If a patient’s insurance covers Wegovy/Ozempic affordably, we may use the brand.

    • If cost, access, or stability is a barrier, we offer a compounding alternative from a vetted pharmacy.

  3. Pharmacy Partnership Criteria

    • Must use semaglutide base only

    • Demonstrate sterility, lot testing, chain of custody

    • Provide clear labeling, dosing aids (e.g. 0.25 mL graduations), and training for the patient

    • Comply with modern FDA guidance for compounding GLP-1s

  4. Structured Titration & Support
    We provide a titration schedule (often starting low and ramping up), side effect mitigation protocols (hydration, small protein meals, fiber), and close follow-up visits to adjust dosing.

  5. Safety Monitoring & Adjustments
    We track patients’ weight, glucose, GI symptoms, labs (lipids, liver, kidney), and adjust dose or agent if needed.

5. Frequently Asked Questions (FAQ)

Q: Are compounded GLP-1s safe?
A: When produced by high-quality compounding pharmacies under sterile conditions, with appropriate oversight and documentation, compounded GLP-1s can be safe and effective in a medically supervised program.

Q: Isn’t the brand safer since it’s FDA-approved?
A: Brand names carry the FDA stamp, but compounding is legal and accepted in medical practice—especially when the pharmacy meets strict standards and the clinician monitors use. The main difference is FDA review vs. clinician/pharmacy oversight.

Q: Which GLP-1 gives the most weight loss?
A: In clinical trials, weekly semaglutide (at obesity dosing) leads the class for average weight reduction. But individual responses vary depending on metabolism, lifestyle, and support.

Q: Can a patient switch from brand to compounded (or vice versa)?
A: Yes—if dosing is equivalent and the transition is medically supervised. Close follow-up ensures safety and continued efficacy.

Q: Will insurance cover a compounded GLP-1?
A: Usually not. Compounded drugs are rarely covered by insurance. That’s why we use compounding when out-of-pocket cost or coverage is a major barrier to therapy.

6. Summary & Next Steps

  • All FDA-approved GLP-1s have pros and trade-offs, but semaglutide (weekly) leads for weight loss and patient convenience.

  • Compounded GLP-1s—especially properly compounded semaglutide base—are a practical alternative when brand options aren’t accessible or affordable.

  • At REJUV Aesthetics & Wellness located in Encinitas & Carlsbad CA we integrate clinical oversight, pharmacy vetting, and patient education to make compounded GLP-1 therapy safe, effective, and responsive to your needs.

Ready to get started?
Schedule a consultation with REJUV Aesthetics & Wellness and let us help you decide whether a brand name or medically supervised compounded GLP-1 is the ideal path for your weight loss journey.

weight loss programs, weight loss, Ozempic, Mounjaro, InjectablesJacob HulcerREJUV Aesthetics & Wellness