Compounded Semaglutide GLP-1 Treatment Plan
Written by Steve Silvestro, MD, Ro
Written by Steve Silvestro, MD, Ro
last updated: Oct 17, 2023
Key takeaways
We know you’re excited to start treatment. But before your first shot, take the time to read your entire treatment plan to understand the potential risks and benefits of compounded semaglutide. Please do not hesitate to contact our medical support team in your Ro account chat if you have any questions.
Here's what we'll cover
Quick Facts
How it works:
Like other GLP-1s, compounded semaglutide mimics a naturally occurring hormone in your body that slows down how fast your stomach empties after you eat and acts on your brain to make you less hungry. It’s believed to help you feel fuller quicker and satiated longer and regulate how much you eat.
When to take it:
You'll inject compounded semaglutide once a week. You can take it any day of the week, at any time, either with or without food. Once you pick a day, stick with it each week to make taking your medication a habit.
How to take it:
Compounded semaglutide comes in small glass vials with syringes that you must carefully prepare to self-administer the injectable medication. Like Wegovy and Ozempic, it's injected weekly in your abdomen, thigh, or upper arm.
Watch our injection video, or keep reading for step-by-step instructions. If at any time you feel uncertain about how to use your medication, please send a message to our medical support team.
Potential side effects:
Like other GLP-1s, most common side effects often improve within the first few weeks of treatment. Common side effects are often gastrointestinal complaints like nausea, diarrhea, and vomiting (see the full list below). More severe side effects are rare but possible, so please keep reading to learn about them all.
More on compounding:
Drug compounding is the process of combining, mixing, or altering ingredients to create a medication tailored to an individual patient's needs. Compounding is conducted by pharmacies or other licensed entities, such as physicians or outsourcing facilities. Ro's compounded semaglutide only uses semaglutide base, the same active ingredient used in Wegovy® and Ozempic®.
Watch: How to inject compounded semaglutide
Read: Step-by-step injection instructions
Be sure to read the instructions that come with the medication before taking your first dose.
Each combination of syringe + needle is meant to be used only once. Do not reuse a syringe + needle.
When your medication arrives:
The medication should arrive in the mail looking clear and colorless. No part of it should be frozen or crystallized, even in winter.
The medication must be stored in the prescription bottle it comes in and placed in your refrigerator as soon as you receive it. The packaging is designed to keep your medication within an appropriate temperature range.
If you haven’t refrigerated your medication within 2 days of it shipping, or if it is not clear, colorless, or fully liquid, contact us at [email protected].
How to store your medication
Refrigerate your medication as soon as it arrives. Store the vial of medication in the prescription bottle it came in. Keep it in your refrigerator at 36º–46º F (2º–8º C). Discard any unused medication 28 days after first using the vial or when the expiration date has passed, whichever comes first.
What to do if you have a previous prescription
If you have a previous prescription for a brand-name semaglutide or another GLP-1 in addition to your compounded semaglutide, do not take both medications simultaneously. Instead, discard your previously prescribed medication. Taking two or more of these medications together increases potentially severe side effects.
When to take your dose
Administer one dose each week, on the same day each week, at any time of day, with or without food.
What to have ready
(Watch this step)
one (1) prescription bottle
one (1) vial of medication
one (1) sterile syringe with needle
two (2) alcohol wipes
one (1) vial seal sticker
hard plastic resealable container to dispose of used needle and syringe
Before you start
(Watch these steps)
1. Wash your hands with soap and water.
2. Double-check the information on the prescription bottle, including the dose amount and expiration date. The medication in the vial should be clear and colorless. There may only be a small amount of medication, especially for lower doses, but it will be sufficient.
Filling the syringe
3. Gently shake the vial. If this is a new vial, remove the plastic cap. If not, remove the seal sticker you previously placed on the top. Now, clean the top of the vial with an alcohol wipe.
4. On the syringe, remove the caps from the plunger and the needle. It’s important to keep the needle sterile, so do not touch it.
5. While holding the syringe with the needle pointed up, pull the plunger down to the correct dose. Use the chart below:
Compounded Semaglutide Dosage | How much to draw |
0.25 mg (0.1 mL) | 10 units, once a week |
0.5 mg (0.2 mL) | 20 units, once a week |
1 mg (0.4 mL) | 40 units, once a week |
1.7 mg (0.68 mL) | 68 units, once a week |
2 mg (0.8 mL) | 80 units, once a week |
2.4 mg (0.96 mL) | 96 units, once a week |
For example, if your dose is 0.25 mg, pull the plunger of the syringe down to the 10 units mark.
6. Insert the needle into the rubber part of the vial top and press down on the plunger completely to inject all of the air from the syringe into the vial. Injecting the air into the medication vial makes the next step easier!
7. While the needle is still in the vial, turn the vial upside down. Make sure the needle tip is surrounded by liquid. Pull back the plunger past your dose amount. For example, if your dose is 10 units of medication, pull the plunger back beyond the 10 units mark.
8. Remove any air bubbles by tapping the syringe with your finger.
9. Push the plunger to the prescribed dose level on the syringe. For example, if your prescribed dose is 10 units, push the plunger to the 10 units mark.
10. Turn the vial upright and then remove the needle.
11. Do not put the needle cap back on the needle. You can put the syringe down by resting it on the needle cap so the tip of the needle doesn’t touch anything.
12. Apply a new vial seal sticker to the cap of the vial after each use. Press firmly to ensure adherence to the cap to prevent contamination.
Administering the injection:
(Watch these steps)
13. Select your injection site. Your abdomen (at least two inches away from your belly button), thigh (front or outer thigh), or upper arm are all good injection sites, but choose a spot that is at least one finger’s width away from the last injection spot.
Change where you give the injection each time. You can inject in the same area of your body each time—just make sure it’s not in the exact same spot every time. Moving injection spots is important to minimize the formation of permanent, fatty nodules that can arise and decrease the efficacy of your treatment. Ensure each injection location is at least one finger’s width away from the previous one.
14. Clean the area you want to inject with an alcohol wipe and allow the skin to dry.
15. Hold the syringe with the needle facing toward the ceiling. Push the plunger slightly until a drop of liquid forms at the end of the needle.
16. Pinch and hold the skin that you will inject. Holding the syringe pointing directly at the pinched skin, quickly push the needle through the skin into the fat tissue, making sure to insert the entire length of the needle. Then, slowly push the plunger to inject all of the medication.
17. Pull the needle out and clean the skin with an alcohol wipe or tissue. It’s normal to see a drop of blood at the injection spot. Press gently on the site for a few seconds for the bleeding to stop.
Safely discard the syringe:
(Watch this step)
18. Discard the syringe in a sharps container or a heavy plastic container with a tight-fitting lid, like an empty detergent bottle. Do not throw away the syringe directly in your household trash.
Additional guidance
If you miss a shot
If you forget to take your shot, but it’s more than 48 hours before the next one is scheduled, you should take the missed shot right away. Then, take the next shot on its regularly scheduled day.
Example: You usually inject on Saturdays, but one time you forget and don’t realize that you’ve forgotten until Wednesday. The next Saturday’s shot is more than 48 hours away, so you should take that missed shot on the day you’ve remembered to take it (Wednesday), then take the next shot on schedule (Saturday).
If the next shot is less than two days away, don’t take the missed one. Instead, wait for the next scheduled shot and take that one on time. If you’re not sure what to do, contact your Ro-affiliated provider for advice.
Example: You usually take your shot on Saturdays, but one time you forget and don’t realize you’ve forgotten until Friday. The next Saturday’s shot is less than 48 hours away, so you should not take the missed shot. Instead, wait for the next scheduled shot (Saturday).
If you’ve missed more than two weeks of shots, don’t take your next one. Contact your Ro-affiliated provider for the next steps.
If you take more than prescribed
In the instance that you should take more than the prescribed dose, contact your Ro-affiliated provider and monitor your symptoms.
The primary side effects of taking more than prescribed are severe nausea, vomiting, and possibly low blood sugar. Should symptoms persist, worsen, or are very severe, contact your primary care practitioner and, if necessary, seek emergency medical attention.
Inform your primary care provider of your GLP-1 prescription
Ro is here to help you meet your goal to lose weight, but we’re not a replacement for a primary care provider (PCP).
Your Ro-affiliated provider will manage your GLP-1 prescription and your weight management treatment. Meanwhile, your PCP is responsible for taking care of your overall health and wellness.
Having a PCP is important for everyone, but especially for people who have overweight or obesity. Having overweight or obesity can increase your risk of developing or worsening chronic diseases, such as diabetes, high blood pressure, high cholesterol, or heart disease. These diseases can affect your quality of life and your life expectancy. A PCP can help you prevent or detect these diseases early, and provide you with the best treatment options. They can also provide you with regular check-ups, screenings, immunizations, and referrals to specialists when needed.
It’s important to let your PCP know that you are taking a GLP-1 through Ro so that they can have a clear picture of all the medications you take and your overall health.
How to find a PCP
If you do not have a PCP, you should find one as soon as possible. Here are some ways to find a PCP near you:
Ask your insurance company for a list of PCPs in your network.
Ask your friends or family for recommendations.
Use online tools, such as Healthgrades or Zocdoc, to search for PCPs and read reviews from other patients.
Full medication details
Side effects of the injection: Patients occasionally note irritation of the skin or small raised areas near or at the injection site. By ensuring that the area of injection is cleaned with an alcohol swab prior to injection and injecting at a perpendicular angle to the skin, you can decrease the chance of these reactions occurring. These usually go away on their own within 4-8 weeks.
Side effects of the medication: The side effects of GLP-1s are generally limited to gastrointestinal complaints, with the most common being nausea and diarrhea. Other side effects included vomiting, constipation, and abdominal pain, dyspepsia (or upset stomach), abdominal distension, and reflux. Non-gastrointestinal side effects included headache, fatigue, and dizziness.
In patients with type 2 diabetes, there were also reports of low blood sugar. Complications of diabetic retinopathy, an eye condition that can cause vision changes and blindness in people with diabetes, was observed in clinical trials with a greater risk seen in people who had a history of diabetic retinopathy before starting GLP-1 treatment.
Less common were serious side effects including inflammation of the pancreas (pancreatitis), gallbladder inflammation and stones, kidney injury, increases in heart rate, and complications related to diabetic retinopathy in patients with type 2 diabetes. Changes in mood have been reported with GLP-1s and you should report these to your Ro-affiliated practitioner. We will also monitor this while you’re undergoing treatment with us.
Possible thyroid tumors, including cancer. You should alert your Ro-affiliated practitioner if you get a lump or swelling in your neck, develop a hoarse voice, have trouble swallowing, trouble breathing, or shortness of breath. While it is not certain if Wegovy, Ozempic, Saxenda, or compounded semaglutide could cause thyroid tumors or a type of thyroid cancer, Wegovy/Ozempic/Saxenda and medications like it have caused tumors in rodent studies. Additionally, cases of medullary thyroid carcinoma (“MTC”) in patients treated with a different medication in the same class as semaglutide (liraglutide, another GLP-1 receptor agonist), have been reported, but the data in these reports are insufficient to establish or exclude a causal relationship between MTC and GLP-1 receptor agonist use in humans.
Medications such as semaglutide, Saxenda, Ozempic, Wegovy, and compounded semaglutide (GLP-1 receptor agonists) are associated with slower emptying of the stomach (slowed gastric emptying) and intestines. This means that when you take the medication, food leaves your stomach and intestines more slowly, which helps you feel more full and for a longer period of time. This process is one of the ways the medication helps some people lose weight—and for most patients, it goes away when the medication is stopped. However, the FDA has received reports that in some people this effect may be more severe. This can sometimes cause stomach paralysis (also called gastroparesis) or intestinal blockage (also called an ileus). This effect may not resolve even after the medication has stopped and can create the risk of unwanted side effects. If you have abdominal pain, nausea, vomiting or severe constipation, please reach out to your Ro-affiliated provider so they can help determine the next steps in your care.
Symptoms of hypersensitivity reactions (allergic reactions) may occur. Do not take it if you are allergic to the GLP-1 medication or any of its ingredients. Stop using the GLP-1 and seek in-person medical care right away if you experience symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, severe rash or itching, very rapid heartbeat, problems breathing or swallowing, or fainting or feeling dizzy.
Risks of self-administering compounded semaglutide: Ro’s compounded semaglutide is supplied in a small glass vial with which you will need to self-prepare the dose. To prepare each dose, you will first gather your medication vial and a new syringe, clean the top of the vial with an alcohol wipe and draw the appropriate amount of medication into the syringe. Like Wegovy and Ozempic, this is injected weekly under the skin. Detailed instructions are included below in “5. How to use GLP-1s.”
Potential risks of self-prepared dosing include:
administering a higher dose than recommended, which can lead to unwanted effects such as severe nausea, severe vomiting, and severe hypoglycemia
administering a lower dose than recommended, which can lead to inadequate treatment
risk of infection with improper cleaning
Closely following the injection instructions provided in this treatment plan will help you minimize these risks.
GLP-1s and GIP/GLP-1s are prescription medications that are clinically-tested, stimulant-free, and non-habit forming. These medications work by mimicking the functions of a naturally occurring hormone in your body to slow down how fast your stomach empties after you eat and act on your brain to make you less hungry. This helps you feel fuller, causing less food intake without uncomfortable hunger. These medications are meant to be used with a reduced calorie diet and regular physical activity.
GLP-1s aren’t for everyone. You shouldn’t take a GLP-1 if you have any of the following risk factors:
Pregnant, possibly pregnant, or planning to get pregnant in the next 3 months; this applies to both men and women who are able to become pregnant
Breastfeeding
History of hypersensitivity to semaglutide, tirzepatide, or other GLP-1 medications
Personal or family history of medullary thyroid carcinoma
History of multiple endocrine neoplasia syndrome type 2 (MEN2)
History of pancreatitis
History of delayed gastric emptying or gastroparesis
History of gallbladder disease or bile duct disease
History of suicidal ideation or history of suicide attempts
History of tachycardia or atrial fibrillation
Type 1 diabetes
History of impaired kidney function
Diabetic retinopathy complications due to type 2 diabetes
GLP-1 medications can cause too low blood sugar in patients who take GLP-1s with another glucose control medication, including insulin. Monitor your blood sugar and watch out for signs of too low blood sugar such as dizziness, blurred vision, mood changes, sweating, or fast heartbeat.
Complications of diabetic retinopathy, an eye condition that can cause vision problems and blindness in people with diabetes, have been observed in clinical trials. The risk was higher for people who already had a history of diabetic retinopathy before starting GLP-1 treatment. If you have type 2 diabetes, tell your provider right away if you experience changes in vision.
GLP-1s can lower blood glucose and using them with other medications that lower blood glucose such as insulin or sulfonylureas can cause hypoglycemia or significantly low blood sugar. If you are currently taking one of these medications, you should mention these medications to your Ro-affiliated provider as well as consult with your prescribing provider regarding its use along with a GLP-1. One of the effects of GLP-1s is decreasing the speed of gastric emptying or the speed that material moves through your gastrointestinal tract. Due to this it can change the absorption of medications taken by mouth. If you are on thyroid medication, specifically levothyroxine, GLP-1s can increase the concentration of the levothyroxine in your blood. Please inform your Ro-affiliated provider that you are taking this medication as well as consult with your prescribing provider regarding its use along with a GLP-1.
Most people who take GLP-1s notice a decrease in hunger, feeling more full for longer or feeling more full after less food. Some people report side effects such as nausea or diarrhea. At lower doses, however, you may not feel any changes at all. That does not mean the medication is not working—you may start seeing small changes on the scale after several weeks, even at low doses—but some people may require higher doses before they notice changes in their appetite. Ultimately, the goal of GLP-1 therapy is weight loss and this may occur without any noticeable differences in how you feel. If you still feel no different and haven’t noticed changes on the scale by the time you’ve been prescribed higher doses of the medication, discuss this with your Ro-affiliated provider.
Drug compounding is the process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual patient. Compounding is conducted by pharmacies or other licensed entities, such as physicians or outsourcing facilities.
Compounded semaglutide is a form of semaglutide produced using the compounding process described above. The key fact about compounded semaglutide prescribed by Ro-affiliated providers is that it is made with semaglutide base, which is the same active ingredient used in Wegovy and Ozempic.
Semaglutide is a peptide. The base version is the active ingredient (called the Active Pharmaceutical Ingredient, or API) in Wegovy and Ozempic. On the other hand, semaglutide salts—such as semaglutide sodium and semaglutide acetate—are altered forms of semaglutide called “pharmaceutical salts.”
Salt forms of drug bases are often made to change one or more features of the drug base, such as its stability, solubility, digestion, and more. Salt forms are not inherently dangerous—in fact, many prescription and over-the-counter medications use the salt form of a drug.
However, salt forms may differ from the drug base in terms of their efficacy, pharmacology, and safety. Clinical trials that evaluated the efficacy and safety of branded semaglutide utilized semaglutide base, not semaglutide salts. Therefore, the safety and efficacy of various semaglutide salts have not been established.
Ro only works with partners who compound using semaglutide base, not compounded semaglutide salts.
In the event you happen to have a previous prescription for brand name GLP-1 (Zepbound, Ozempic, Wegovy or Saxenda) or another GLP-1 in addition to your compounded GLP-1, do not take both medications simultaneously. Taking two or more of these medications together increases potentially severe side effects. You can reach out to your provider in your Ro account chat for more guidance.
Contact your Ro-affiliated provider and all of your healthcare providers if you experience any new symptoms after beginning your GLP-1 or GIP/GLP-1 treatment. If you have any serious signs or symptoms like, but not limited to, blood in your stool, severe diarrhea, fainting, or severe abdominal pain, please seek out emergency medical treatment.
(A) WARNING: RAPID WEIGHT LOSS MAY CAUSE SERIOUS HEALTH PROBLEMS. RAPID WEIGHT LOSS IS WEIGHT LOSS OF MORE THAN 1.5 POUNDS TO 2 POUNDS PER WEEK OR WEIGHT LOSS OF MORE THAN 1 PERCENT OF BODY WEIGHT PER WEEK AFTER THE SECOND WEEK OF PARTICIPATION IN A WEIGHT-LOSS PROGRAM.
(B) CONSULT YOUR PERSONAL PHYSICIAN BEFORE STARTING ANY WEIGHT-LOSS PROGRAM.
(C) ONLY PERMANENT LIFESTYLE CHANGES, SUCH AS MAKING HEALTHFUL FOOD CHOICES AND INCREASING PHYSICAL ACTIVITY, PROMOTE LONG-TERM WEIGHT LOSS.
(D) QUALIFICATIONS OF THIS PROVIDER ARE AVAILABLE UPON REQUEST.
(E) YOU HAVE A RIGHT TO:
1. ASK QUESTIONS ABOUT THE POTENTIAL HEALTH RISKS OF THIS PROGRAM AND ITS NUTRITIONAL CONTENT, PSYCHOLOGICAL SUPPORT, AND EDUCATIONAL COMPONENTS.
2. RECEIVE AN ITEMIZED STATEMENT OF THE ACTUAL OR ESTIMATED PRICE OF THE WEIGHT-LOSS PROGRAM, INCLUDING EXTRA PRODUCTS, SERVICES, SUPPLEMENTS, EXAMINATIONS, AND LABORATORY TESTS.
3. KNOW THE ACTUAL OR ESTIMATED DURATION OF THE PROGRAM.
4. KNOW THE NAME, ADDRESS, AND QUALIFICATIONS OF THE DIETITIAN OR NUTRITIONIST WHO HAS REVIEWED AND APPROVED THE WEIGHT-LOSS PROGRAM ACCORDING TO s. 468.505(1)(j), FLORIDA STATUTES.