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Important safety information

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Summarized from the FDA prescribing information for the brand products (Zepbound®/Mounjaro® — tirzepatide; Wegovy®/Ozempic® — semaglutide). Compounded versions are not FDA-approved and carry additional risks noted below. This summary is not complete and is not medical advice; the full prescribing information and your clinician govern.

Boxed warning — risk of thyroid C-cell tumors. In rodents, these medicines caused thyroid C-cell tumors; it is unknown whether they cause medullary thyroid carcinoma (MTC) in humans. Do not use with a personal or family history of MTC or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Tell your clinician about any neck mass, hoarseness, trouble swallowing, or shortness of breath.

Do not use if

You have a personal/family history of MTC or MEN 2; you are pregnant (weight-loss indications) or planning pregnancy without clinician guidance; or you have had a serious hypersensitivity reaction to the active ingredient.

Warnings and precautions

Acute pancreatitis (severe, persistent abdominal pain, sometimes radiating to the back, with or without vomiting — stop and seek care); gallbladder disease including cholelithiasis and cholecystitis; hypoglycemia, especially with insulin or sulfonylureas; acute kidney injury, usually secondary to dehydration from GI effects; diabetic retinopathy complications in people with type 2 diabetes (semaglutide); delayed gastric emptying affecting oral medication absorption and anesthesia (tell every clinician, including before procedures); severe GI disease; depression or suicidal ideation has been reported — seek help promptly for mood changes; ileus has been reported postmarketing.

Common adverse reactions

Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, injection-site reactions, fatigue — most common during titration and dose increases.

Compounded-specific risks

Compounded products are not FDA-reviewed; formulations, inactive ingredients (including added B12 or similar), and concentrations vary by pharmacy. Concentration differences and self-drawn syringes are a documented source of dosing errors — follow the pharmacy label exactly and never convert doses yourself. The FDA has also warned about semaglutide salt forms (sodium/acetate) it considers different active ingredients from the approved drug.

Report problems

Side effects: your clinician, and FDA MedWatch (fda.gov/medwatch or 1-800-FDA-1088). Suspected compounding quality issues can also be reported to your state board of pharmacy. In an emergency, call 911 — not a telehealth portal, and not this website.

[Editorial gate: have a licensed clinician review this page against the current prescribing information before launch — per our editorial policy, no "medically reviewed" badge appears until that genuinely happens.]