Medications Safety Information

Compounded Semaglutide Safety Information

Your medical provider may recommend compounded semaglutide based on a medical review. Compounded drugs are not FDA approved and are not evaluated for safety, effectiveness, or quality standards.This document is a summary of product information and does NOT have all possible information and potential side effects of the product. This is not medical advice and does not substitute advice from your health care provider.Compounded drugs are permitted to be prescribed under federal law but are not FDA-approved and do not undergo safety, effectiveness, or manufacturing review. Your provider may recommend certain doses of compounded semaglutide based on your medical evaluation

‍

Indications and Use:

Compounded semaglutide is an injectable prescription medicine that may help adults and adolescents with obesity and excess weight (overweight) - who may also have weight-related medical problems - lose weight and keep it off. It should be used with a reduced-calorie diet and increased physical activity.Compounded semaglutide is a synthetic glucagon-like peptide-1 (GLP-1) receptor agonist used for chronic weight management, along with a reduced calorie diet and increased physical activity, for people with an initial body mass index (BMI) of 27 kg/m2 or higher.Compounded semaglutide should not be used with other semaglutide-containing products or any other GLP-1/GIP receptor agonist medicines. It is not known if compounded semaglutide is safe and effective when taken with other prescription, over-the-counter, or herbal weight loss products. It is not known if compounded semaglutide can be used in people who have had pancreatitis. It is not known if compounded semaglutide is safe and effective for use in children under 18 years of age.

At lower (micro) doses, compounded semaglutide may also be beneficial for patients who:

• Have side effects at higher doses
• Would like to reduce cardiovascular disease risk
• Would like to reduce inflammation
• Would like to improve gastrointestinal conditions such as inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS)
• Would like to protect against Alzheimer’s or Parkinson’s disease
• Would like to reduce the use of alcohol or tobacco

‍

Important Safety Information for Compounded Tirzepatide Injection

Warning: Risk of Thyroid C-Cell Tumors

In studies with mice and rats, semaglutide caused thyroid tumors, including thyroid cancer. It is not known if compounded semaglutide will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.Do not use compounded semaglutide if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Limitations of Use:

Compounded semaglutide should not be used in combination with other semaglutide-containing products or any other GLP-1/GIP receptor agonist medicines.The safety and efficacy of coadministration with other products for weight loss have not been established.Compounded semaglutide has not been studied in patients with a history of pancreatitis.Note: Compounded medications are not FDA approved and do not have indications for treatment as an FDA approved medication would.

‍

Who should not use compounded semaglutide?

Do not use compounded semaglutide if:

You or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).You have a known allergic reaction to compounded semaglutide.

‍

How should compounded semaglutide be administered?

You can take compounded semaglutide with or without food. The pre-filled vial is self-administered with a needle and syringe as a subcutaneous injection in the stomach, thigh, or upper arm once a week on the same day every week. Your provider will guide you on a treatment regimen that may include an increase in dose every four weeks.You should not change your dosing regimen or stop taking compounded semaglutide as prescribed without discussing with your provider first.

‍

What should I tell my provider before using compounded semaglutide?

Compounded semaglutide has certain drug interactions. It’s important to tell your provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

‍

Some medications to watch out for include:

Medications used to treat type 1 or type 2 diabetes, including insulin or sulfonylureas (such as Amaryl or Glucotrol XL).Compounded semaglutide causes a delay in gastric emptying, so it has the potential to impact the absorption of medications that are taken by mouth at the same time. Your provider can guide you on how to schedule your medications.

Other GLP-/GIP medications, including Wegovy® (semaglutide), Ozempic® (semaglutide), Saxenda® (liraglutide), Zepbound® (tirzepatide), Mounjaro® (tirzepatide), Victoza® (liraglutide), Byetta® (exenatide), or Bydureon® (exenatide).If you’re using other products for weight loss, including dietary supplements.

‍

It’s important to share your entire medical history with your provider.

In particular, tell your provider if you have a past history of:

• Type 1 or type 2 diabetes
• Thyroid cancer
• Pancreatitis
• Kidney disease
• Diabetic retinopathy
• Depression
• Suicidal thoughts or behavior

‍

Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding.

If you are pregnant: Compounded semaglutide should not be used during pregnancy. Based on animal studies, there may be potential risks to an unborn baby from exposure to compounded semaglutide during pregnancy. There is no benefit to weight loss during pregnancy and it may cause harm to the unborn baby.

If you are a female or male of reproductive potential: Discontinue compounded semaglutide at least 2 months before a planned pregnancy since the drug can stay in the bloodstream for a long time.

If you are breastfeeding: Compounded semaglutide was found in the milk of lactating rats. Tell your provider if you are breastfeeding before you start compounded semaglutide. At this time, we do not recommend taking compounded semaglutide if you are breastfeeding or bottle-feeding with breastmilk.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

‍

What are the most serious side effects that I or a caregiver should monitor for when taking compounded semaglutide?

The most common side effects are typically mild and usually resolve after the first several weeks of treatment. These can include nausea, vomiting, diarrhea, constipation, abdominal pain, upset stomach, abdominal distension, reflux, headache, fatigue, and dizziness. Swelling, redness, and itchiness at the injection site may occur. The FDA has issued its most serious warning (called a BOXED WARNING)

that GLP-1s may be associated with a type of thyroid cancer called medullary thyroid carcinoma. So far, this side effect has primarily been seen in laboratory studies using rodents, so the risk to humans has not been determined.

‍

SIDE EFFECTS:

Nausea, vomiting, stomach upset, diarrhea, tiredness, dizziness, or constipation may occur. Nausea usually lessens as you continue to use semaglutide. If any of these effects last or get worse, tell your provider or pharmacist promptly. Remember that this medication has been prescribed because your provider has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Vomiting/diarrhea that doesn’t stop may result in dehydration. Contact your provider promptly if you notice any symptoms of dehydration, such as unusual dry mouth/thirst or dizziness/ lightheadedness. Tell your provider right away if you have any serious side effects, including: signs of kidney problems (such as change in the amount of urine), vision changes (such as decreased/blurred vision), fast heartbeat, mental/mood changes (such as depression, thoughts of suicide), signs of low blood sugar (sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, tingling hands/feet).

Get medical help right away if you have any very serious side effects, including: signs of pancreas or gallbladder disease (such as nausea/vomiting that doesn’t stop, severe stomach/abdominal pain). A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your provider or pharmacist.In the US -  Call your provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch

‍

WARNING:

This medication has been found to cause a certain type of thyroid tumor (thyroid C-cell tumors) in rats and mice. It is unknown if this medication can cause similar tumors in humans. Talk with your provider about the benefits and risks of treatment with this medication. This medication should not be used by

people with a personal/family history of a certain type of cancer (medullary thyroid carcinoma) or by people with a certain inherited disease (Multiple Endocrine Neoplasia syndrome type 2 or MEN 2). While using this medication, tell your provider right away if you notice any signs or symptoms of thyroid tumors, including unusual growth or lump in the neck, difficulty swallowing, shortness of breath, or unusual/lasting hoarseness.

‍

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

‍

These serious side effects can occur with compounded semaglutide. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

‍

Thyroid C-Cell Tumors: In mice and rats, semaglutide caused an increase in thyroid C-cell tumors, including medullary thyroid carcinoma (MTC). It is unknown whether compounded semaglutide causes thyroid C-cell tumors in humans. There were cases of MTC reported in patients who took liraglutide (the active ingredient in Victoza® and Saxenda®) after the drug was put on the market. Compounded semaglutide is contraindicated in patients with a family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.

‍

Inflammation of Pancreas (Acute Pancreatitis): Monitor for signs of acute pancreatitis, including severe abdominal pain that does not go away, sometimes radiating to the back, with or without vomiting.

‍

Acute Gallbladder Disease: Compounded semaglutide may cause gallbladder problems, including gallstones. Some gallbladder problems require surgery. Tell your provider right away if you have pain in your upper stomach, yellowing of skin or eyes (jaundice), fever, or clay-colored stools.

‍

Low Blood Sugar (Hypoglycemia): Compounded semaglutide may lower blood glucose. It can cause low blood sugar in patients with type 2 diabetes who also take another glucose control medication. 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.

‍

Acute Kidney Injury: In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration) which may cause kidney problems to get worse. It is important for you to drink plenty of water to help reduce your chance of dehydration.

‍

Serious Allergic Reactions: Stop using compounded semaglutide right away if you experience symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, severe rashor itching, very rapid heartbeat, problems breathing or swallowing, or fainting or feeling dizzy.

‍

Diabetic Retinopathy Complications in Patients with Type 2 Diabetes: If you have type 2 diabetes, tell your provider right away if you experience changes in vision.

‍

Increase in Heart Rate: Tell your provider right away if you have a racing heartbeat while at rest.Suicidal Behavior and Ideation: You should pay attention to any mental health changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.

‍

Never Share a Vial/Needle/Syringe: Sharing poses a risk of infection.

‍

Current/Recent Prescriptions

If you have any current/recent prescriptions for either compounded or brand name weight loss medications, do not take both medications. You will be asked to provide evidence of the current/recent prescription including dose specifics. Taking two or more GLP-1/GIP medications at the same time increases the risk of potentially serious side effects. Notify your provider immediately if you have any current or previous prescriptions for compounded or brand name weight loss medications.

‍

Medical History

Failure to fully disclose your medical history to your provider may result in serious side effects, includingdeath.

‍

Before using Compounded Semaglutide

Your healthcare provider will direct you to instructions on how to administer your GLP-1 therapy.

Tell your healthcare provider if you are taking medicines to treat diabetes including insulin or sulfonylureas which could increase your risk of low blood sugar. Talk to your healthcare provider about low blood sugar levels and how to manage them.

If you take birth control pills by mouth, talk to your healthcare provider before you use compounded semaglutide. Birth control pills may not work as well while using compounded semaglutide. Your healthcare provider may recommend another type of birth control for 4 weeks after you start compounded semaglutide and for 4 weeks after each increase in your dose of compounded semaglutide.

‍

Review these questions with your healthcare provider:

• Do you have other medical conditions, including problems with your pancreas or kidneys, or severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis)or problems digesting food?
• Do you take diabetes medicines, such as insulin or sulfonylureas?
• Do you have a history of diabetic retinopathy?
• Do you take any other prescription medicines or over-the-counter drugs, vitamins, or herbal supplements?
• Are you pregnant, plan to become pregnant, breastfeeding, or plan to breastfeed? Compounded semaglutide may harm your unborn baby. Tell your healthcare provider if you become pregnant while using compounded semaglutide. It is not known if compounded semaglutide passes into your breast milk. You should talk with your healthcare provider about the best way to feed your baby while using compounded semaglutide.

‍

How to take:

• Read the instructions that come with compounded semaglutide.
• Use compounded semaglutide exactly as your healthcare provider says.
• Compounded semaglutide is injected under the skin (subcutaneously) of your stomach (abdomen), thigh, or upper arm.
• Use compounded semaglutide 1 time each week on the same day every week.
• Change (rotate) your injection site with each weekly injection. Do not use the same site for each injection.
• If you take too much compounded semaglutide, call your healthcare provider, seek medical advice promptly, or contact a Poison Center expert right away at 1-800-222-1222

‍‍

Legal Disclaimers:

Compounded semaglutide is not approved by the FDA. The FDA does not evaluate compounded productsfor safety, effectiveness, or quality.

Zepbound and Mounjaro is a registered trademark of Eli Lilly and Company. Ozempic, Wegovy, Saxenda, and Victoza are registered trademarks of Novo Nordisk A/S. Byetta and Bydureon are registeredtrademarks of Amylin Pharmaceuticals, Inc.

Compound Tirzepatide Safety Information

Your medical provider may recommend compounded tirzepatide based on a medical review. Compounded drugs are not FDA approved and are not evaluated for safety, effectiveness,or quality standards.This document is a summary of product information and does NOT have all possible information and potential side effects of the product. This is not medical advice and does not substitute advice from your health care provider.Compounded drugs are permitted to be prescribed under federal law but are not FDA-approved and do not undergo safety, effectiveness, or manufacturing review. Your provider may recommend certain doses of compounded tirzepatide based on your medical evaluation.

‍

Indications and Use:

Compounded tirzepatide is an injectable prescription medicine that may help adults and adolescents with obesity and excess weight (overweight) - who may also have weight-related medical problems - lose weight and keep it off. It should be used with a reduced-calorie diet and increased physical activity. Compounded tirzepatide is a synthetic glucagon-like peptide-1 (GLP-1) receptor agonist used for chronic weight management, along with a reduced calorie diet and increased physical activity, for people with an initial body mass index (BMI) of 27 kg/m2 or higher.

Compounded tirzepatide should not be used with other tirzepatide-containing products or any other GLP-1/GIP receptor agonist medicines. It is not known if compounded tirzepatide is safe and effective when taken with other prescription, over-the-counter, or herbal weight loss products. It is not known if compounded tirzepatide can be used in people who have had pancreatitis. It is not known if compounded tirzepatide is safe and effective for use in children under 18 years of age.

At lower (micro) doses, compounded tirzepatide may also be beneficial for patients who:

• Have side effects at higher doses
• Would like to reduce cardiovascular disease risk
• Would like to reduce inflammation
• Would like to improve gastrointestinal conditions such as inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS)
• Would like to protect against Alzheimer’s or Parkinson’s disease
• Would like to reduce the use of alcohol or tobacco

‍

Important Safety Information for Compounded Tirzepatide Injection

Warning: Risk of Thyroid C-Cell Tumors

In studies with mice and rats, tirzepatide caused thyroid tumors, including thyroid cancer. It is not known if compounded tirzepatide will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.Do not use compounded tirzepatide if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

‍

Limitations of Use:

Compounded tirzepatide should not be used in combination with other tirzepatide-containing products or any other GLP-1/GIP receptor agonist medicines.

The safety and efficacy of coadministration with other products for weight loss have not been established.

Compounded tirzepatide has not been studied in patients with a history of pancreatitis.

Note: Compounded medications are not FDA approved and do not have indications for treatment as an FDA approved medication would.

‍

Who should not use compounded tirzepatide?

Do not use compounded tirzepatide if:

You or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).You have a known allergic reaction to compounded tirzepatide.

‍

How should compounded tirzepatide be administered?

You can take compounded tirzepatide with or without food. The pre-filled vial is self-administered with a needle and syringe as a subcutaneous injection in the stomach, thigh, or upper arm once a week on the same day every week. Your provider will guide you on a treatment regimen that may include an increase in dose every four weeks.

You should not change your dosing regimen or stop taking compounded tirzepatide as prescribed without discussing with your provider first.

‍

What should I tell my provider before using compounded tirzepatide?

Compounded tirzepatide has certain drug interactions. It’s important to tell your provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

‍

Some medications to watch out for include:

Medications used to treat type 1 or type 2 diabetes, including insulin or sulfonylureas (such as Amaryl or Glucotrol XL).Compounded tirzepatide causes a delay in gastric emptying, so it has the potential to impact the absorption of medications that are taken by mouth at the same time. Your provider can guide you on how to schedule your medications.

Other GLP-/GIP medications, including Wegovy® (tirzepatide), Ozempic® (tirzepatide), Saxenda® (liraglutide), Zepbound® (tirzepatide), Mounjaro® (tirzepatide), Victoza® (liraglutide), Byetta® (exenatide), or Bydureon® (exenatide).If you’re using other products for weight loss, including dietary supplements.

‍

It’s important to share your entire medical history with your provider.

In particular, tell your provider if you have a past history of:

• Type 1 or type 2 diabetes
• Thyroid cancer
• Pancreatitis
• Kidney disease
• Diabetic retinopathy
• Depression
• Suicidal thoughts or behavior

‍

Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding.

If you are pregnant: Compounded tirzepatide should not be used during pregnancy. Based on animal studies, there may be potential risks to an unborn baby from exposure to compounded tirzepatide during pregnancy. There is no benefit to weight loss during pregnancy and it may cause harm to the unborn baby.

If you are a female or male of reproductive potential: Discontinue compounded tirzepatide at least 2 months before a planned pregnancy since the drug can stay in the bloodstream for a long time.

If you are breastfeeding: Compounded tirzepatide was found in the milk of lactating rats. Tell your provider if you are breastfeeding before you start compounded tirzepatide. At this time, we do not recommend taking compounded tirzepatide if you are breastfeeding or bottle-feeding with breastmilk.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

‍

What are the most serious side effects that I or a caregiver should monitor for when taking compounded tirzepatide?

The most common side effects are typically mild and usually resolve after the first several weeks of treatment. These can include nausea, vomiting, diarrhea, constipation, abdominal pain, upset stomach, abdominal distension, reflux, headache, fatigue, and dizziness. Swelling, redness, and itchiness at the injection site may occur. The FDA has issued its most serious warning (called a BOXED WARNING)

that GLP-1s may be associated with a type of thyroid cancer called medullary thyroid carcinoma. So far, this side effect has primarily been seen in laboratory studies using rodents, so the risk to humans has not been determined.

‍

SIDE EFFECTS:

Nausea, vomiting, stomach upset, diarrhea, tiredness, dizziness, or constipation may occur. Nausea usually lessens as you continue to use tirzepatide. If any of these effects last or get worse, tell your provider or pharmacist promptly. Remember that this medication has been prescribed because your provider has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Vomiting/diarrhea that doesn’t stop may result in dehydration. Contact your provider promptly if you notice any symptoms of dehydration, such as unusual dry mouth/thirst or dizziness/ lightheadedness. Tell your provider right away if you have any serious side effects, including: signs of kidney problems (such as change in the amount of urine), vision changes (such as decreased/blurred vision), fast heartbeat, mental/mood changes (such as depression, thoughts of suicide), signs of low blood sugar (sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, tingling hands/feet).

Get medical help right away if you have any very serious side effects, including: signs of pancreas or gallbladder disease (such as nausea/vomiting that doesn’t stop, severe stomach/abdominal pain). A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your provider or pharmacist.

In the US -  Call your provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch

‍

WARNING:

This medication has been found to cause a certain type of thyroid tumor (thyroid C-cell tumors) in rats and mice. It is unknown if this medication can cause similar tumors in humans. Talk with your provider about the benefits and risks of treatment with this medication. This medication should not be used by

people with a personal/family history of a certain type of cancer (medullary thyroid carcinoma) or by people with a certain inherited disease (Multiple Endocrine Neoplasia syndrome type 2 or MEN 2). While using this medication, tell your provider right away if you notice any signs or symptoms of thyroid tumors, including unusual growth or lump in the neck, difficulty swallowing, shortness of breath, or unusual/lasting hoarseness

‍

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

‍

These serious side effects can occur with compounded semaglutide. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

‍

Thyroid C-Cell Tumors: In mice and rats, tirzepatide caused an increase in thyroid C-cell tumors, including medullary thyroid carcinoma (MTC). It is unknown whether compounded tirzepatide causes thyroid C-cell tumors in humans. There were cases of MTC reported in patients who took liraglutide (the active ingredient in Victoza® and Saxenda®) after the drug was put on the market. Compounded tirzepatide is contraindicated in patients with a family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.

‍

Inflammation of Pancreas (Acute Pancreatitis): Monitor for signs of acute pancreatitis, including severe abdominal pain that does not go away, sometimes radiating to the back, with or without vomiting.

‍

Acute Gallbladder Disease: Compounded tirzepatide may cause gallbladder problems, including gallstones. Some gallbladder problems require surgery. Tell your provider right away if you have pain in your upper stomach, yellowing of skin or eyes (jaundice), fever, or clay-colored stools.

‍

Low Blood Sugar (Hypoglycemia): Compounded tirzepatide may lower blood glucose. It can cause low blood sugar in patients with type 2 diabetes who also take another glucose control medication. 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.

‍

Acute Kidney Injury: In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration) which may cause kidney problems to get worse. It is important for you to drink plenty of water to help reduce your chance of dehydration.

‍

Serious Allergic Reactions: Stop using compounded tirzepatide 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.

‍

Diabetic Retinopathy Complications in Patients with Type 2 Diabetes: If you have type 2 diabetes, tell your provider right away if you experience changes in vision.

‍

Increase in Heart Rate: Tell your provider right away if you have a racing heartbeat while at rest.

‍

Suicidal Behavior and Ideation: You should pay attention to any mental health changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.

‍

Never Share a Vial/Needle/Syringe: Sharing poses a risk of infection.

‍

Current/Recent Prescriptions

If you have any current/recent prescriptions for either compounded or brand name weight loss medications, do not take both medications. You will be asked to provide evidence of the current/recent prescription including dose specifics. Taking two or more GLP-1/GIP medications at the same time increases the risk of potentially serious side effects. Notify your provider immediately if you have any current or previous prescriptions for compounded or brand name weight loss medications.

‍

Medical History

Failure to fully disclose your medical history to your provider may result in serious side effects, including death.

‍

Before using Compounded Tirzepatide

Your healthcare provider will direct you to instructions on how to administer your GLP-1 therapy.

Tell your healthcare provider if you are taking medicines to treat diabetes including insulin or sulfonylureas which could increase your risk of low blood sugar. Talk to your healthcare provider about low blood sugar levels and how to manage them.

If you take birth control pills by mouth, talk to your healthcare provider before you use compounded tirzepatide. Birth control pills may not work as well while using compounded tirzepatide. Your healthcareprovider may recommend another type of birth control for 4 weeks after you start compounded tirzepatideand for 4 weeks after each increase in your dose of compounded tirzepatide.

‍

Review these questions with your healthcare provider:

• Do you have other medical conditions, including problems with your pancreas or kidneys, or severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis)or problems digesting food?
• Do you take diabetes medicines, such as insulin or sulfonylureas?
• Do you have a history of diabetic retinopathy?
• Do you take any other prescription medicines or over-the-counter drugs, vitamins, or herbal supplements?
• Are you pregnant, plan to become pregnant, breastfeeding, or plan to breastfeed? Compounded tirzepatide may harm your unborn baby. Tell your healthcare provider if you become pregnant while using compounded tirzepatide. It is not known if compounded tirzepatide passes into your breast milk. You should talk with your healthcare provider about the best way to feed your baby while using compounded tirzepatide.

‍

How to take:

• Read the instructions that come with compounded tirzepatide.
• Use compounded tirzepatide exactly as your healthcare provider says.
• Compounded tirzepatide is injected under the skin (subcutaneously) of your stomach (abdomen), thigh, or upper arm.
• Use compounded tirzepatide 1 time each week on the same day every week.
• Change (rotate) your injection site with each weekly injection. Do not use the same site for each injection.
• If you take too much compounded tirzepatide, call your healthcare provider, seek medical advice promptly, or contact a Poison Center expert right away at 1-800-222-1222.

Depending on your specific situation, your maintenance dose could be lower than 15 mg once a week.

Follow the dosing instructions from your provider, as they may personalize your plan for your individual needs.

Oral forms of compounded tirzepatide are typically dosed between 3-6 mg daily.

For micro-dosing purposes, compounded tirzepatide dosing starts at 1.25 mg once or twice weekly. Orally micro-dosed compounded tirzepatide is typically at 1.5 mg daily

‍‍

Legal Disclaimers:

Compounded tirzepatide is not approved by the FDA. The FDA does not evaluate compounded products for safety, effectiveness, or quality. Zepbound and Mounjaro is a registered trademark of Eli Lilly and Company. Ozempic, Wegovy, Saxenda, and Victoza are registered trademarks of Novo Nordisk A/S. Byetta and Bydureon are registeredtrademarks of Amylin Pharmaceuticals, Inc.

Zepbound® (tirzepatide) Safety Information

Important Safety Information for Zepbound® (tirzepatide) injection
Warning: Risk of Thyroid C-Cell Tumors

In rats, Zepbound® (tirzepatide) caused thyroid tumors, including thyroid cancer. It is not known if Zepbound® (tirzepatide) will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
Do not use Zepbound® (tirzepatide) if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

‍

What is the FDA-approved use of Zepbound® (tirzepatide)?

Zepbound® (tirzepatide) is used along with a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of:

• 30 kg/m^2 or greater (obesity) or
• 27 kg/m^2 or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, dyslipidemia, type 2 diabetes mellitus, obstructive sleep apnea, or cardiovascular disease).

‍

Limitations of use:

• Zepbound® (tirzepatide) should not be used in combination with other tirzepatide-containing products or any other GLP-1 receptor agonist.
• The safety and efficacy of coadministration with other products for weight management have not been established.
• Zepbound® (tirzepatide) has not been studied in patients with a history of pancreatitis.

‍

Who should not use Zepbound® (tirzepatide)?

Do not use Zepbound® (tirzepatide) if:

• You or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
• You have a known allergic reaction to Zepbound® (tirzepatide).

‍

How should I take Zepbound® (tirzepatide)?

You can take Zepbound® with or without food. The pre-filled injector pen is self-administered as a subcutaneous injection in the stomach, thigh, or upper arm once a week on the same day every week. Your Fridays provider will guide you on a treatment regimen that may include an increase in dose every four weeks.
You should not change your dosing regimven or stop taking Zepbound® (tirzepatide) as prescribed without discussing with your provider first.

‍

What should I tell my Fridays provider before using Zepbound® (tirzepatide)?

Zepbound® (tirzepatide) has certain drug interactions.It’s important to tell your Fridays provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

Some medications to watch out for include:

• Medications for diabetes:Medications used to treat type 1 or type 2 diabetes, including insulin or sulfonylureas (such as Amaryl or Glucotrol XL)
• Other oral medications: Zepbound® (tirzepatide) causes a delay in gastric emptying, so it has the potential to impact the absorption of medications that are taken by mouth at the same time. Your provider can guide you on how to schedule your medications.
  • Hormonal birth control:If you are using an oral hormonal contraceptive (birth control), Zepbound® (tirzepatide) may decrease its efficacy, especially after the first dose. Switch to a non-oral contraceptive method or use a barrier method of contraception for 4 weeks after starting Zepbound® (tirzepatide) and for 4 weeks after each dose escalation, until you reach a maintenance dose.
• Other GLP-1 medications, including WeGovy® (semaglutide), Ozempic® (semaglutide), Saxenda® (liraglutide), Zepbound® (tirzepatide), Mounjaro® (tirzepatide), Victoza® (liraglutide), Byetta® (exenatide), or Bydureon® (exenatide).
• Other products for weight loss:Including dietary supplements
• It’s important to share your entire medical history with your provider.In particular, tell your provider if you have a past history of:
  • Type 1 or type 2 diabetes
  • Thyroid cancer
  • Gastrointestinal disease
  • Pancreatitis
  • Kidney disease
  • Diabetic retinopathy
  • Depression
  • Suicidal thoughts or behavior
• Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding.
  • If you are pregnant: Zepbound® (tirzepatide) should not be used during pregnancy. Based on animal studies, there may be potential risks to an unborn baby from exposure to Zepbound® (tirzepatide) during pregnancy. There is no benefit to weight loss during pregnancy and it may cause harm to the unborn baby.
  • If you are a female reproductive potential:Zepbound® (tirzepatide) may reduce the efficacy of oral hormonal contraceptives. Switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after starting medication and for 4 weeks after each dose escalation until you reach a maintenance dose.
  • If you are breastfeeding: It is not known if Zepbound® (tirzepatide) passes into breast milk. Talk to your provider first about the benefits and risks of using Zepbound® (tirzepatide) while breastfeeding.
• Pregnancy registry:There will be a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to Zepbound® (tirzepatide) during pregnancy. Pregnant patients exposed to Zepbound® (tirzepatide) and healthcare providers are encouraged to contact Eli Lilly and Company at 1-800-LillyRx (1-800-545-5979).

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

‍

What are the most serious side effects that I or a caregiver should monitor for when taking Zepbound® (tirzepatide)?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with Zepbound® (tirzepatide). You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

• Thyroid C-Cell Tumors: In rats, Zepbound® (tirzepatide) caused a dose-dependent and treatment-duration-dependent increase in thyroid C-cell tumors. It is unknown whether Zepbound® (tirzepatide) causes thyroid C-cell tumors in humans. Zepbound® (tirzepatide) is contraindicated in patients with a family history of medullary thyroid cancer (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
• Severe Gastrointestinal Disease: Zepbound® (tirzepatide) is associated with gastrointestinal side effects, such as nausea, diarrhea, vomiting, constipation, and stomach pain, and can sometimes be severe. It hasn’t been studied in patients with severe gastrointestinal disease and isn’t recommended in these patients. The majority of nausea, vomiting, and/or diarrhea events occurred during a dose increase and decreased over time.
• Acute Kidney Injury: Gastrointestinal side effects of Zepbound® (tirzepatide) like diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems if dehydration is severe. It is important for you to drink plenty of water to help reduce your chance of dehydration.
• Acute Gallbladder Disease: Zepbound® (tirzepatide), other GLP-1 receptor agonists, and weight loss are associated with an increased chance of acute gallbladder disease. Tell your provider right away if you have pain in your upper stomach, yellowing of skin or eyes (jaundice), fever, or clay-colored stools.
• Inflammation of Pancreas (Acute Pancreatitis): Monitor for signs of acute pancreatitis, including severe abdominal pain that does not go away, sometimes radiating to the back, with or without vomiting.
• Allergic Reactions: Stop using Zepbound® (tirzepatide) 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.
• Low Blood Sugar (Hypoglycemia): Zepbound® (tirzepatide) lowers blood glucose. It can cause too low blood sugar in patients with type 2 diabetes who also take another glucose control medication. 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.
• Diabetic Retinopathy Complications in Patients with a History of Diabetic Retinopathy: Rapid improvement of glucose control has been associated with temporary worsening of diabetic retinopathy. Tell your provider right away if you experience changes in vision.
• Suicidal Behavior and Ideation: You should pay attention to any mental health changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.
• Never Share a Pen: Pen-sharing poses a risk of infection.

‍

What are the most common side effects of Zepbound® (tirzepatide)?

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Stomach pain
• Indigestion
• Injection site reactions
• Feeling tired
• Allergic reactions
• Belching
• Hair loss
• Gastroesophageal reflux disease (heartburn)

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Disclaimer: Ozempic®, WeGovy®,  Saxenda® and Victoza® are registered trademarks of Novo Nordisk.  Zepbound® and Mounjaro® are registered trademarks of Eli Lilly.  Fridays Health has no affiliation with Novo Nordiskor Eli Lilly .  The compounded products available as part of Fridays Health’s Weight Loss Program are not made by Novo Nordiskor Eli Lilly  or any company affiliated with Novo Nordisk or Eli Lilly .

Wegovy® (Semaglutide) Safety Information

Warning: Risk of Thyroid C-Cell Tumors

• In studies with mice and rats, semaglutide (the active ingredient in Wegovy® and Ozempic®) caused thyroid tumors, including thyroid cancer. It is not known if Wegovy® (semaglutide) will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
• Do not use Wegovy® (semaglutide) if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

‍

What is the FDA-approved use of Wegovy® (semaglutide)?

Wegovy® (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist for chronic weight management, along with a reduced calorie diet and increased physical activity, for people with an initial body mass index (BMI) of:

• 30 kg/m2 or greater (obesity) or
• 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia).

‍

Limitations of use:

• Wegovy® (semaglutide) should not be used in combination with other semaglutide-containing products or any other GLP-1 receptor agonist
• The safety and efficacy of coadministration with other products for weight loss have not been established
• Wegovy® (semaglutide) has not been studied in patients with a history of pancreatitis

‍

Who should not use Wegovy® (semaglutide)?

Do not use Wegovy® (semaglutide) if:

• You or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
• You have a known allergic reaction to semaglutide (the active ingredient in Wegovy® or Ozempic).

‍

How should Wegovy® (semaglutide) be administered?

You can take Wegovy® (semaglutide) with or without food. The pre-filled injector pen is self-administered as a subcutaneous injection in the stomach, thigh, or upper arm once a week on the same day every week. Your Fridays provider will guide you on a treatment regimen that may include an increase in dose every four weeks.
You should not change your dosing regimen or stop taking Wegovy® (semaglutide) as prescribed without discussing with your provider first.

‍

What should I tell my Fridays provider before using Wegovy® (semaglutide)?

Wegovy® (semaglutide) has certain drug interactions. It’s important to tell your Fridays provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

Some medications to watch out for include:

• Medications used to treat type 1 or type 2 diabetes, including insulin or sulfonylureas (such as Amaryl or Glucotrol XL)
• Wegovy® (semaglutide) causes a delay in gastric emptying, so it has the potential to impact the absorption of medications that are taken by mouth at the same time. Your provider can guide you on how to schedule your medications.
• Other GLP-1 medications, including WeGovy® (semaglutide), Ozempic® (semaglutide), Saxenda® (liraglutide), Zepbound® (tirzepatide), Mounjaro® (tirzepatide), Victoza® (liraglutide), Byetta® (exenatide), or Bydureon® (exenatide).
• If you’re using other products for weight loss, including dietary supplements

It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:

• Type 1 or type 2 diabetes
• Thyroid cancer
• Pancreatitis
• Kidney disease
• Diabetic retinopathy
• Depression
• Suicidal thoughts or behavior

Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding.

• If you are pregnant: Wegovy® (semaglutide) should not be used during pregnancy. Based on animal studies, there may be potential risks to an unborn baby from exposure to Wegovy® (semaglutide) during pregnancy. There is no benefit to weight loss during pregnancy and it may cause harm to the unborn baby.
• If you are a female or male of reproductive potential:Discontinue Wegovy® (semaglutide) at least 2 months before a planned pregnancy since the drug can stay in the bloodstream for a long time.
• If you are breastfeeding: Wegovy® (semaglutide) was found in the milk of lactating rats. Tell your Fridays provider if you are breastfeeding before you start Wegovy® (semaglutide).

Pregnancy registry: There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to semaglutide (the active ingredient in Wegovy® and Ozempic®) during pregnancy. Pregnant women exposed to these products and healthcare providers are encouraged to contact Novo Nordisk at 1-800-727-6500.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

‍

What are the most serious side effects that I or a caregiver should monitor for when taking Wegovy® (semaglutide)?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects can occur with Wegovy® (semaglutide). You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

• Thyroid C-Cell Tumors:In mice and rats, semaglutide (the active ingredient in Wegovy® and Ozempic®) caused an increase in thyroid C-cell tumors, including medullary thyroid carcinoma (MTC). It is unknown whether Wegovy® (semaglutide)  causes thyroid C-cell tumors in humans. There were cases of MTC reported in patients who took liraglutide (the active ingredient in Victoza® and Saxenda®) after the drug was put on the market. Wegovy® (semaglutide) is contraindicated in patients with a family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
• Inflammation of Pancreas (Acute Pancreatitis): Monitor for signs of acute pancreatitis, including severe abdominal pain that does not go away, sometimes radiating to the back, with or without vomiting.
• Acute Gallbladder Disease:Wegovy® (semaglutide) may cause gallbladder problems, including gallstones. Some gallbladder problems require surgery. Tell your provider right away if you have pain in your upper stomach, yellowing of skin or eyes (jaundice), fever, or clay-colored stools.
• Low Blood Sugar (hypoglycemia): Wegovy® (semaglutide) lowers blood glucose. It can cause too low blood sugar in patients with type 2 diabetes who also take another glucose control medication. 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.
• Acute Kidney Injury: In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration) which may cause kidney problems to get worse. It is important for you to drink plenty of water to help reduce your chance of dehydration.
• Serious Allergic Reactions: Stop using Wegovy® (semaglutide) 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.
• Diabetic Retinopathy Complications in Patients with Type 2 Diabetes: If you have type 2 diabetes, tell your provider right away if you experience changes in vision.
• Increase in Heart Rate: Tell your provider right away if you have a racing heartbeat while at rest.
• Suicidal Behavior and Ideation:You should pay attention to any mental health changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.
• Never Share a Pen: Pen-sharing poses a risk of infection.

‍

What are the most common side effects of Wegovy® (semaglutide)?

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Abdominal pain
• Headache
• Fatigue
• Dyspepsia
• Dizzyness
• Abdominal distension
• Eructation
• Hypoglycemia in patients with type 2 diabetes
• Flatulence
• Gastroenteritis
• Gastroesophageal reflux disease

You are encouraged to report negative side effects of prescription products:

• Contact Novo Nordisk Inc. at 1-833-934-6891
• Contact FDA MedWatch at 1-800-FDA-1088 or visit fda.gov/medwatch

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Disclaimer: Ozempic®, WeGovy® and Saxenda® are registered trademarks of Novo Nordisk.  Zepbound® and Mounjaro® are registered trademarks of Eli Lilly.  Fridays Health has no affiliation with Novo Nordiskor Eli Lilly .  The compounded products available as part of Fridays Health’s Weight Loss Program are not made by Novo Nordiskor Eli Lilly  or any company affiliated with Novo Nordiskor Eli Lilly .

Mounjaro® (tirzepatide) Safety Information

Important Safety Information for Mounjaro® (tirzepatide) injection

Warning: Risk of Thyroid C-Cell Tumors

Mounjaro® (tirzepatide) injection may cause tumors in the thyroid, including thyroid cancer. Watch for possible symptoms, such as a lump or swelling in the neck, hoarseness, trouble swallowing, or shortness of breath. If you have any of these symptoms, tell your healthcare provider.

• Do not use Mounjaro® (tirzepatide) injection if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC).
• Do not use Mounjaro® (tirzepatide) injection if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

‍

What is the FDA-approved use of Mounjaro® (tirzepatide) injection?

Mounjaro® (tirzepatide) injection (mown-JAHR-OH) is an injectable medicine for adults with type 2 diabetes used along with diet and exercise to improve blood sugar (glucose).

‍

Limitations of use:

It is not known if Mounjaro® (tirzepatide) injection can be used in people who have had inflammation of the pancreas (pancreatitis). Mounjaro® (tirzepatide) injection is not for use in people with type 1 diabetes. It is not known if Mounjaro® (tirzepatide) injection is safe and effective for use in children under 18 years of age.

‍

Who should not use Mounjaro® (tirzepatide) injection?

Do not use Mounjaro® (tirzepatide) injection if:

• You or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC) or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
• You have a known allergic reaction to Mounjaro® (tirzepatide) injection.

‍

How should I take Mounjaro® (tirzepatide) injection?

You can take Mounjaro® (tirzepatide) injection with or without food. The pre-filled injector pen is self-administered as a subcutaneous injection in the stomach, thigh, or upper arm once a week on the same day every week.  You should change your injection site each week.  Do not use the same site for each injection. Your Fridays provider will guide you on a treatment regimen that may include an increase in dose every four weeks.

You should not change your dosing regimen or stop taking Mounjaro® (tirzepatide) injection as prescribed without discussing with your provider first.  If you take too much Mounjaro® (tirzepatide) injection, call your healthcare provider or seek medical advice promptly.

‍

What should I discuss with my Fridays provider before using Mounjaro®?

• Mounjaro® (tirzepatide) injection has certain drug interactions.It’s important to tell your Fridays provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.
• Your healthcare provider should show you how to use Mounjaro® (tirzepatide) injection before you use it for the first time.
• Talk to your healthcare provider about low blood sugar and how to manage it.
• If you take birth control pills by mouth, talk to your healthcare provider before you use Mounjaro® (tirzepatide) injection. Birth control pills may not work as well while using Mounjaro® (tirzepatide) injection. Your healthcare provider may recommend another type of birth control for 4 weeks after you start Mounjaro® (tirzepatide) injection and for 4 weeks after each increase in your dose of Mounjaro® (tirzepatide) injection.

Some medications to watch out for include:

• Medications for diabetes: Medications used to treat type 1 or type 2 diabetes, including insulin or sulfonylureas (such as Amaryl or Glucotrol XL)
• Other oral medications: Mounjaro® (tirzepatide) injection causes a delay in gastric emptying, so it has the potential to impact the absorption of medications that are taken by mouth at the same ti Your provider can guide you on how to schedule your medications.
• Hormonal birth control:If you are using an oral hormonal contraceptive (birth control), Mounjaro® (tirzepatide) injection may decrease its efficacy, especially after the first dose. Switch to a non-oral contraceptive method or use a barrier method of contraception for 4 weeks after starting Mounjaro® (tirzepatide) injection and for 4 weeks after each dose escalation, until you reach a maintenance dose.
• Other GLP-1 medications: Including Zepbound® (tirzepatide) injection, Wegovy® (semaglutide), Ozempic® (semaglutide), Saxenda® (liguratide), Victoza® (liguratide), Byetta® (Exenatide), Bydureon ® (Exenatide), or compounded GLP-1 formularies. These medications should not be taken with Mounjaro® (tirzepatide) injection.
• Other products for weight loss: Including dietary supplements
• It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
• Type 1 or type 2 diabetes
• Thyroid cancer
• Gastrointestinal disease
• Pancreatitis
• Kidney disease
• Diabetic retinopathy
• Depression
• Suicidal thoughts or behavior
• Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. 
• If you are pregnant: Mounjaro® (tirzepatide) injection should not be used during pregnancy. Based on animal studies, there may be potential risks to an unborn baby from exposure to Mounjaro® (tirzepatide) injection during pregnancy. There is no benefit to weight loss during pregnancy and it may cause harm to the unborn baby.
• If you are a female reproductive potential:Mounjaro® (tirzepatide) injection may reduce the efficacy of oral hormonal contraceptives. Switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after starting medication and for 4 weeks after each dose escalation until you reach a maintenance dose.
• If you are breastfeeding:It is not known if Mounjaro® (tirzepatide) injection passes into breast milk. Talk to your provider first about the benefits and risks of using Mounjaro® (tirzepatide) injection while breastfeeding.
• Pregnancy registry:There will be a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to Mounjaro® (tirzepatide) injection during pregnancy. Pregnant patients exposed to Mounjaro® (tirzepatide) injection and healthcare providers are encouraged to contact Eli Lilly and Company at 1-800-LillyRx (1-800-545-5979).

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

‍

What are the most serious side effects that I or a caregiver should monitor for when taking Mounjaro® (tirzepatide) injection?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.
These serious side effects are rare, but can occur with Mounjaro® (tirzepatide) injection. You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

• Thyroid C-Cell Tumors: In rats, Mounjaro® (tirzepatide) injection caused a dose-dependent and treatment-duration-dependent increase in thyroid C-cell tumors. It is unknown whether Mounjaro® causes thyroid C-cell tumors in humans. Mounjaro® (tirzepatide) injection is contraindicated in patients with a family history of medullary thyroid cancer (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
• Severe Gastrointestinal Disease: Mounjaro® (tirzepatide) injection is associated with gastrointestinal side effects, such as nausea, diarrhea, vomiting, constipation, and stomach pain, and can sometimes be severe. It hasn’t been studied in patients with severe gastrointestinal disease and isn’t recommended in these patients. The majority of nausea, vomiting, and/or diarrhea events occurred during a dose increase and decreased over time.
• Inflammation of the pancreas (pancreatitis). Stop using Mounjaro® (tirzepatide) injection and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.
• Low blood sugar (hypoglycemia).Your risk for getting low blood sugar may be higher if you use Mounjaro® (tirzepatide) injection with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include dizziness or light-headedness, sweating, confusion or drowsiness, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability, or mood changes, hunger, weakness and feeling jittery.
• Serious allergic reactions.Stop using Mounjaro® (tirzepatide) injection and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, and very rapid heartbeat.
• Kidney problems (kidney failure). In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration.
• Severe stomach problems.Stomach problems, sometimes severe, have been reported in people who use Mounjaro® (tirzepatide) injection. Tell your healthcare provider if you have stomach problems that are severe or will not go away.
• Changes in vision.Tell your healthcare provider if you have changes in vision during treatment with Mounjaro® (tirzepatide) injection.
• Gallbladder problems.Gallbladder problems have happened in some people who use Mounjaro® (tirzepatide) injection. Tell your healthcare provider right away if you get symptoms of gallbladder problems, which may include pain in your upper stomach (abdomen), fever, yellowing of skin or eyes (jaundice), and clay-colored stools.
• Diabetic Retinopathy Complications in Patients with a History of Diabetic Retinopathy: Rapid improvement of glucose control has been associated with temporary worsening of diabetic retinopathy. Tell your provider right away if you experience changes in vision.
• Suicidal Behavior and Ideation: You should pay attention to any mental health changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.
• Never Share a Pen: Pen-sharing poses a risk of infection.

‍

What are the most common side effects of Mounjaro® (tirzepatide) injection?

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Stomach pain
• Indigestion
• Injection site reactions
• Feeling tired
• Allergic reactions
• Belching
• Hair loss
• Gastroesophageal reflux disease (heartburn)

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Disclaimer: Ozempic®, WeGovy® and Saxenda® are registered trademarks of Novo Nordisk.  Zepbound® and Mounjaro® are registered trademarks of Eli Lilly. Fridays Health has no affiliation with Novo Nordiskor Eli Lilly .  The compounded products available as part of Fridays Health’s Weight Loss Program are not made by Novo Nordiskor Eli Lilly  or any company affiliated with Novo Nordiskor Eli Lilly .

Ozempic® (semaglutide) Safety Information

Important Safety Information for Ozempic® (semaglutide) injection

Warning: Risk of Thyroid C-Cell Tumors

Ozempic® (semaglutide) may cause serious side effects, including: Possible thyroid tumors, including cancer. Tell your health care provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Ozempic®  (semaglutide) and medicines that work like Ozempic®  (semaglutide) caused thyroid tumors, including thyroid cancer. It is not known if Ozempic®  (semaglutide) will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.

Do not use Ozempic®  (semaglutide) if you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

‍

What is the FDA-approved use of Ozempic® (semaglutide)?

Ozempic® (semaglutide) injection 0.5 mg, 1 mg, or 2 mg is an injectable prescription medicine used:

• along with diet and exercise to improve blood sugar (glucose) in adults with type 2 diabetes.
• to reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes with known heart disease.

‍

Limitations of use:

It is not known if Ozempic® (semaglutide) can be used in people who have had pancreatitis. Ozempic® (semaglutide) is not for use in people with type 1 diabetes. It is not known if Ozempic® (semaglutide) is safe and effective for use in children under 18 years of age.

‍

Who should not use Ozempic® (semaglutide)?

Do not use Ozempic® (semaglutide) if:

• you or any of your family have ever had MTC or if you have MEN 2.
• you are allergic to semaglutide or any of the ingredients in Ozempic®. See symptoms of serious allergic reaction in “What are the possible side effects of Ozempic®?”.

‍

How should I take Ozempic® (semaglutide)?

You can take Ozempic® (semaglutide) with or without food. The pre-filled injector pen is self-administered as a subcutaneous injection in the stomach, thigh, or upper arm once a week on the same day every week.  You should change your injection site each week.  Do not use the same site for each injection. Your Fridays provider will guide you on a treatment regimen that may include an increase in dose every four weeks.

You should not change your dosing regimen or stop taking Ozempic® (semaglutide) as prescribed without discussing with your provider first.  If you take too much Ozempic® (semaglutide), call your healthcare provider or seek medical advice promptly.

‍

What should I discuss with my Fridays provider before using Ozempic® (semaglutide)?

• Your healthcare provider should show you how to use Mounjaro® (tirzepatide) injection before you use it for the first time.
• Talk to your healthcare provider about low blood sugar and how to manage it.
• If you take birth control pills by mouth, talk to your healthcare provider before you use Ozempic® (semaglutide) injection. Birth control pills may not work as well while using Ozempic® (semaglutide) injection. Your healthcare provider may recommend another type of birth control for 4 weeks after you start Ozempic® (semaglutide) injection and for 4 weeks after each increase in your dose of Ozempic® (semaglutide) injection.

• Ozempic® (semaglutide) injection has certain drug interactions.It’s important to tell your Fridays provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements.

Some medications to watch out for include:

• Medications for diabetes: Other medications used to treat type 1 or type 2 diabetes, including insulin or sulfonylureas (such as Amaryl or Glucotrol XL)
• Other oral medications: Ozempic® (semaglutide) causes a delay in gastric emptying, so it has the potential to impact the absorption of medications that are taken by mouth at the same time. Your provider can guide you on how to schedule your medications.
• Hormonal birth control: Other GLP-1 medications have been shown to potentially decrease the efficacy of oral birth control pills.  If you are using an oral hormonal contraceptive (birth control), Ozempic® (semaglutide) may decrease its efficacy, especially after the first dose. Switch to a non-oral contraceptive method or use a barrier method of contraception for 4 weeks after starting Ozempic® (semaglutide) and for 4 weeks after each dose escalation, until you reach a maintenance dose.
• Other GLP-1 medications:Including Zepbound® (tirzepatide), Mounjaro® (tirzepatide), Wegovy® (semaglutide), Saxenda® (liraglutide), Victoza® (liraglutide), Byetta® (exenatide), Bydureon® (exenatide), or compound GLP-1 formularies. These medications should not be taken with Ozempic® (semaglutide).
• Other products for weight loss: Including dietary supplements
• It’s important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
• Type 1 or type 2 diabetes
• Thyroid cancer
• Gastrointestinal disease
• Pancreatitis
• Kidney disease
• Diabetic retinopathy
• Depression
• Suicidal thoughts or behavior
• Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. 
• If you are pregnant: Ozempic® (semaglutide) should not be used during pregnancy. Based on animal studies, there may be potential risks to an unborn baby from exposure to Ozempic® (semaglutide) during pregnancy. There is no benefit to weight loss during pregnancy and it may cause harm to the unborn baby.
• If you are a female reproductive potential:Ozempic® (semaglutide) may reduce the efficacy of oral hormonal contraceptives. Switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after starting medication and for 4 weeks after each dose escalation until you reach a maintenance dose.
• If you are breastfeeding: It is not known if Ozempic® (semaglutide) passes into breast milk. Talk to your provider first about the benefits and risks of using Ozempic® (semaglutide) while breastfeeding.

Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.

‍

What are the most serious side effects that I or a caregiver should monitor for when taking Ozempic® (semaglutide)?

If you are experiencing a medical emergency, call 911 or seek immediate medical attention.

These serious side effects are rare, but can occur with Ozempic® (semaglutide). You or a caregiver should carefully monitor for these side effects, especially in the beginning of treatment and with dose changes.

• Thyroid C-Cell Tumors: In rats, Ozempic® (semaglutide) caused a dose-dependent and treatment-duration-dependent increase in thyroid C-cell tumors. It is unknown whether Ozempic® (semaglutide) causes thyroid C-cell tumors in humans. Ozempic® (semaglutide) is contraindicated in patients with a family history of medullary thyroid cancer (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Tell your provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer.
• Severe Gastrointestinal Disease: Ozempic® (semaglutide) is associated with gastrointestinal side effects, such as nausea, diarrhea, vomiting, constipation, and stomach pain, and can sometimes be severe. It hasn’t been studied in patients with severe gastrointestinal disease and isn’t recommended in these patients. The majority of nausea, vomiting, and/or diarrhea events occurred during a dose increase and decreased over time.
• Inflammation of your pancreas (pancreatitis): Stop using Ozempic® (semaglutide) and call your health care provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.
• Low blood sugar (hypoglycemia): Your risk for getting low blood sugar may be higher if you use Ozempic® (semaglutide) with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include: dizziness or lightheadedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, and feeling jittery.
• Kidney problems (kidney failure): In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration.
• Serious allergic reactions: Stop using Ozempic® (semaglutide) and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat.
• Gallbladder problems: Gallbladder problems have happened in some people who take Ozempic® (semaglutide). Tell your health care provider right away if you get symptoms which may include: pain in your upper stomach (abdomen), fever, yellowing of the skin or eyes (jaundice), or clay-colored stools.
• Severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use Ozempic® (semaglutide). Tell your healthcare provider if you have stomach problems that are severe or will not go away.
• Changes in vision. Tell your healthcare provider if you have changes in vision during treatment with Ozempic® (semaglutide).
• Diabetic Retinopathy Complications in Patients with a History of Diabetic Retinopathy: Rapid improvement of glucose control has been associated with temporary worsening of diabetic retinopathy. Tell your provider right away if you experience changes in vision.
• Suicidal Behavior and Ideation: You should pay attention to any mental health changes, especially sudden changes in your mood, behaviors, thoughts, or feelings. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.
• Never Share a Pen: Pen-sharing poses a risk of infection.

‍

What are the most common side effects of Ozempic® (semaglutide)?

• Nausea
• Diarrhea
• Vomiting
• Constipation
• Stomach pain
• Indigestion
• Injection site reactions
• Feeling tired
• Allergic reactions
• Belching
• Hair loss
• Gastroesophageal reflux disease (heartburn)

You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

This information is not comprehensive. Please see the full Prescribing Information for complete safety information.

Disclaimer: Ozempic®, WeGovy®, Saxenda® and Victoza® are registered trademarks of Novo Nordisk. Zepbound® and Mounjaro® are registered trademarks of Eli Lilly. Fridays Health has no affiliation with Novo Nordiskor Eli Lilly . The compounded products available as part of Fridays Health’s Weight Loss Program are not made by Novo Nordiskor Eli Lilly or any company affiliated with Novo Nordiskor Eli Lilly .

NAD+ STAT RX — Drug Information

Your prescriber has ordered this compounded medication based on your individual medical needs.

Compounded Drug Forms: Sublingual Solution

‍Medication Description:

• NAD+ – Visually clear homogenous golden liquid solution (dosage will vary per your prescription)

What is NAD+ (Nicotinamide Adenine Dinucleotide)?

NAD+ is an essential coenzyme in the body that plays a crucial role in energy production, DNA repair, and cellular health. It acts as a coenzyme for many enzymes and is central to metabolic processes, with levels declining with age.

What should I tell my health care provider before I take this medicine?

Before taking your medication, make sure your doctor knows about any of the following health conditions: Cancer or a family history of cancer; Liver or kidney disease; Diabetes/Metabolic disorders; Cardiovascular conditions; Mental health conditions; Allergies (to NAD+ or vitamin B3); Pregnancy or breastfeeding; Inflammatory disorders; Endocrine or thyroid tumors. Tell your doctor about all your current medication especially: Insulin and Blood Sugar-Lowering Medications; Blood Pressure Medications; Blood Thinners (Anticoagulants); Cancer Treatments; Antidepressants; Antioxidants.

How should I use this medicine?

Follow the package directions provided by the pharmacy and by your prescriber. Your dosage is based on your medical condition and response to therapy. Follow the dosing schedule provided carefully. Sublingual solutions should be taken as indicated by your healthcare provider. See recommended administration guide for further instruction.

• Prepare for dose: Before use, swirl the container well to ensure the medication is evenly mixed.
• Administer sublingually: Place the prescribed amount, located on your prescription label, of the liquid solution under your tongue.
• Do not swallow immediately: Hold the solution under your tongue for as long as possible, typically 1 minute, to allow it to be absorbed through the blood vessels. Avoid swallowing your saliva during this time.
• The sublingual (under the tongue) delivery allows the medication to be absorbed directly into the bloodstream, bypassing the digestive system. This results in a faster onset of action than traditional oral tablets, often within 15–30 minutes.
• Do not eat, drink, or smoke while the medication is dissolving or for at least 5 minutes afterward.
• Do not brush your teeth immediately before or after medication use.

What if I miss a dose?

• If you miss a dose within 4 hours of the scheduled dose, administer it as soon as possible.
• If more than 4 hours have passed since the missed dose, skip the missed dose, and continue with your regular dosing schedule.
• Do not take double the dose at once, and do not exceed one dose in 24 hours.

What common side effects may I notice from receiving this medicine?

Side effects that may occur and may go away as your body gets used to the medication include:

• Nausea, diarrhea, or other digestive issues.
• Headaches.
• Flushing (a warm, tingling, or itching feeling under the skin).
• Dizziness.
• Fatigue, or in some cases difficulty sleeping.
• Mild increases in heart rate.

What serious side effects prompt immediate attention?

Contact your doctor immediately or seek medical attention if you experience:

• Allergic Reactions: Symptoms such as hives, rash, facial or throat swelling, difficulty breathing, or rapid heartbeat warrant immediate medical care.
• Liver Issues: High doses and long-term use may stress the liver, potentially leading to elevated liver enzymes or, in rare cases, liver toxicity/damage.
• Blood Pressure Changes: Significant drops or spikes in blood pressure can occur, especially if you are taking blood pressure medications.
• Persistent or Severe Symptoms: Ongoing nausea, vomiting, or severe, frequent headaches beyond the initial adjustment phase may signal intolerance or excessive dosing.
• Blood Cell Count Changes: In some studies, low platelet counts (thrombocytopenia) have been reported.
• Cancer Concerns: Some animal studies have suggested that high doses of certain NAD precursors might be linked to tumor progression in specific cancers, though this has not been confirmed in humans. Individuals with a history of cancer should use caution and consult a doctor.

Seek medical attention if an allergic reaction occurs. Symptoms of an allergic reaction include rash, itching, swelling, severe dizziness, and/or trouble breathing.

What should I watch for while using this medicine?

• Signs of allergic reaction: Difficulty breathing, swelling of the face or throat, widespread hives, or a rapid heart rate.
• Signs of liver problems: Yellowing of the skin or eyes (jaundice), dark urine, or significant abdominal pain.
• Major changes in blood pressure or sudden dizziness/lightheadedness when standing up quickly.
• Persistent or severe symptoms: Nausea, vomiting, or headaches that last for more than a few days or are unusually intense.
• Elevated liver enzymes noted on a blood test (requires regular monitoring if on long-term supplementation).
• Other medical conditions: Inform your doctor if you have cancer, cardiovascular, kidney, liver issues or other medical conditions, as dosage adjustments or closer monitoring may be necessary.
• Drug interactions: This medication can interact with many other drugs. Make sure your doctor and pharmacist are aware of all your current medications, including over-the-counter drugs and supplements.

v. 1Contraindications or require Caution: individuals who are pregnant or breastfeeding, have a history of cancer, or have pre-existing liver or kidney conditions. They also have significant interactions with certain medications.

What may interact with this medicine?

Medications

• Blood Sugar-Lowering Medications (e.g., insulin, metformin): NAD supplements can affect glucose metabolism and alter insulin sensitivity, potentially making these medications less effective or requiring dose adjustments.
• Blood Pressure-Lowering Medications (Antihypertensives): High doses of NAD supplements might reduce blood pressure, which, combined with antihypertensive drugs, could cause blood pressure to drop too low (hypotension).
• Blood Thinners (Anticoagulants, e.g., warfarin): Some forms of NAD precursors (like niacin) may affect how the body metabolizes blood thinners, potentially increasing the risk of bleeding. Close monitoring of the International Normalized Ratio (INR), or blood clotting test, may be necessary if combined.
• Cancer Treatments (Chemotherapy): Because cancer cells can use NAD+ to fuel their growth and increase treatment resistance, NAD supplements are generally not recommended for people undergoing cancer treatment. Some cancer medications work by reducing NAD+ levels, and the supplements could interfere with their effectiveness.
• Antidepressants: Antidepressants may affect how some NAD+ precursors are produced in the body, which could reduce the effectiveness of the NAD supplements or the medication itself.
• Statins and other lipid-lowering medications: The nicotinic acid form of NAD supplements may increase the risk of side effects when combined with statins.

Other Supplements

• Antioxidants (e.g., resveratrol, quercetin, Coenzyme Q10): These supplements can also increase NAD+ levels in the body. Combining them with NAD supplements can amplify the effects, but also potentially increase side effects like hot flashes, nausea, or headaches.
• Melatonin: Both melatonin and NAD supplements can affect the body's circadian rhythm (sleep-wake cycle). Taking them together, especially at night, may amplify sleepiness and grogginess.
• Other NAD precursors (e.g., NMN, NR, Niacinamide): Combining different precursors may have unpredictable effects on NAD+ levels and side effects due to the different metabolic pathways involved.
• This is not a complete list of all possible interactions. Always inform your doctor and pharmacist of all medications, supplements, and herbal products you take, especially before starting or stopping any new medication.

Additional Information:

• Store medication at room temperature and protect from light.
• Do not share this medication with others to whom it was not prescribed.
• Keep out of reach of children and pets.
• Do not use after Beyond Use Date.
• If an overdose is suspected contact your local poison control center at 1-800-222-1222 or go to the nearest emergency room.
• Do not flush down the toilet or pour down a drain. Check with your pharmacist if you have questions about the best way to dispose of medications. There may be a drug take-back program in your area.

If you have any questions concerning this or any of your medications, a pharmacist is available during normal business hours to answer your questions. You can report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medication or any other medication. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does not include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. For questions about the source of any of the information provided herein, pharmacists at Pharmacy are available. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of this medicine.  

Important: Compounded medications are not evaluated or approved by the FDA for safety, efficacy, or quality.  

‍

NAD Injection - DRUG INFORMATION

Your prescriber has ordered this compounded medication based on your individual medical needs

Compounded Drug Forms: Injectable Solution

Medication Description:

• NAD+ Injection 100mg/mL – Clear liquid solution

What is NAD+ (Nicotinamide Adenine Dinucleotide)?

NAD+ is an essential coenzyme in the body that plays a crucial role in energy production, DNA repair, and cellular health. It acts as a coenzyme for many enzymes and is central to metabolic processes, with levels declining with age.

What should I tell my health care provider before I take this medicine?

Before taking your medication, make sure your doctor knows about any of the following health conditions: Cancer or a family history of cancer; Liver or kidney disease; Diabetes/Metabolic disorders; Cardiovascular conditions; Mental health conditions; Allergies (to NAD+ or vitamin B3); Pregnancy or breastfeeding; Inflammatory disorders; Endocrine or thyroid tumors.

Tell your doctor about all your current medication especially: Insulin and Blood Sugar-Lowering Medications; Blood Pressure Medications; Blood Thinners (Anticoagulants); Cancer Treatments; Antidepressants; Antioxidants.

How should I use this medicine?

Follow the package directions provided by the pharmacy and by your prescriber. Your dosage is based on your medical condition and response to therapy. Follow the dosing schedule provided carefully. Injections should be taken as indicated by your healthcare provider. See recommended administration guide for further instruction.

• Visually inspect the vial, making sure not to use it if it’s cloudy or contains any particulates.
• Let the vial warm to room temperature before injecting.
• Wash your hands and clean the injection site with an alcohol swab.
• Wipe the rubber stopper on top of vial with an alcohol wipe. Draw the correct dose into the syringe from your NAD+ vial.
• Pinch the skin at your chosen injection site, making sure to rotate injection sites.
• Insert the needle at a 90-degree angle for subcutaneous injections.
• Inject slowly and steadily, then remove the needle.
• Dispose of all used needles and syringes immediately in an FDA-cleared sharps container. Visit safeneedledisposal.org to find a drop-off location.

What if I miss a dose?

• If you miss a dose within 4 hours of the scheduled dose, administer it as soon as possible.
• If more than 4 hours have passed since the missed dose, skip the missed dose, and continue with your regular dosing schedule.
• Do not exceed one dose in 24 hours, take as prescribed.

What common side effects may I notice from receiving this medicine?

Side effects that may occur and may go away as your body gets used to the medication include:

• Nausea, diarrhea, or other digestive issues.
• Headaches.
• Flushing (a warm, tingling, or itching feeling under the skin).
• Dizziness.
• Fatigue, or in some cases difficulty sleeping.
• Mild increases in heart rate.

What serious side effects prompt immediate attention?

Contact your doctor immediately or seek medical attention if you experience:

• Allergic Reactions: Symptoms such as hives, rash, facial or throat swelling, difficulty breathing, or rapid heartbeat warrant immediate medical care.
• Liver Issues: High doses and long-term use may stress the liver, potentially leading to elevated liver enzymes or, in rare cases, liver toxicity/damage.
• Blood Pressure Changes: Significant drops or spikes in blood pressure can occur, especially if you are taking blood pressure medications.
• Persistent or Severe Symptoms: Ongoing nausea, vomiting, or severe, frequent headaches beyond the initial adjustment phase may signal intolerance or excessive dosing.
• Blood Cell Count Changes: In some studies, low platelet counts (thrombocytopenia) have been reported.
• Cancer Concerns: Some animal studies have suggested that high doses of certain NAD precursors might be linked to tumor progression in specific cancers, though this has not been confirmed in humans. Individuals with a history of cancer should use caution and consult a doctor.

Seek medical attention if an allergic reaction occurs. Symptoms of an allergic reaction include rash, itching, swelling, severe dizziness, and/or trouble breathing.v. 1

What should I watch for while using this medicine?

• Signs of allergic reaction: Difficulty breathing, swelling of the face or throat, widespread hives, or a rapid heart rate.
• Signs of liver problems: Yellowing of the skin or eyes (jaundice), dark urine, or significant abdominal pain.
• Major changes in blood pressure: or sudden dizziness/lightheadedness when standing up quickly.
• Persistent or severe symptoms: Nausea, vomiting, or headaches that last for more than a few days or are unusually intense.
• Elevated liver enzymes: noted on a blood test (requires regular monitoring if on long-term supplementation).
• Other medical conditions: Inform your doctor if you have cancer, cardiovascular, kidney, liver issues or other medical conditions, as dosage adjustments or closer monitoring may be necessary.
• Drug interactions: This medication can interact with many other drugs. Make sure your doctor and pharmacist are aware of all your current medications, including over-the-counter drugs and supplements.

Contraindications or require Caution: individuals who are pregnant or breastfeeding, have a history of cancer, or have pre-existing liver or kidney conditions. They also have significant interactions with certain medications.

What may interact with this medicine?

• Medications
  • Blood Sugar-Lowering Medications (e.g., insulin, metformin): NAD supplements can affect glucose metabolism and alter insulin sensitivity, potentially making these medications less effective or requiring dose adjustments.
  • Blood Pressure-Lowering Medications (Antihypertensives): High doses of NAD supplements might reduce blood pressure, which, combined with antihypertensive drugs, could cause blood pressure to drop too low (hypotension).
  • Blood Thinners (Anticoagulants, e.g., warfarin): Some forms of NAD precursors (like niacin) may affect how the body metabolizes blood thinners, potentially increasing the risk of bleeding. Close monitoring of the International Normalized Ratio (INR) may be necessary if combined.
  • Cancer Treatments (Chemotherapy): Because cancer cells can use NAD+ to fuel their growth and increase treatment resistance, NAD supplements are generally not recommended for people undergoing cancer treatment. Some cancer medications work by reducing NAD+ levels, and the supplements could interfere with their effectiveness.
  • Antidepressants: Antidepressants may affect how some NAD+ precursors are produced in the body, which could reduce the effectiveness of the NAD supplements or the medication itself.
  • Statins and other lipid-lowering medications: The nicotinic acid form of NAD supplements may increase the risk of side effects when combined with statins.
• Other Supplements
  • Antioxidants (e.g., resveratrol, quercetin, Coenzyme Q10): These supplements can also increase NAD+ levels in the body. Combining them with NAD supplements can amplify the effects, but also potentially increase side effects like hot flashes, nausea, or headaches.
  • Melatonin: Both melatonin and NAD supplements can affect the body's circadian rhythm (sleep-wake cycle). Taking them together, especially at night, may amplify sleepiness and grogginess.
  • Other NAD precursors (e.g., NMN, NR, Niacinamide): Combining different precursors may have unpredictable effects on NAD+ levels and side effects due to the different metabolic pathways involved.
• This is not a complete list of all possible interactions. Always inform your doctor and pharmacist of all medications, supplements, and herbal products you take, especially before starting or stopping any new medication.

Additional Information:

• Store compounded NAD+ injections under refrigeration and keep protected from light.
• Do not share this medication with others to whom it was not prescribed.
• Keep out of reach of children and pets.
• Do not use after Beyond Use Date. Discard remainder of vial 28 days after first puncture.
• If an overdose is suspected contact your local poison control center at 1-800-222-1222 or go to the nearest emergency room.
• Do not flush down the toilet or pour down a drain. Check with your pharmacist if you have questions about the best way to dispose of medications. There may be a drug take-back program in your area.

If you have any questions concerning this or any of your medications, a pharmacist is available during normal business hours to answer your questions. You can report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.  

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medication or any other medication. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does not include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. For questions about the source of any of the information provided herein, pharmacists at Pharmacy are available. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of this medicine.  

Important: Compounded medications are not evaluated or approved by the FDA for safety, efficacy, or quality.  

‍

SEMAGLUTIDE - DRUG INFORMATION

Your prescriber has ordered this compounded medication based on your individual medical needs

Drug Forms: Compounded Sublingual Solution and Manufactured Tablets

‍Medication Description:

• Semaglutide compounded Sublingual Solution - Clear golden liquid (dosage will vary per your prescription)
• Ozempic 1.5mg, 4mg, 9mg and 25mg Tablets – White round tablet with the dose imprinted on one side.

What is Semaglutide? Semaglutide (Pronunciation: sem a GLOO tide) is a glucagon-like peptide-1 (GLP-1) receptor agonist.

FDA black box warning for thyroid C-cell tumor risk

What should I tell my health care provider before I take this medicine?

• Allergy to Semaglutide or any of the additives
• History of medullary thyroid cancer or other thyroid C-cell cancer
• History of pancreatitis
• History of tachyarrhythmias
• History of depression, suicidal thoughts or actions
• History of diabetic retinopathy
• Upcoming surgery or medical procedure
• Pregnant, planning on becoming pregnant or breastfeeding

How should I use this medicine?

Follow the package directions provided by the pharmacy and by your prescriber. Your dosage is based on your medical condition and response to therapy.

Follow the dosing schedule provided carefully. Sublingual solutions and ODTs should be taken as indicated by your healthcare provider. See recommended administration guide for further instruction.

• For Sublingual Solution — Prepare the dose, place the drops under the tongue for 1 minute. After holding the liquid under your tongue, you can swallow any remaining solution. Make sure to properly discard the empty top and vial once dose is administered.
• For Tablets – Wake up and take the tablet with a sip of water (up to 4 oz) on an empty stomach. Wait at least 30 minutes before eating, drinking, or taking other oral medications. DO NOT SPLIT, CRUSH, or CHEW THE TABLET.
• Do not eat, drink, or smoke while the medication is dissolving or for at least 5 minutes afterward.
• Do not brush your teeth immediately before or after medication use.

What if I miss a dose?

• If a dose is missed, skip the missed dose and take the next dose the following day.
• Do not take double the dose at once.

What should I watch for while using this medicine?

• Signs of an allergic reaction: hives, blistering, swelling of the mouth, face, lips tongue throat, trouble breathing.
• Signs of new or worsening depression, suicidal thoughts, or unusual changes in mood or behavior
• Blood levels monitored for B12, and CBC are advised before treatment and ongoing as your prescriber deems necessary.
• Regular check-ups with your provider are recommended.

What may interact with this medicine?

• Due to the nature of the medication, Semaglutide may slow gastric emptying. This could interfere with the breakdown of other medications.
• Anesthesia while on GLP-1 therapy
• Consult your provider before any medical procedure
• Drug interactions exist with this medication.
• Discuss your medication regimen with your health care provider to determine the best therapy for you

What side effects may I notice from receiving this medicine?

Side effects that may occur and may go away as your body gets used to the medication include:

• Gastrointestinal issues, such as:
  • Abdominal pain or stomach upset
  • Constipation or diarrhea
  • Nausea or vomiting
  • Indigestion (dyspepsia)
  • Headache
  • Fatigue
  • Dizziness

What serious side effects prompt immediate attention?

Contact your doctor immediately or seek medical attention if you experience:

• A lump or swelling in the neck (possible sign of thyroid tumor
• Trouble breathing or swallowing
• Vocal hoarseness that will not go away
• Kidney problems or urinary complications
• Gallbladder problems
• Eyesight changes
• Severe dizziness
• Signs of low blood sugar
• Pancreas problems
• Worsening behavioral or mood changes like depression or thoughts of self-harm  
• Rapid heartbeat  

You may experience side effects not listed. Contact your doctor with questions. An allergic reaction to this medication is unlikely but seek medical attention if it occurs. Symptoms of an allergic reaction include rash, itching, swelling, severe dizziness, and/or trouble breathing.  

Contraindications: Hypersensitivity to Semaglutide, or any component of the formulation. Semaglutide is contraindicated in patients with a personal or family history of medullary thyroid cancer (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).  

Additional Information:

• Store medication at room temperature and protect from light.  
• Do not share this medication with others to whom it was not prescribed.
• Keep out of reach of children and pets.
• Do not use after expiration date or Beyond Use Date.
• If an overdose is suspected contact your local poison control center at 1-800-222-1222 or go to the nearest emergency room.
• Do not flush down a toilet or pour down a drain. Check with your pharmacist if you have questions about the best way to dispose of medications. There may be a drug take-back program in your area.

If you have any questions concerning this or any of your medications, a pharmacist is available during normal business hours to answer your questions.You can report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medication or any other medication. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does not include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. For questions about the source of any of the information provided herein, pharmacists at Pharmacy are available. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of this medicine.  

Important: Compounded medications are not evaluated or approved by the FDA for safety, efficacy, or quality.

1. How to take a tablet

Always start by washing your hands thoroughly to prevent the spread of germs and make sure your hands are thoroughly dry before handling medication.

Place the tablet in your mouth and swallow whole with a sip of water (up to 4 oz) on an empty stomach. Wait at least 30 minutes before eating, drinking, or taking other oral medications. DO NOT SPLIT, CRUSH, or CHEW THE TABLET.

2. How to take an oral sublingual solution

Always start by washing your hands thoroughly to prevent the spread of germs. Prepare the dose for administration. Keep the liquid under your tongue for a specific period of time, typically 1 minute. This allows for proper absorption into the bloodstream through the tissue under the tongue. After holding the liquid under your tongue for the instructed time, you can swallow any remaining solution. To ensure optimal absorption, avoid eating, drinking or smoking for approximately 5 minutes. Make sure to properly discard the empty top and vial once dose is administered.  

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SERMORELIN Injection - DRUG INFORMATION

Your prescriber has ordered this compounded medication based on your individual medical needs

Compounded Drug Forms: Injectable Solution

Medication Description:

• Sermorelin Injection 0.9mg/mL – Clear liquid solution

What is Sermorelin?

Sermoreline is a synthetic peptide that stimulates the body's pituitary gland to produce and secrete its own natural growth hormone (GH).

What should I tell my health care provider before I take this medicine?

Before taking your medication, make sure your doctor knows about any of the following health conditions:

• Thyroid conditions, especially untreated hypothyroidism, which must be managed before starting treatment.
• Cancer or tumors (active or history of), as sermorelin may promote cell growth.
• Diabetes (Type 1 or Type 2) or any history of blood sugar problems.
• Brain or pituitary gland disorders, including tumors or any previous head/brain injury or surgery.
• Autoimmune diseases.
• If you are pregnant, planning to become pregnant, or breastfeeding
• Allergies to any medicines, foods, dyes, or preservatives, particularly to sermorelin or any of its ingredients.

How should I use this medicine?

Follow the package directions provided by the pharmacy and by your prescriber. Your dosage is based on your medical condition and response to therapy. Follow the dosing schedule provided carefully. Injections should be taken as indicated by your healthcare provider. See recommended administration guide for further instruction.

• Visually inspect the vial, making sure not to use it if it’s cloudy or contains any particulates.
• Let the vial warm to room temperature before injecting.
• Injections are typically administered once daily in the evening, right before bedtime, to align with the body's natural GH production cycle.
• Wash your hands and clean the injection site with an alcohol swab.
• Wipe the rubber stopper on top of vial with an alcohol wipe.
• Draw the correct dose into the syringe from your vial.
• Pinch the skin at your chosen injection site.
• Insert the needle at a 90-degree angle for subcutaneous injections.
• Inject slowly and steadily, then remove the needle.
• Dispose of all used needles and syringes immediately in an FDA-cleared sharps container. Visit safeneedledisposal.org to find a drop-off location.
• Common injection sites include the lower abdomen (at least two inches from the navel), the outer area of the upper arm, or the front of the thigh. Rotate injection sites daily to prevent irritation, redness, or the formation of lumps.

What if I miss a dose?

• If you miss a dose within 4 hours of the scheduled dose, administer it as soon as possible.
• If more than 4 hours have passed since the missed dose, skip the missed dose, and continue with your regular dosing schedule.
• Do not take double the dose at once, take as prescribed.

What should I watch for while using this medicine?

• Signs of allergic reaction: Difficulty breathing, swelling of the face or throat, widespread hives, or a rapid heart rate.
• Persistent or severe symptoms: Nausea, vomiting, or headaches that last for more than a few days or are unusually intense.
• Other medical conditions: Inform your doctor if you have cancer, cardiovascular, kidney, liver issues or other medical conditions, as dosage adjustments or closer monitoring may be necessary.
• Drug interactions: This medication can interact with many other drugs. Make sure your doctor and pharmacist are aware of all your current medications, including over-the-counter drugs and supplements.

What common side effects may I notice from receiving this medicine?

Side effects that may occur and may go away as your body gets used to the medication include:

• Injection site reactions (pain, redness, swelling, irritation)
• Warmth or flushing of the face
• Headache
• Nausea

What serious side effects prompt immediate attention?

Contact your doctor immediately or seek medical attention if you experience:

• Allergic Reactions: Symptoms such as hives, rash, facial or throat swelling, difficulty breathing, or rapid heartbeat warrant immediate medical care.
• Fluid retention (edema): Swelling in the hands, feet, or limbs.
• Joint pain or stiffness: Often in the knees or ankles, spine/back pain.
• Nerve pain: Including symptoms similar to carpal tunnel syndrome (numbness or tingling in the hands/wrists).
• Increased intracranial pressure: Very rare, symptoms can include severe headaches and visual disturbances.
• Insulin resistance: Sermorelin can affect how the body processes glucose, increasing the risk of developing diabetes with chronic use.
• Potential to exacerbate existing cancer: Sermorelin is generally contraindicated in patients with active cancers or a history of certain hormone-sensitive malignancies, as growth hormone can theoretically promote cell proliferation.

Seek medical attention if an allergic reaction occurs. Symptoms of an allergic reaction include rash, itching, swelling, severe dizziness, and/or trouble breathing.

What may interact with this medicine?

• Medications
  • Other growth hormone medications or sermorelin-like products.
  • Insulin or other diabetes medications.
  • Thyroid medications (e.g., propylthiouracil, levothyroxine).
  • Steroid medications/Glucocorticoids (e.g., prednisone, dexamethasone).
  • Anti-inflammatory drugs such as high-dose aspirin, indomethacin (Cyclooxygenase inhibitors)
  • Certain blood pressure and neurological medications, including clonidine and levodopa — discuss with your provider (Somatostatin-containing medicines)
• Other Supplements
  • Growth Hormone Boosters: Supplements such as arginine, GABA, and melatonin are sometimes used to raise growth hormone levels. Combining these with sermorelin could potentially increase the risk of side effects like joint pain or swelling due to excessively high growth hormone activity.
  • Minerals (Calcium, Zinc) & Fiber: The absorption of some oral medications, like levothyroxine (which interacts with sermorelin), can be affected by minerals such as calcium and dietary fiber, so timing of administration may be important.
  • Vitamin D: Co-administration with Vitamin D analogs (like Vitamin D3) may require caution in patients with or predisposed to cardiac arrhythmias due to potential changes in serum calcium concentrations.
  • L-Carnitine and CoQ10: These are listed as potential interactions on some drug checkers, though specific mechanisms for concern beyond general caution require professional consultation.

This is not a complete list of all possible interactions. Always inform your doctor and pharmacist of all medications, supplements, and herbal products you take, especially before starting or stopping any new medication.

Contraindications or require Caution:

individuals who are pregnant or breastfeeding, active malignancy (cancer), untreated hypothyroidism, intracranial lesions/tumors, and acute critical illness. They also have significant interactions with certain medications.

Additional Information:

• Store reconstituted Sermorelin injections under refrigeration and keep protected from light. Stable at room temperature for 7 days.
• Do not share this medication with others to whom it was not prescribed.
• Keep out of reach of children and pets.
• Do not use after Beyond Use Date. Discard remainder of vial 28 days after first puncture.
• If an overdose is suspected contact your local poison control center at 1-800-222-1222 or go to the nearest emergency room.
• Do not flush down the toilet or pour down a drain. Check with your pharmacist if you have questions about the best way to dispose of medications. There may be a drug take-back program in your area.

If you have any questions concerning this or any of your medications, a pharmacist is available during normal business hours to answer your questions. You can report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medication or any other medication. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does not include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. For questions about the source of any of the information provided herein, pharmacists at Pharmacy are available. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of this medicine.  

Important: Compounded medications are not evaluated or approved by the FDA for safety, efficacy, or quality.  

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B12 and MIC Injectable - DRUG INFORMATION

Your prescriber has ordered this compounded medication based on your individual medical needs.

‍Medication Description:

• B12, Methionine, Inositol and Choline injectable compound in an amber vial (dosage will vary per your prescription)

Compounded Drug Forms: Subcutaneous injection

What is B12?
‍Vitamin B12 is essential for energy production and helps keep your metabolism running efficiently.

What is MIC?
‍The "MIC" stands for Methionine, Inositol, and Choline, which are essential nutrients.

What should I tell my health care provider before I take this medicine?

Liver or kidney disease; Diabetes or metabolic disorders; Cardiovascular conditions; Cobalamin (B12) or sulfonamide allergy; Leber’s disease or other optic nerve conditions; Pregnancy or breastfeeding; Polycythemia vera; Hypokalemia (low potassium); History of cancer. Tell your doctor about all your current medications, especially: Metformin (may reduce B12 absorption); Proton pump inhibitors or H2 blockers; Chloramphenicol; Anticoagulants (blood thinners); Any injectable medications.

How should I use this medicine?

Follow the package directions provided by the pharmacy and by your prescriber. Your dosage is based on your medical condition and response to therapy. Follow the dosing schedule provided carefully. Injectable medications should be given subcutaneously or intramuscularly as directed by your healthcare provider. See recommended administration guide for further instruction.  

What if I miss a dose?

• If you miss a dose within 3 days of the scheduled weekly dose, administer it as soon as possible.  

• If more than 3 days have passed since the missed dose, skip the missed dose, and continue with your regular dosing schedule.  

• Do not take double the dose at once.

What should I watch for while using this medicine?

• Signs of allergic reaction: Difficulty breathing, swelling of the face or throat, widespread hives, or a rapid heart rate.
• Signs of infection at the injection site: Increasing redness, warmth, swelling, or discharge.
• Low potassium signs: Muscle weakness, cramps, or irregular heartbeat — particularly important in patients on diuretics.
• Neurological changes: New or worsening numbness, tingling, or weakness.
• Persistent or severe symptoms: Nausea, vomiting, or headaches that last more than a few days or are unusually intense.

What side effects may I notice from receiving this medicine?

Side effects that may occur and may go away as your body gets used to the medication include:

• Mild pain, redness, swelling, or itching at the injection site.
• Nausea or mild digestive upset.
• Headache.
• Mild flushing (warm or tingling sensation under the skin).
• Dizziness or lightheadedness.
• Fatigue or, rarely, sleep disturbance.

What serious side effects prompt immediate attention?

Contact your doctor immediately or seek medical attention if you experience:

• Allergic Reactions: Symptoms such as hives, rash, facial or throat swelling, difficulty breathing, or rapid heartbeat warrant immediate medical care.
• Severe Injection Site Reaction: Increasing pain, warmth, pus, or spreading redness may indicate infection.
• Neurological Symptoms: Numbness, tingling, or weakness not related to the injection site.
• Low potassium (hypokalemia): Muscle weakness, cramping, or irregular heartbeat, particularly early in treatment.
• Persistent or Severe Symptoms: Ongoing nausea, vomiting, or severe headaches beyond the initial adjustment phase.

You may experience side effects not listed. Contact your doctor with questions. An allergic reaction to this medication is unlikely but seek medical attention if it occurs. Symptoms of an allergic reaction include rash, itching, swelling, severe dizziness, and/or trouble breathing.  

Contraindications or require Caution: Individuals who are pregnant or breastfeeding, have a known allergy to cobalamin (Vitamin B12), or have pre-existing liver, kidney, or optic nerve conditions. These patients also have significant interactions with certain medications.  

What may interact with this medicine?

Medications

• Metformin and Acid-Reducing Medications (e.g., omeprazole, ranitidine): Long-term use may reduce B12 absorption, potentially reducing the effectiveness of supplementation.
• Blood Thinners (Anticoagulants, e.g., warfarin): Vitamin B12 may affect clotting pathways; close monitoring of INR may be warranted.
• Chloramphenicol: This antibiotic can antagonize the hematopoietic response to B12 and reduce its effectiveness.
• Colchicine: May impair B12 absorption from the gastrointestinal tract with long-term use.

Other Supplements

• Other B-vitamins or multivitamins containing B12: Combining supplemental sources may lead to higher-than-intended B12 levels; inform your clinician of all supplements taken.
• Choline-containing supplements: Concurrent use with the choline in this formulation may produce additive effects on liver fat metabolism; discuss with your clinician.
• Inositol supplements: Overlapping supplementation may amplify effects on insulin sensitivity and mood; monitor for unexpected changes.

This is not a complete list of all possible interactions. Always inform your doctor and pharmacist of all medications, supplements, and herbal products you take, especially before starting or stopping any new medication.v. 1

Additional Information:

• Store compounded B12/MIC injections under refrigeration (36–46°F / 2–8°C) and keep protected from light.
• Check the solution before each use — do not use if cloudy, discolored, or if particles are visible.
• Do not share this medication with others to whom it was not prescribed.
• Keep out of reach of children and pets.
• Do not use after Beyond Use Date. Discard remainder of vial 28 days after first puncture.
• If an overdose is suspected, contact your local poison control center at 1-800-222-1222 or go to the nearest emergency room.
• Do not flush down the toilet or pour down a drain. Check with your pharmacist if you have questions about the best way to dispose of medications. There may be a drug take-back program in your area.
• Dispose of all used needles and syringes immediately in an FDA-cleared sharps container. Visit safeneedledisposal.org to find a drop-off location.

If you have any questions concerning this or any of your medications, a pharmacist is available during normal business hours to answer your questions. You can report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medication or any other medication. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does not include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. For questions about the source of any of the information provided herein, pharmacists at Pharmacy are available. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of this medicine.  

Important: Compounded medications are not evaluated or approved by the FDA for safety, efficacy, or quality.  

1. How to do an Injection

A subcutaneous injection is given in the fatty layer of tissue just under the skin. Syringes for subcutaneous injections will use smaller needles than those used for injections into a muscle. The typical Insulin or TB syringes will have a 1/2 inch or less needle length because it only needs to go slightly below the skin level. Only certain types of injections can be given through this route.  

Subcutaneous injections can be given straight and at a 90-degree angle, or at a 45-degree angle. You can give the shot at a 90-degree angle if 2 inches of skin can be grasped between your thumb and first (index) finger. If only skin can be grasped, give the shot at a 45-degree angle.  

2. Injection Sites on the Body

• Upper Arm: Uncover the arm to the shoulder to see the whole arm. Stand with a hand on the hip. Find the area in the middle part of the arm, halfway between the elbow and shoulder. Gently grasp the skin at the back of the arm between your thumb and first 2 fingers. You should have 1-2 inches of skin.
• Abdomen: Uncover the abdomen to see the whole area. Find the waist area. You may give a shot bounded by these landmarks below the waist, to just above the hip bone, and from where the body curves at the side to about 2 inches from the middle of the abdomen. Use the natural line in the middle of the body as a marker. It may be hard to see, but it is there unless it’s been covered by surgery. Avoid the surrounding area 2 inches from the belly button.  

• Thigh: Uncover the entire leg and the area between the knee and hip. The middle of the thigh, from mid-front to mid-side, on the outside part of the thigh, is a safe site. Gently grasp the area to make sure you can pinch 1-2 inches of skin.  

3. How To Inject with a Syringe

1. Wash your hands thoroughly with soap and dry them completely.  
2. Open the foil covering the alcohol wipe.  
3. Wipe the area where you plan to give the shot. Let the area dry.  
4. Take the cover off the needle. Hold the syringe with your writing hand and pull the cover off with your other hand, like taking a cap off a pen.  
5. Insert needle into rubber stopper and withdraw prescribed amount of medication. Pull needle out.  
6. If you will give the shot at a 45-degree angle, hold the syringe with your writing hand. Place the syringe between your thumb and your index and second fingers. The bevel of the needle ((the angled, open tip of the needle) should be pointing upwards at the 45-degree angle you plan to use.  
7. If you will give the shot at a 90-degree angle, hold the syringe with your writing hand. Hold the syringe under your thumb and first finger. Let the barrel of the syringe rest on your second finger. (Many people hold a pen this way when they write).  
8. Grasp the skin with the hand not holding the syringe. Holding the syringe barrel tightly with your writing hand, use your wrist to insert the needle through the skin. Sometimes the needle goes in easily. Some people have tougher skin and a little more pressure or quickness will be required.  
9. Once the needle is all the way in, push the plunger down slowly to inject the syringe’s contents.  
10. Remove the needle at the same angle you put it in.  
11. Dispose of the syringe and needle in a Sharps Container.

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