Semaglutide: be careful when buying a slimming drug online

A few years ago, celebrity weight management practices were out of reach for most people. Live-in cooks and personal trainers, not to mention elaborate surgical procedures like Brazilian butt lifts, weren’t real options for most. But with the advent of drugs like semaglutide, it seems anyone can go online and buy the same wonder drug that billionaires like Elon Musk use to stay in shape.

However, are online shoppers really getting the same product? If not, what do they get? And is it safe?

Semaglutide is in a class of drugs known as GLP-1 receptor agonists. The first GLP-1 drug was made by copying a chemical found in the venom of the Gila monster. These drugs work by helping the body produce the right amount of insulin at the right time, which helps regulate blood sugar. This means they are highly effective for people with type 2 diabetes.

Semaglutide, marketed under the brand name Ozempic, has been used as a diabetes drug for over five years. But Ozempic and other GLP-1 drugs have also been found to lead to significant weight loss, and not just in people with diabetes.

Pharmaceutical companies such as Novo Nordisk and Eli Lilly have now developed GLP-1 drugs specifically for weight loss. Novo Nordisks semaglutide (under the brand name Wegovy) is now approved as a treatment for obesity and weight-related health conditions in the UK, EU and elsewhere.

This doesn’t mean that Ozempic and Wegovy are easy to get hold of. Indeed, there is a global shortage that affects even those with prescriptions. Meanwhile, TikTok and Instagram are inundated with people sharing their semaglutide weight loss journeys. Some social media posters explain the disparity by saying they are taking generic semaglutide. But semaglutide (like similar drugs like liraglutide and tirzepatide) is still under patent, which means it’s illegal to make a generic form.

What are they buying?

Many drugs, including familiar ones like acetaminophen, aren’t patented, meaning any company with the right license and an up-to-date manufacturing facility can make and market their own generic version. But this is not the case with semaglutide or any other GLP-1 drug. So what are online shoppers taking?

One possible answer can be gleaned from a recent warning from the US Food and Drug Administration about the dangers of buying GLP-1 drugs without a prescription. The warning applies to saline forms including semaglutide sodium and semaglutide acetate. Drug manufacturers often develop a saline form of a drug if the pure chemical form cannot be absorbed into the body.

Novo Nordisk itself markets semaglutide sodium as a diabetes drug called Rybelsus. While many forms of salt are perfectly safe, others are only approved for research use and may not even be considered safe for use in humans. If buyers receive unlicensed salt forms of semaglutide, they cannot be sure that the medicine they are taking is safe or effective.

Another possibility is that buyers receive compounded versions of semaglutide. Often the chemicals used to make medicines are manufactured by third parties. In some circumstances, for example, when there is a recognized shortage of a pharmaceutical preparation, pharmacies or laboratories may purchase raw materials directly from manufacturers and produce their own version of that drug.

Novo Nordisk has issued cease-and-desist letters to companies it accuses of infringing on its patent by combining semaglutide. But compounding pharmacies counter that Novo Nordisks’ patents apply to finished medicines like Ozempic, not the chemical that makes up semaglutide. They argue that the shortages of Ozempic and Wegovy give them the right to manufacture and market equivalent compounds.

Even though it’s legal to make compound versions of semaglutide, these versions are still prescription drugs. This means that online shoppers without a prescription are faced with two somewhat alarming possibilities: either they are not taking semaglutide legally or they are not taking semaglutide at all.

In the former case, people have none of the protections they would have when taking a properly prescribed drug. In the latter case, they could be wasting money on something that is ineffective at best and dangerous at worst.