Yes, up to 15 mg. Maintenance levels at 5, 10, and 15. If you cannot tolerate a maintenance level you can still get it, but insurance will not cover it ($1000/mo rather than $15/mo.) This is not an unreasonable situation.
Luckily during the “shortage” you can currently get GLP-1’s in vials rather than injection pens.
The brand name GLP’s you can’t control the dose. But when you get it in a vial from a compounding pharmacy you can inject however much or little you want.
Not looking forward to ever using the brand name version specifically for this reason
The injection pen I have see has two marked dosages, but there is nothing stopping you from injecting more or less.
Basically it is a ratcheting mechanism where after ~10 clicks you get .25 mg dosage and 20 clicks gets you .50. Basically, no doctor is going to endorse it, but you can dial a dose to whatever amount you want.
Aren’t any states like California trying to ban compounding pharmacies? It’s an unfortunate attack on individual freedom, but I am not sure if we will still have them 20 years from now.
> Aren’t any states like California trying to ban compounding pharmacies?
No. California has not banned compounding pharmacies, nor is there a significant movement to do so in the legislature, among the people (who could do so by ballot measure), or a proposal by the governor to do so. California does require additional licensure for sterile compounding, but that is very much not a ban on sterile compounding or compounding more generally.
Relevant to GLP-1s, though, several state pharmacy boards (not California’s, as far as I know) have raised issues that compounded GLP-1 drugs that they have seen appear to be illegal, because they use a form other than the FDA-approved base form of semaglutide (which is only available from Novo Nordisk), and th3 form used is not itself approved for human use, and have taken steps to crack down on that. But that's also not banning compounding, but enforcing existing rules on compounding.
I think the issue is more the FDA has hit compounding by announcing semaglutide and tirzepatide are no longer in shortage - so compounding pharmacies aren't legally able to sell the cheaper compounded versions. Since most insurances don't cover GLP-1 for weight loss, this is a huge issue given they cost almost $2000/month in the US out of pocket.
I was approved for semaglutide but now compounding pharmacies like Hims are stating their cheaper (<$200/month) compounded versions are out of stock.
First, there's no legislation. What is happening is that the branded drug was in shortage so compounding pharmacies were legally allowed to step in under existing regulations.
The shortage status was first updated in the summer, and Novo went on a lawsuit spree. Suing everyone mentioning GLP on a website.
But, there have been more back and forths since, very recent.
TLDR what is restricted now is not the sale of the compound, but the manufacture of it. Therefore, you can keep selling inventory past the restriction, but of course that will either run out, expire, or be restricted as well. As of now, if everything stays the same, expect the last few compound pharmacies to run out of product at the end of Q3/25 .
However, I understand there's groundbreaking legislation being worked on that will dramatically change the status quo for the better, meaning more choice for end consumers and less profits for Novo.
Hum, I don't know, here in the UK, no one is forcing you to do anything. I am free to chose if I want to step up, down or stay on the current dosage every month. And I took the cautious approach to only step up when I stopped feeling the effects at the current dosage, so 8 months in, I am only starting on 10mg (range is 2.5 to 15mg in 2.5 increments).
If you want lower dosage, then there's a simple trick: just use less frequent injections. For example, try one in 10 days instead of 1 every week. It will result in lower steady-state GLP-1 levels.
https://www.goodrx.com/zepbound/dosage