GLP1s justification for prescribing

To support the clinical appropriateness and regulatory clarity of our prescribing practices, we’d like to provide context regarding our use of compounded semaglutide formulations.

We understand that not all patients are suitable candidates for compounded semaglutide, especially when additives such as B12 or glycine are included. In cases where the compounded version is not appropriate, our providers prescribe the commercially available product.

However, when a provider determines that a compounded formulation is in the patient’s best interest, the rationale is clearly documented in the patient’s chart, including diagnostic justification as needed. This decision is always based on individualized patient care and clinical need.

Examples of clinical indications for prescribing compounded semaglutide may include:

  • Risk of B12 deficiency due to proton pump inhibitor use such as omeprazole (ICD-10: K21.00)
  • SSRI-related concerns (ICD-10: F32.A)
  • Use of metformin and its impact on nutrient absorption
  • Pre-existing conditions such as gallbladder disease (K91.5), hypothyroidism (E03.9), Crohn’s Disease, or a history of bariatric surgery
  • Low caloric intake (D51.3)
  • Intolerance or nausea associated with standard GLP-1 dosages

 

  • Use of SSRIs or SNRIs, which may impact appetite, metabolic regulation, or nutrient absorption (ICD-10: F32.A)
  • Metformin-associated B12 depletion, common in patients with type 2 diabetes
  • History of bariatric surgery, leading to altered absorption or tolerance issues
  • Chronic gastrointestinal conditions such as Crohn’s disease or IBS
  • Gallbladder disease or impaired gallbladder function (ICD-10: K91.5)
  • Hypothyroidism (ICD-10: E03.9), which can complicate weight loss efforts
  • Low caloric intake or malabsorption syndromes (ICD-10: D51.3)
  • Nausea or intolerance to standard GLP-1 dosages, where titration or formulation adjustment is clinically necessary
  • Gastroparesis or delayed gastric emptying, where slower dose escalation and alternative formulations may be indicated

In each case, our clinical team ensures that the chosen therapy aligns with the patient’s health status, minimizes risks, and maximizes outcomes. All decisions regarding compounded medications are made under the supervision of licensed providers and documented in full compliance with applicable standards.

 

Clarification on Use of Compounded GLPs

We’d like to provide clarification regarding our clinical rationale for prescribing compounded GLPs in certain cases.

While we recognize that not every patient is an appropriate candidate for a compounded formulation—especially those containing additional ingredients such as B12 or glycine—there are instances where this approach provides a safer or more suitable therapeutic outcome than the commercially available version. In all cases, when compounded GLPs is prescribed, our providers document the specific clinical reasons and supporting diagnoses in the patient’s chart.

Some of the key medical considerations for prescribing compounded GLPs include:

  • Risk of Vitamin B12 deficiency due to long-term use of proton pump inhibitors like omeprazole (ICD-10: K21.00)
  • Use of SSRIs or SNRIs, which may impact appetite, metabolic regulation, or nutrient absorption (ICD-10: F32.A)
  • Metformin-associated B12 depletion, common in patients with type 2 diabetes
  • History of bariatric surgery, leading to altered absorption or tolerance issues
  • Chronic gastrointestinal conditions such as Crohn’s disease or IBS
  • Gallbladder disease or impaired gallbladder function (ICD-10: K91.5)
  • Hypothyroidism (ICD-10: E03.9), which can complicate weight loss efforts
  • Low caloric intake or malabsorption syndromes (ICD-10: D51.3)
  • Nausea or intolerance to standard GLP-1 dosages, where titration or formulation adjustment is clinically necessary
  • Gastroparesis or delayed gastric emptying, where slower dose escalation and alternative formulations may be indicated

All compounded GLPs prescriptions are made on an individualized basis and under the supervision of a licensed provider. These decisions are guided by what is safest and most effective for each patient’s unique medical profile.