Be careful of impure, compounded versions of GLP-1 RAs (e.g. Semaglutide: Ozempic, Rybelsus, Wegovy) that are circulating in the market
GL-1 receptor agonists or GLP-1 RAs such as semaglutide (Ozempic, Rybelsus, and Wegovy) have made the headlines over the past years. Hollywood celebrities and influencers have been reported to use this class of medications to lose weight.
So, what are GLP-1 RAs and how do they work?
GLP-1 RAs are a class of medications that include semaglutide (Ozempic, Rybelsus, and Wegovy), liraglutide (Saxenda) and dulaglutide.
GLP-1 RAs act on the receptor for a certain hormone produced in the gut. They help to control blood sugar and weight in several ways:
Increases production of the hormone that lowers blood sugar level, especially after taking food.
Reduces production of the hormone that increases fasting sugar, optimising fasting sugar levels.
Slows gastric emptying and decreases appetite, which makes you eat less, feel full longer, lose weight and also slows the release of glucose from your food.
Overhauls “hunger and craving hormones”, working on the reward centre of the brain, reducing cravings.
GLP-1 RAs have been shown to control blood sugar effectively, making them a good option for many diabetes patients. In a clinical trial in patients with type 2 diabetes (the Sustain 7 Study), Ozempic (the injectable form of semaglutide) was shown to lead to a reduction in HbA1c of up to 1.8% over 40 weeks. GLP-1 RAs such as semaglutide, liraglutide, and dulaglutide can be used on their own, along with lifestyle modifications such as exercise and a healthy diet. If your doctor advises, they can also be combined with other diabetes medications (such as metformin).
Semaglutide, along with other GLP-1 RAs, have also been shown to result in weight loss, which may in turn help to reduce the risk of diabetes complications. In multiple clinical studies of Saxenda, using the medication consistently resulted in weight loss of 4 to 6 kg. Nearly two-thirds of patients lost at least 5% of their body weight, and nearly one-third lost at least 10%. Meanwhile, with Wegovy, patients achieved 5%–20% or greater weight loss. Further, Wegovy was found not only superior at reducing body weight compared with other antidiabetic drugs, but also cardioprotective.
In a study of Zepbound / Mounjaro (tirzepatide), adults without diabetes had an average weight loss of 20.9% while taking the 15 mg dose, and 19.5% for the 10 mg dose. Meanwhile, adults with diabetes had an average weight loss of 14.7% for the 15 mg dose, and 12.8% for 10 mg.
Semaglutide (Ozempic, Rybelsus, and Wegovy): A Game Changer
GLP-1 RAs have been called a “game changer”. As the clinical trials have shown, participants taking semaglutide lost an average of 15% of their body weight.
How does it fare in the real world?
A real-world data presented at the European Association for the Study of Diabetes (EASD) showed that semaglutide (Ozempic, Novo Nordisk) significantly improved the A1c level and body weight for up to 3 years in a large cohort of adults with type 2 diabetes. GLP-1 RA (semaglutide) treatment has been proven to be effective in improving blood sugar control and weight loss in the long-term.
The popularity of semaglutide (Ozempic, Rybelsus, and Wegovy) and other GLP-1 RAs has been further intensified thanks to media coverage of these weight loss medications – and thanks to the revelation of Elon Musk and Oprah Winfrey, among others.
The Semaglutide Shortage
The demand for semaglutide (Ozempic, Rybelsus, and Wegovy), as people started to take it to shed pounds, has led to a supply shortage in countries that include Britain, Germany, Belgium and the United States. This means that the pace of semaglutide manufacturing has not been able to keep up with the demand.
To cope with this shortage, some countries have set out various guidelines. In the UK, for example, clinicians are not allowed to prescribe GLP-1 RAs outside of their approved use – those approved for diabetes treatment cannot be prescribed for weight loss.
In November 2023, Belgium issued a new law banning doctors from prescribing semaglutide (Ozempic) and other GLP-1 medications for weight loss. Meanwhile, Germany is considering an export ban on semaglutide (Ozempic, specifically) due to its worsening shortage.
As manufacturers cope with the demand and authorized distributors struggle to get hold of the medication, counterfeit and compounded GLP-1 RAs started to flourish online.
Warning Issued by the FDA: Counterfeit and Compounded GLP-1RAs (Ozempic, Rybelsus, and Wegovy)
The US Food and Drug Administration (FDA) has recently issued a warning about counterfeit and compounded versions of GLP-1 RAs, particularly Ozempic, a brand of semaglutide. According to the FDA, these compounded semaglutide “may not contain the same active ingredient as FDA-approved semaglutide products and may be the salt formulations." Some of the compounded versions are even promoted on Groupon, which is an online coupon platform known for deals on meals, services, travel and consumer goods, making it easily available without prescription.
Given that GLP-1 RAs are used to address diabetes and obesity, which are both serious diseases, these compounded and counterfeit semaglutide may pose some serious risks. Further, they have not even been proven to be safe or effective.
In Singapore, there is a form of semaglutide called Wegovy that has been approved for weight loss. Meanwhile, there are two different forms of semaglutide that are currently approved for use in Singapore – Ozempic, which is given by injection once a week, and Rybelsus, which is a tablet. Dulaglutide (Trulicity) and liraglutide (Victoza) are also approved for treating diabetes in Singapore.
For people who are considering purchasing GLP-1RAs such as semaglutide from non-authorized sources in countries outside of Singapore, you should be aware that there is a risk that you may obtain compounded or counterfeit versions of these products.
When it comes to GLP-1RAs, consultation with, and an ongoing relationship with healthcare providers is critical.
Healthcare Relationship is Critical
GLP-1 RAs such as semaglutide are not available over the counter. They can only be obtained through a prescription after a consultation with a doctor – after a thorough evaluation of your health and a comprehensive discussion of its benefits and risks. In Singapore, not all clinics carry GLP-1 RAs such as Ozempic, Rybelsus, Wegovy, and Saxenda, so if this is an option that you’d like to explore, it is recommended that you call the clinic to check before making an appointment.
Here at NOVI, we offer some of these medications to certain patients. This requires an appointment with one of our specialist doctors, to evaluate whether a GLP-1 RA medication would be a good option for you.
We also believe that medication alone is not the best approach; a healthy lifestyle is also important. Our patients receive personalized nutrition and fitness advice from a dedicated health coach, to help them develop and stick to a healthy lifestyle plan.
Our Comprehensive GLP-1 RA Program
NOVI Optimum Plus, our holistic GLP-1 RA program includes:
Doctor consultation
Dietitian consultation
Digital health coaching
GLP-1 RA
How it Works
Interested in this program? Sign up for NOVI Optimum Plus.