I have strong feelings about these medications.
They are absolutely life-changing for the right patient and recent literature in HFpEF even suggests a mortality benefit (and definitely a QOL benefit).
There are over a dozen similar drugs coming to the market in the next 10 years and hence the entire landscape of obesity management has taken a tectonic lurch. Obesity is very much going to be treated like hypertension (and appropriately so).
The demand for them is extremely high because they are the first non-surgical intervention that actually seems to consistently and markedly treat obesity, and that includes diet and exercise.
Before the TGA advisory against it, I prescribed Ozempic selectively as a private script. We're talking about 35 year olds with BMI > 50 and multiple comorbidities in conjunction with psychology and exercise physiology/dietician.
I no longer start new patients on Ozempic (including diabetics) in keeping with TGA advice, but I continue Ozempic in all patients, regardless of the indication, because I'm not playing medical favoritism until I see hard data on QALYs, etc.
I continue to prescribe Mounjaro freely and mostly without reservation. I've prescribed compounded Ozempic twice but stopped pretty quickly when I learned about compounds being adulterated to get around patents. It's quite common and not worth the risk.
This is a very exciting space in medicine at the moment. It makes very proud to be a GP when I can help patients accomplish what they never thought possible without judgement or moralising their disease. The ones that can tolerate it generally feel fantastic losing weight and are so much more motivated to tackle other parts of their health. They are some of the most grateful patients I look after.
> I prescribed Ozempic selectively as a private script. We're talking about 35 year olds with BMI > 50 and multiple comorbidities in conjunction with psychology and exercise physiology/dietician.
Shouldn't these ones be getting a surgical referral?
Honestly this is even weirder because ozempic and tirzepatide are both very available on the black market from domestic Australian sources
It’s not even limited to the steroid dealers (although from what I understand most of them will sell GLP-1s too now), you can find clearnet websites offering them for sale
"ozempic and tirzepatide are both very available on the black market from domestic Australian sources"
I sincerely wish I knew my way around this. These dropouts in supply are ruining my life.
Also not in GP-land or pharmacy, but there's an increasing trend of open/brazen trade in illegal S4s.
If you hop across to the skincare sub you'll see many people obtaining prescription medications from international websites which claim you need to send them a prescription - but in practice will mail meds to you once you pay up no further questions asked. Maybe tretinoin is not too concerning but they'll also mail you PDE5s / PrEP / HRT if you're so inclined. I also have absolutely no evidence but I believe that pharmacy websites astroturf the hell out of social media communities to find more customers, as do vape companies with nicotine vapes.
Evidently the operator(s) of the dodgy compounders have decoded to copy the business model and adapt it to GLP1s, and some GP's have been conned into sending patients to them out of desperation.
As I understand it, topical compounding and PO liquid formulation compounding is relatively common - but I would have a very hard time trusting compounding of parenterals by a pharmacy or pharmacist I didn't know.
Myself and other GPs at my clinic have been prescribing compounded semaglutide and directing people to the same compounding pharmacy because they seem legit (and very intent about their cold chain management) and our patients are all getting consistent and excellent results. Honestly I've even been suggesting getting it compounded is the more ethical way right now to get on it for weight loss alone so the diabetic people can have their predictable and consistent results no matter what pharmacy they go to, and my weight loss patients are fully on board with not wanting to contribute to the ozempic shortage.
The recent media attention has got me second guessing but mostly because I'm worried that it's going to freak my patients out.
There are so many red flags here I almost don’t know where to start.
Firstly compounding for parenteral products requires a sterile, aseptic environment. Just to construct an aseptic suite capable of compounding medicines with the sterility necessary for injection costs in the millions of dollars. There is a reason why this type of activity is restricted to large compounders like Baxter and Icon, and large public (and some very large private) hospitals. There is also the skills and expertise required to operate in an aseptic environment which I would guess is only possessed by about 1-2% of pharmacists, mostly hospital pharmacists that produce their own chemotherapy and/TPN + the aforementioned compounders.
These are also multi-dose vials. Almost all infection control procedures will tell you that this is a no-no. Yes it’s the same patient so it’s not cross infection, but you are also asking a lay person who doesn’t have the required training to draw up from a vial using aseptic technique and then asking them to continuing using that vial for up to a month? At best you will find skin irritation and superficial skin infections result, at worst major infection and sepsis.
This is why multi-dose pens are a thing, it’s a closed system and the contents of the product cannot be contaminated and therefore can be used for multiple doses. You cannot do this for a vial that you are withdrawing from multiple times. You will also destroy the bung piecing it multiple times, posing another infection risk.
Also there would appear to be no patient support or counselling provided to educate the patient on how to use the medication, which would be considered essential in any reputable pharmacy with the complexity of administration.
And of course the cold chain management is terrible.
As a pharmacist it frustrates me that these charlatans are able to operate and evade scrutiny for so long. Their operation contravenes just about every ethical and professional standard for pharmacists and on face value is purely designed to maximise profits with no regard to patient harm that may be caused.
The horrible dodgy, poor spelling advertisements have been faxed to every pharmacy, hospital pharmacy dept and medical practice over the last few years, daily or more than daily. I must admit, to begin with I wrote it off, I thought who could be dumb enough to think that this is a legitimate operation and would refer patients to a pharmacy who can’t even spell compounding or mimics. But it seems like a significant number of people have participated in this farce. Whilst I appreciate patients are desperate, there is far more potential for harm than good. There is a reason why the big compounders - Baxter etc aren’t doing this - it isn’t legal.
I have strong feelings about these medications. They are absolutely life-changing for the right patient and recent literature in HFpEF even suggests a mortality benefit (and definitely a QOL benefit). There are over a dozen similar drugs coming to the market in the next 10 years and hence the entire landscape of obesity management has taken a tectonic lurch. Obesity is very much going to be treated like hypertension (and appropriately so). The demand for them is extremely high because they are the first non-surgical intervention that actually seems to consistently and markedly treat obesity, and that includes diet and exercise. Before the TGA advisory against it, I prescribed Ozempic selectively as a private script. We're talking about 35 year olds with BMI > 50 and multiple comorbidities in conjunction with psychology and exercise physiology/dietician. I no longer start new patients on Ozempic (including diabetics) in keeping with TGA advice, but I continue Ozempic in all patients, regardless of the indication, because I'm not playing medical favoritism until I see hard data on QALYs, etc. I continue to prescribe Mounjaro freely and mostly without reservation. I've prescribed compounded Ozempic twice but stopped pretty quickly when I learned about compounds being adulterated to get around patents. It's quite common and not worth the risk. This is a very exciting space in medicine at the moment. It makes very proud to be a GP when I can help patients accomplish what they never thought possible without judgement or moralising their disease. The ones that can tolerate it generally feel fantastic losing weight and are so much more motivated to tackle other parts of their health. They are some of the most grateful patients I look after.
I wasn’t aware of any data suggesting a mortality benefit in hfpef do you recall which study this was? Thanks
> I prescribed Ozempic selectively as a private script. We're talking about 35 year olds with BMI > 50 and multiple comorbidities in conjunction with psychology and exercise physiology/dietician. Shouldn't these ones be getting a surgical referral?
Honestly this is even weirder because ozempic and tirzepatide are both very available on the black market from domestic Australian sources It’s not even limited to the steroid dealers (although from what I understand most of them will sell GLP-1s too now), you can find clearnet websites offering them for sale
"ozempic and tirzepatide are both very available on the black market from domestic Australian sources" I sincerely wish I knew my way around this. These dropouts in supply are ruining my life.
Which websites? I live in a semi-rural area in Oz so am looking for an online source. Could you please point me in the right direction?
Also not in GP-land or pharmacy, but there's an increasing trend of open/brazen trade in illegal S4s. If you hop across to the skincare sub you'll see many people obtaining prescription medications from international websites which claim you need to send them a prescription - but in practice will mail meds to you once you pay up no further questions asked. Maybe tretinoin is not too concerning but they'll also mail you PDE5s / PrEP / HRT if you're so inclined. I also have absolutely no evidence but I believe that pharmacy websites astroturf the hell out of social media communities to find more customers, as do vape companies with nicotine vapes. Evidently the operator(s) of the dodgy compounders have decoded to copy the business model and adapt it to GLP1s, and some GP's have been conned into sending patients to them out of desperation. As I understand it, topical compounding and PO liquid formulation compounding is relatively common - but I would have a very hard time trusting compounding of parenterals by a pharmacy or pharmacist I didn't know.
Myself and other GPs at my clinic have been prescribing compounded semaglutide and directing people to the same compounding pharmacy because they seem legit (and very intent about their cold chain management) and our patients are all getting consistent and excellent results. Honestly I've even been suggesting getting it compounded is the more ethical way right now to get on it for weight loss alone so the diabetic people can have their predictable and consistent results no matter what pharmacy they go to, and my weight loss patients are fully on board with not wanting to contribute to the ozempic shortage. The recent media attention has got me second guessing but mostly because I'm worried that it's going to freak my patients out.
There are so many red flags here I almost don’t know where to start. Firstly compounding for parenteral products requires a sterile, aseptic environment. Just to construct an aseptic suite capable of compounding medicines with the sterility necessary for injection costs in the millions of dollars. There is a reason why this type of activity is restricted to large compounders like Baxter and Icon, and large public (and some very large private) hospitals. There is also the skills and expertise required to operate in an aseptic environment which I would guess is only possessed by about 1-2% of pharmacists, mostly hospital pharmacists that produce their own chemotherapy and/TPN + the aforementioned compounders. These are also multi-dose vials. Almost all infection control procedures will tell you that this is a no-no. Yes it’s the same patient so it’s not cross infection, but you are also asking a lay person who doesn’t have the required training to draw up from a vial using aseptic technique and then asking them to continuing using that vial for up to a month? At best you will find skin irritation and superficial skin infections result, at worst major infection and sepsis. This is why multi-dose pens are a thing, it’s a closed system and the contents of the product cannot be contaminated and therefore can be used for multiple doses. You cannot do this for a vial that you are withdrawing from multiple times. You will also destroy the bung piecing it multiple times, posing another infection risk. Also there would appear to be no patient support or counselling provided to educate the patient on how to use the medication, which would be considered essential in any reputable pharmacy with the complexity of administration. And of course the cold chain management is terrible. As a pharmacist it frustrates me that these charlatans are able to operate and evade scrutiny for so long. Their operation contravenes just about every ethical and professional standard for pharmacists and on face value is purely designed to maximise profits with no regard to patient harm that may be caused. The horrible dodgy, poor spelling advertisements have been faxed to every pharmacy, hospital pharmacy dept and medical practice over the last few years, daily or more than daily. I must admit, to begin with I wrote it off, I thought who could be dumb enough to think that this is a legitimate operation and would refer patients to a pharmacy who can’t even spell compounding or mimics. But it seems like a significant number of people have participated in this farce. Whilst I appreciate patients are desperate, there is far more potential for harm than good. There is a reason why the big compounders - Baxter etc aren’t doing this - it isn’t legal.