Patient Safety in the Era of Compounded Obesity Therapy: A Case Report of An Unintentional Semaglutide Overdose

Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) used for obesity management, but due to barriers such as supply shortages, lack of insurance coverage, and high medication cost, patients may have a difficult time obtaining it. Because of this, patients are turning to on-line weight-loss clinics to obtain a compounded semaglutide salt form, bypassing regulatory efforts of the FDA to confirm efficacy and safety. Very few cases are available in the literature to guide management of GLP-1RA toxicity. We report a case from the emergency department where a woman presents after injecting too much compounded semaglutide she obtained from an online source. Though no hypoglycemia or gastrointestinal effects occurred during her observation period, health care providers must be prepared to intervene to help patients avoid overdoses and patient harm, and advocate for patients to have access to safe and effective medications.