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Alternative medication classes should be considered if GLP-1 therapy proves intolerable: SGLT2 inhibitors (such as dapagliflozin, empagliflozin) for type 2 diabetes, which work via a completely different mechanism and rarely cause gastrointestinal side effects DPP-4 inhibitors (such as sitagliptin, linagliptin), which enhance endogenous GLP-1 activity more gently Metformin remains first-line for type 2 diabetes, though it can also cause gastrointestinal side effects Orlistat for weight management, though this also has gastrointestinal side effects of a different nature For weight management specifically, NICE recommends a comprehensive approach including dietary modification, increased physical activity, and behavioural interventions, with or without pharmacotherapy

We start with baseline labs (fasting glucose, IGF-1, lipid panel, HbA1c), confirm there are no contraindications, and walk patients through the cycle structure and dosing protocol before any prescription is written

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The regulatory environment for compounded GLP-1 medications continues to evolve, and reviewing the FDA's current public guidance before making treatment decisions is worth the time