Important safety information

GLP-1 medications (compounded semaglutide and tirzepatide)

Compounded semaglutide and tirzepatide are not FDA-approved. The information below is based on the FDA-approved products that contain the same active ingredients.

Risk of thyroid C-cell tumors. In studies in rodents, semaglutide and tirzepatide caused thyroid C-cell tumors. It isn't known whether they cause these tumors, including medullary thyroid carcinoma (MTC), in people. Do not use a GLP-1 medication if you or a family member has had MTC, or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Tell your clinician right away about a lump or swelling in your neck, trouble swallowing, a hoarse voice or shortness of breath.

Don't use if you're allergic to any ingredient, or if you're pregnant or breastfeeding. Stop at least 2 months before a planned pregnancy.

Serious side effects can include inflammation of the pancreas (severe stomach pain that may spread to the back, with or without vomiting), gallbladder problems, low blood sugar (especially with insulin or sulfonylureas), kidney problems from dehydration, serious allergic reactions, changes in vision in people with diabetes, and depression or thoughts of self-harm. Tell your clinician before any surgery or procedure that uses anesthesia or deep sedation.

Tirzepatide and birth control. Tirzepatide can make birth-control pills less effective. Use a non-oral method, or add a barrier method, for 4 weeks after starting and after each dose increase.

Common side effects include nausea, vomiting, diarrhea, constipation, stomach pain, indigestion, headache and tiredness. They're most common when starting or increasing a dose.

Menopause hormone therapy (estradiol and progesterone)

Estrogen therapy can increase the risk of endometrial cancer in women who have a uterus and take estrogen without a progestogen, as well as stroke, blood clots, heart attack, breast cancer and probable dementia in women 65 and older. Use the lowest dose that works for you, and review your treatment with your clinician regularly.

Don't use if you are or may be pregnant, or have unexplained vaginal bleeding, a history of breast cancer or other estrogen-dependent cancer, blood clots, stroke, heart attack, liver disease or a bleeding disorder.

Common side effects include headache, breast tenderness, irregular bleeding or spotting, bloating, nausea and mood changes. Progesterone can cause drowsiness or dizziness; take it at bedtime and don't drive until you know how it affects you.

Read the patient information that comes with your medication.

NAD+ injections

Compounded NAD+ is not FDA-approved, and research in people is limited.

Possible side effects include injection-site pain or redness, nausea, flushing, headache, stomach cramps, lightheadedness and fatigue, which are more likely if the injection is given quickly.

Tell your clinician if you're pregnant or breastfeeding, or have any chronic conditions.

Vitamin B12 injections

Don't use if you're allergic to cobalt or vitamin B12.

Possible side effects include injection-site pain, mild diarrhea and itching. Rarely, serious allergic reactions can occur; get emergency help for swelling of the face or throat, or trouble breathing.

Sermorelin

Compounded sermorelin is not FDA-approved.

Possible side effects include injection-site pain, swelling or redness, headache, flushing, dizziness and trouble sleeping.

Tell your clinician if you're pregnant or breastfeeding, have a thyroid condition, or have ever had cancer.

Glutathione injections

Compounded glutathione is not FDA-approved, and research in people is limited.

Possible side effects include injection-site pain or redness and stomach upset. Rarely, allergic reactions can occur; get emergency help for swelling or trouble breathing.

ED treatment (sildenafil and tadalafil)

Never take sildenafil or tadalafil with nitrates (such as nitroglycerin, or "poppers") or riociguat. The combination can cause a sudden, dangerous drop in blood pressure.

Tell your clinician about heart problems, low or high blood pressure, and any alpha-blockers or other medications you take. Avoid drinking a lot of alcohol.

Get medical help right away for an erection lasting more than 4 hours, sudden loss of vision in one or both eyes, or sudden hearing loss.

Common side effects include headache, flushing, stuffy nose, indigestion and, with tadalafil, back or muscle pain.

Finasteride

Women who are or may become pregnant should not handle crushed or broken tablets.

Possible side effects include lower sex drive, trouble getting an erection, and changes in ejaculation. Depression and thoughts of self-harm have been reported; tell your clinician about mood changes. Report breast lumps, pain or nipple discharge.

Finasteride can lower PSA test results. Tell any doctor who orders a PSA test that you take it.