Can I use compounded semaglutide (glucagon-like peptide-1 receptor agonist) that has been left at room temperature overnight?

Compounded Semaglutide Left at Room Temperature Overnight

Compounded semaglutide that has been left at room temperature overnight should not be used due to potential degradation and safety concerns.

Understanding Semaglutide Storage Requirements

Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) with specific storage requirements to maintain its efficacy and safety. When considering compounded formulations:

• Compounded semaglutide lacks the stability testing and safety features of FDA-approved manufactured products 1
• Unlike manufactured pens that have built-in safety features, compounded formulations are more vulnerable to temperature variations
• Peptide medications like semaglutide are temperature-sensitive and can degrade when not properly refrigerated

Risks of Using Improperly Stored Semaglutide

Efficacy Concerns

• Temperature excursions can lead to reduced potency of the medication
• Degraded semaglutide may not provide the expected therapeutic effects for weight management or glycemic control

Safety Concerns

• Improperly stored compounded medications may have altered pharmacokinetics
• Semaglutide has a half-life of approximately 7 days 2, but this assumes proper storage conditions
• Compromised medication could potentially cause unpredictable adverse effects

Clinical Implications of Semaglutide Use

Semaglutide already has significant effects on gastric emptying and gastrointestinal motility that require careful management:

• Patients on semaglutide have significantly higher rates of retained gastric contents (24.2% vs 5.1% in controls) 3
• The medication causes delayed gastric emptying that persists even after extended fasting periods 3
• These effects can lead to serious complications including aspiration risk during procedures 4

Using potentially degraded medication could exacerbate these known side effects or create unpredictable reactions.

Proper Handling of Semaglutide

The American Gastroenterological Association (AGA) guidelines emphasize the importance of proper medication handling for GLP-1 RAs 4:

• Semaglutide requires careful dose titration to minimize adverse effects
• Special clinical considerations include proper storage to maintain efficacy
• Proper patient education about medication handling is essential

Recommendations for This Situation

1. Do not use the compounded semaglutide that was left at room temperature overnight
2. Contact the compounding pharmacy for guidance on proper disposal
3. Obtain a new properly stored dose of the medication
4. Ensure proper storage going forward (refrigeration between 2-8°C/36-46°F)
5. If experiencing any unusual side effects from previously used medication, contact your healthcare provider

Common Pitfalls to Avoid

• Assuming compounded medications have the same stability as manufactured products: Compounded semaglutide lacks the extensive stability testing of FDA-approved products
• Underestimating temperature sensitivity: Peptide medications are particularly vulnerable to temperature variations
• Ignoring proper storage instructions: Even brief temperature excursions can potentially compromise medication integrity
• Self-adjusting dosing: If medication efficacy is compromised, patients might be tempted to self-adjust dosing, which can lead to serious adverse effects 1

By following proper storage guidelines and obtaining a new, properly stored dose, you can ensure both the safety and efficacy of your semaglutide treatment.