From the Guidelines
The patient's request for compounded semaglutide should be carefully evaluated considering her medical history and the potential risks associated with GLP-1 receptor agonist therapy, particularly the contraindications of pancreatitis and medullary thyroid cancer, as noted in the study by 1. The patient is a 57-year-old female with a past medical history of hot flashes and hyperlipidemia who presents to clinic today requesting medication refills and laboratory tests. She is specifically requesting compounded semaglutide to be sent to a compounding pharmacy in Lubbock, noting that both her husband and daughter have had positive experiences with this medication. The patient denies any history of pancreatitis or medullary thyroid cancer, and reports no family history of these conditions. These are important considerations as they represent contraindications to GLP-1 receptor agonist therapy such as semaglutide, as highlighted in the study by 1 and further supported by the review in 1, which emphasizes the need for careful patient selection and monitoring when prescribing antiobesity medications. The patient appears to be seeking this medication likely for weight management purposes, given the context of family members' positive experiences, though her current weight, BMI, and specific indications for this medication request were not explicitly mentioned in the available information. Key considerations for the use of semaglutide include its mechanism of action as a GLP-1 analog, the need for titration of the dose every 4 weeks as tolerated by the patient, and the potential for common side effects such as nausea, vomiting, diarrhea, and constipation, as outlined in the study by 1. Given the potential benefits of semaglutide for weight management, as evidenced by the mean weight loss of 10.3-12.4% over 68 weeks and 12.6% over 104 weeks, as reported in the study by 1, it is crucial to weigh these benefits against the potential risks and to carefully monitor the patient for any adverse effects, particularly in the context of her medical history and the absence of explicit contraindications. The FDA indication for semaglutide, which includes a BMI ≥ 30 kg/m² or BMI ≥ 27 kg/m² with significant complications, should also guide the decision-making process, as noted in the study by 1. Ultimately, the decision to prescribe compounded semaglutide should be based on a thorough evaluation of the patient's individual needs and risk profile, with consideration of the most recent and highest-quality evidence available, as reflected in the studies by 1 and 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
History of Present Illness (HPI)
The patient is a 57-year-old woman with a past medical history (PMH) of hot flashes and hyperlipidemia (HLD). She presents to the clinic for medication refills and laboratory tests.
- She requires compounded semaglutide to be sent to a compounding pharmacy in Lubbock.
- Her husband and daughter are doing well.
- She denies any history of pancreatitis or medullary thyroid cancer, as well as any family history of these conditions.
Relevant Medical History
- Hot flashes: According to a study published in the Journal of Mid-life Health 2, hot flashes are a common symptom of menopause, caused by abnormal hypothalamic thermoregulatory control and estrogen deficiency.
- Hyperlipidemia (HLD): There is no direct information provided about the patient's HLD, but it is a relevant aspect of her medical history.
- Semaglutide use: Studies have investigated the safety of semaglutide, including its potential risks for pancreatitis and thyroid cancer 3, 4, 5, 6.
Medication and Treatment
- Semaglutide: The patient requires compounded semaglutide, which has been shown to be effective in improving glycemic control and causing weight loss, with a mostly favorable risk/benefit profile 3.
- Potential risks: While there are concerns about the potential risks of semaglutide, including pancreatitis and thyroid cancer, studies have found that these risks are low and not significantly increased with semaglutide use 4, 5, 6.