What are GLP-1 drugs and how do they differ?
A GLP-1 receptor agonist increases insulin release when glucose is high, slows stomach emptying, and reduces appetite. Tirzepatide adds a second target, the GIP receptor. [1] [2] The investigational drugs go further: survodutide and mazdutide add the glucagon receptor, retatrutide targets GIP, GLP-1, and glucagon together, and cagrilintide works through the separate amylin pathway. Each peptide page below carries the trials behind those mechanisms.
Among the peptides we track, only semaglutide, tirzepatide, and liraglutide are approved in the United States for chronic weight management; orforglipron, a non-peptide GLP-1 pill approved in April 2026, is outside this dataset. Dulaglutide and exenatide are diabetes drugs, and branded exenatide was discontinued in October 2024. A 2026 network meta-analysis of 262 trials estimated one year weight loss beyond lifestyle change of 14.9% for tirzepatide and 9.8% for injectable semaglutide. [1] [11] [16] [29]
Every GLP-1 and incretin peptide we track
Badges come from each peptide’s own record, so this table stays in step with the peptide pages.
| Peptide | What the evidence shows | Status |
|---|---|---|
| Semaglutide | FDA approved GLP-1 agonist with about 15% average weight loss in a 68 week RCT and proven cardiovascular benefit. | Evidence: Human RCT evidenceRegulatory: FDA approvedWADA: Not WADA prohibited |
| Tirzepatide | FDA approved weekly GIP and GLP-1 drug with 20.9% average weight loss at 15 mg in a 72 week randomized trial; beat semaglutide head to head. | Evidence: Human RCT evidenceRegulatory: FDA approvedWADA: Not WADA prohibited |
| Liraglutide | First daily GLP-1 drug: FDA approved since 2010, about 8% weight loss at 3 mg over 56 weeks, proven heart benefit, now available as a generic. | Evidence: Human RCT evidenceRegulatory: FDA approvedWADA: Not WADA prohibited |
| Retatrutide | Investigational triple agonist, nicknamed reta or GLP-3, with 24.2% weight loss at 48 weeks in phase 2 and 28.3% in a phase 3 topline; not FDA approved. | Evidence: Human RCT evidenceRegulatory: Not eligible for compoundingWADA: WADA prohibited |
| Cagrilintide | Experimental weekly copy of the appetite hormone amylin: 10.8% weight loss alone at 26 weeks and 20.4% with semaglutide at 68 weeks; not FDA approved. | Evidence: Human RCT evidenceRegulatory: Not eligible for compoundingWADA: WADA prohibited |
| Dulaglutide | FDA approved weekly GLP-1 drug for type 2 diabetes that cut heart attacks, strokes, and heart deaths by 12% over 5.4 years in REWIND; not for weight loss. | Evidence: Human RCT evidenceRegulatory: FDA approvedWADA: Not WADA prohibited |
| Exenatide | The first GLP-1 drug, FDA approved in 2005; lowers HbA1c (3 month blood sugar) 0.8 to 1.9 points with 2 to 4 kg weight loss; no proven heart benefit. | Evidence: Human RCT evidenceRegulatory: FDA approvedWADA: Not WADA prohibited |
| Survodutide | Investigational glucagon/GLP-1 dual agonist: 13% weight loss at 76 weeks in phase 3 and strong liver (MASH) data, but not FDA approved. | Evidence: Human RCT evidenceRegulatory: Not eligible for compoundingWADA: WADA prohibited |
| Mazdutide | GLP-1/glucagon dual agonist with 14% weight loss at 48 weeks in a Chinese phase 3 trial and 18% at 16 mg in a US phase 2; not FDA approved. | Evidence: Human RCT evidenceRegulatory: Not eligible for compoundingWADA: WADA status unclear |
| PramlintideRelated, not a GLP-1 | FDA approved lab-made amylin used with mealtime insulin; lowers HbA1c about 0.3 to 0.4 points more than placebo, modest weight loss, boxed low sugar warning. | Evidence: Human RCT evidenceRegulatory: FDA approvedWADA: Not WADA prohibited |
| SetmelanotideRelated, not a GLP-1 | FDA approved hunger-pathway (MC4R) drug for rare genetic obesity (POMC, PCSK1, LEPR, Bardet-Biedl) and acquired hypothalamic obesity; not for common obesity. | Evidence: Human RCT evidenceRegulatory: FDA approvedWADA: Not WADA prohibited |
Semaglutide vs tirzepatide vs retatrutide
The three most searched incretin drugs, side by side. Semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro) are approved; retatrutide, nicknamed reta or GLP-3 online, is still in trials. Weight loss figures come from separate trials with different lengths and populations, so only the SURMOUNT-5 row is a direct comparison. [20] [28]
| Feature | Semaglutide | Tirzepatide | Retatrutide |
|---|---|---|---|
| Brand names [1] [2] | Wegovy, Ozempic, Rybelsus | Zepbound, Mounjaro | None yet (nicknamed reta or GLP-3 online) |
| Receptors [1] [2] [28] | GLP-1 | GIP and GLP-1 | GIP, GLP-1, and glucagon |
| Weight loss vs placebo [18] [19] [28] [30] | 14.9% vs 2.4% at 68 weeks (STEP 1, 2.4 mg) | 20.9% vs 3.1% at 72 weeks (SURMOUNT-1, 15 mg) | 24.2% vs 2.1% at 48 weeks (phase 2, 12 mg); 28.3% at 80 weeks in a phase 3 topline release, not peer reviewed |
| Head-to-head [20] | 13.7% at 72 weeks in SURMOUNT-5 | 20.2% at 72 weeks in SURMOUNT-5 | No head-to-head trial published |
| Heart outcomes [23] [27] | SELECT: 20% fewer major cardiovascular events in obesity with heart disease | SURPASS-CVOT: noninferior to dulaglutide in type 2 diabetes (hazard ratio 0.92) | No outcome trial reported |
| Form [1] [2] [28] | Weekly injection or daily tablet | Weekly injection | Weekly injection, in trials only |
| Self-pay price [13] [14] | From 149 USD a month (tablets); 349 USD for the pen | From 299 USD a month (2.5 mg KwikPen) | No lawful price; not on the market |
| FDA status | Regulatory: FDA approved | Regulatory: FDA approved | Regulatory: Not eligible for compounding |
| WADA | WADA: Not WADA prohibited | WADA: Not WADA prohibited | WADA: WADA prohibited |
Peptide pages: Semaglutide, Tirzepatide, Retatrutide.
Go deeper: Wegovy vs Zepbound, retatrutide vs tirzepatide, semaglutide vs retatrutide, and why retatrutide has no lawful price.
When was each GLP-1 approved?
25 dated FDA actions, from the first GLP-1 agonist in 2005 to the most recent label expansions. Each links to its primary source.
- FDA
FDA approves Symlin (pramlintide) as an adjunct to insulin
FDA approved pramlintide injection (Symlin), a synthetic amylin analog, for use with mealtime insulin in type 1 and type 2 diabetes.
Regulatory: FDA approvedSource: Drugs@FDA: Symlin (pramlintide) NDA 021332Affects:Pramlintide
- FDA
FDA approves Byetta (exenatide), the first GLP-1 receptor agonist
FDA approved twice-daily exenatide injection (Byetta) as adjunctive therapy for type 2 diabetes, the first GLP-1 receptor agonist to reach the US market.
Regulatory: FDA approvedSource: Drugs@FDA: Byetta (exenatide) NDA 021773Affects:Exenatide
- FDA
FDA approves Victoza (liraglutide) for type 2 diabetes
FDA approved once-daily liraglutide injection (Victoza) to improve glycemic control in adults with type 2 diabetes, with a boxed warning about thyroid C-cell tumors seen in rodents.
Regulatory: FDA approvedSource: Drugs@FDA: Victoza (liraglutide) NDA 022341Affects:Liraglutide
- FDA
FDA approves Bydureon, once-weekly extended-release exenatide
FDA approved the extended-release, once-weekly formulation of exenatide (Bydureon) for type 2 diabetes after earlier complete response letters.
Regulatory: FDA approvedSource: Drugs@FDA: Bydureon (exenatide extended-release) NDA 022200Affects:Exenatide
- FDA
FDA approves Trulicity (dulaglutide) for type 2 diabetes
FDA approved once-weekly dulaglutide injection (Trulicity) to improve glycemic control in adults with type 2 diabetes.
Regulatory: FDA approvedSource: Drugs@FDA: Trulicity (dulaglutide) BLA 125469Affects:Dulaglutide
- FDA
FDA approves Saxenda (liraglutide 3 mg) for chronic weight management
FDA approved liraglutide 3 mg injection (Saxenda) for chronic weight management in adults with obesity or overweight with at least one weight-related condition, as an adjunct to diet and exercise.
Regulatory: FDA approvedSource: Drugs@FDA: Saxenda (liraglutide) NDA 206321Affects:Liraglutide
- FDA
FDA approves Ozempic (semaglutide) for type 2 diabetes
FDA approved once-weekly semaglutide injection (Ozempic) to improve glycemic control in adults with type 2 diabetes, the first semaglutide product to reach the US market.
Regulatory: FDA approvedSource: Drugs@FDA: Ozempic (semaglutide) NDA 209637Affects:Semaglutide
- FDA
FDA approves Rybelsus, the first oral GLP-1 receptor agonist
FDA approved oral semaglutide tablets (Rybelsus) for adults with type 2 diabetes, the first GLP-1 receptor agonist available in a pill rather than an injection.
Regulatory: FDA approvedSource: Drugs@FDA: Rybelsus (semaglutide tablets) NDA 213051Affects:Semaglutide
- FDA
FDA adds cardiovascular risk reduction to the Ozempic label
FDA approved a label expansion for Ozempic (semaglutide) to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease, based on the SUSTAIN-6 trial.
Regulatory: FDA approvedSource: Drugs@FDA: Ozempic (semaglutide) NDA 209637Affects:Semaglutide
- FDA
FDA approves Imcivree (setmelanotide) for rare genetic obesity
FDA approved setmelanotide injection (Imcivree), an MC4R agonist, for chronic weight management in patients with obesity due to POMC, PCSK1, or LEPR deficiency confirmed by genetic testing.
Regulatory: FDA approvedSource: Drugs@FDA: Imcivree (setmelanotide) NDA 213793Affects:Setmelanotide
- FDA
FDA approves Wegovy (semaglutide 2.4 mg) for chronic weight management
FDA approved once-weekly semaglutide 2.4 mg injection (Wegovy) for chronic weight management in adults with obesity or overweight with at least one weight-related condition, the first new weight-management drug approved since 2014.
Regulatory: FDA approvedSource: Drugs@FDA: Wegovy (semaglutide) NDA 215256Affects:Semaglutide
- FDA
FDA approves Mounjaro (tirzepatide) for type 2 diabetes
FDA approved tirzepatide injection (Mounjaro), the first dual GIP and GLP-1 receptor agonist, to improve glycemic control in adults with type 2 diabetes.
Regulatory: FDA approvedSource: Drugs@FDA: Mounjaro (tirzepatide) NDA 215866Affects:Tirzepatide
- FDA
FDA expands Wegovy to adolescents aged 12 and older
FDA approved Wegovy (semaglutide 2.4 mg) for chronic weight management in pediatric patients aged 12 years and older with obesity, based on the STEP TEENS trial.
Regulatory: FDA approvedSource: Drugs@FDA: Wegovy (semaglutide) NDA 215256Affects:Semaglutide
- FDA
FDA approves Zepbound (tirzepatide) for chronic weight management
FDA approved tirzepatide injection (Zepbound) for chronic weight management in adults with obesity or overweight with at least one weight-related condition.
Regulatory: FDA approvedSource: FDA approves new medication for chronic weight managementAffects:Tirzepatide
- FDA
FDA approves Wegovy to reduce cardiovascular risk in adults with obesity
FDA approved a new indication for Wegovy (semaglutide 2.4 mg) to reduce the risk of major adverse cardiovascular events in adults with established cardiovascular disease and obesity or overweight, based on the SELECT trial.
Regulatory: FDA approvedSource: FDA approves first treatment to reduce risk of serious heart problems specifically in adults with obesity or overweightAffects:Semaglutide
- FDA
FDA approves the first generic liraglutide injection
In December 2024 FDA approved the first generic version of once-daily liraglutide injection referencing Victoza, the first generic GLP-1 receptor agonist in the US.
Regulatory: FDA approvedSource: First generic drug approvalsAffects:Liraglutide
- FDA
FDA approves Zepbound for obstructive sleep apnea in adults with obesity
FDA approved Zepbound (tirzepatide) for moderate to severe obstructive sleep apnea in adults with obesity, the first drug approved for that indication.
Regulatory: FDA approvedSource: FDA approves first medication for obstructive sleep apneaAffects:Tirzepatide
- FDA
FDA approves Ozempic for chronic kidney disease in type 2 diabetes
FDA approved Ozempic (semaglutide) to reduce the risk of kidney disease worsening, kidney failure, and cardiovascular death in adults with type 2 diabetes and chronic kidney disease, based on the FLOW trial.
Regulatory: FDA approvedSource: Drugs@FDA: Ozempic (semaglutide) NDA 209637Affects:Semaglutide
- FDA
FDA grants accelerated approval of Wegovy for MASH with fibrosis
FDA granted accelerated approval of Wegovy (semaglutide 2.4 mg) for adults with noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver fibrosis, based on histologic endpoints from the ESSENCE trial.
Regulatory: FDA approvedSource: Drugs@FDA: Wegovy (semaglutide) NDA 215256Affects:Semaglutide
- FDA
FDA approves oral semaglutide (Wegovy tablets) for weight management
In December 2025 FDA approved a once-daily oral formulation of semaglutide for chronic weight management, the first oral GLP-1 receptor agonist approved for obesity.
Regulatory: FDA approvedSource: Drugs@FDA: Wegovy (semaglutide) NDA 215256Affects:Semaglutide
- FDA
FDA approves a 7.2 mg Wegovy dose for chronic weight management
FDA approved a higher 7.2 mg dose of Wegovy (semaglutide) injection, marketed as Wegovy HD, for weight loss and long-term maintenance of weight loss in certain adults.
Regulatory: FDA approvedSource: FDA press release: FDA approves fourth product under national priority voucher program, higher dose semaglutide (March 19, 2026)Affects:Semaglutide
- FDA
FDA approves Imcivree (setmelanotide) for acquired hypothalamic obesity
FDA extended Imcivree to acquired hypothalamic obesity in adults and children 4 years and older, based on the phase 3 TRANSCEND trial.
Regulatory: FDA approvedSource: Manufacturer press release: FDA approval of Imcivree for acquired hypothalamic obesity (March 19, 2026)Affects:Setmelanotide
- FDA
FDA proposes to keep semaglutide, tirzepatide and liraglutide off the 503B bulks list
FDA proposed not to include semaglutide, tirzepatide or liraglutide on the 503B bulks list, after tentatively finding no clinical need for outsourcing facilities to compound them from bulk. The notice was published May 1, 2026, and the comment period was extended to July 30, 2026. The proposal was not final as of September 2026. It does not change the 503A rules for patient specific compounding.
- FDA
FDA approves Mounjaro to reduce cardiovascular risk in adults with type 2 diabetes
FDA added an indication for Mounjaro to lower the risk of major adverse cardiovascular events (cardiovascular death, non-fatal heart attack, or non-fatal stroke) in adults with type 2 diabetes who are at high risk for these events. The approval rests on SURPASS-CVOT, in which tirzepatide was non-inferior to dulaglutide (hazard ratio 0.92, 95.3% CI 0.83 to 1.01) but did not show superiority.
Regulatory: FDA approvedSource: Manufacturer press release: FDA approves Mounjaro (tirzepatide) to reduce cardiovascular risk in adults with type 2 diabetes (August 28, 2026)Affects:Tirzepatide
- FDA
FDA warning letter treats GLP-1 plus vitamin combinations as essentially copies
In a warning letter dated September 18, 2026 and posted September 22, FDA said compounded tirzepatide with niacinamide and semaglutide with cyanocobalamin (vitamin B12) appeared to be essentially copies of approved drugs, that the volume produced suggested the claimed differences were a pretext, and that significant-difference statements were repeated verbatim across many records or chosen from preset menus on prescribing platforms. The letter's findings are specific to one pharmacy, but they apply FDA's April 1, 2026 policy that a combination within 10% of approved strengths by the same route may be treated as essentially a copy without a documented prescriber determination.
Affects:SemaglutideTirzepatide
What happened with the shortage and compounded GLP-1s?
Semaglutide went on FDA’s drug shortage list in 2022 and tirzepatide late that year, which let 503A pharmacies and 503B outsourcing facilities make copies. FDA declared the tirzepatide shortage resolved on December 19, 2024 and semaglutide on February 21, 2025; the last grace period ended on May 22, 2025. [6] [9]
Compounded versions are now limited to patients whose needs an approved drug cannot meet. FDA reports adverse events tied to dosing errors with compounded products, warns that semaglutide salt forms are not the approved ingredient, and in March 2026 sent warning letters to 30 telehealth companies over misleading marketing of compounded GLP-1s. [7] [8]
FAERS reports naming a GLP-1, by year, are charted in our State of Peptides report, with the caveats on what report counts can and cannot show.
- FDA
FDA lists semaglutide injection on the drug shortage list
In March 2022 FDA added semaglutide injection to its drug shortage list as demand for Wegovy and Ozempic outpaced supply. While a drug is in shortage, 503A and 503B compounders may prepare essentially a copy under FDA's shortage-related compounding policies.
Affects:Semaglutide
- FDA
FDA lists tirzepatide injection on the drug shortage list
In December 2022 FDA added tirzepatide injection (Mounjaro) to its drug shortage list, opening the door to compounded tirzepatide under FDA's shortage compounding policies.
Affects:Tirzepatide
- FDA
FDA warns about compounded semaglutide made with salt forms
In May 2023 FDA published its concerns about compounded semaglutide, stating it had received adverse event reports and that products made with semaglutide sodium or semaglutide acetate salts are not the same active ingredient as the approved drugs and do not meet the compounding exemption requirements.
Affects:Semaglutide
- FDA
FDA declares the tirzepatide shortage resolved
FDA announced that the shortage of tirzepatide injection (Mounjaro and Zepbound) was resolved, meaning compounders could no longer rely on the shortage to prepare copies of the approved products.
Affects:Tirzepatide
- Other
FDA agrees to reconsider the tirzepatide shortage decision after compounder lawsuit
After the Outsourcing Facilities Association sued over the October 2 resolution decision, FDA told the court it would reconsider the tirzepatide shortage determination and would not take enforcement action against compounders in the interim.
Affects:Tirzepatide
- FDA
FDA reaffirms the tirzepatide shortage is resolved and sets grace periods
After reconsideration, FDA confirmed the tirzepatide shortage was resolved and announced enforcement discretion periods: 503A pharmacies until February 18, 2025 and 503B outsourcing facilities until March 19, 2025.
Affects:Tirzepatide
- FDA
503A grace period for compounded tirzepatide ends
FDA's enforcement discretion for 503A pharmacies compounding tirzepatide ended. After this date 503A pharmacies may not compound copies of Mounjaro or Zepbound on shortage grounds.
Affects:Tirzepatide
- FDA
FDA declares the semaglutide shortage resolved
FDA announced that the shortage of semaglutide injection (Ozempic and Wegovy) was resolved and set enforcement discretion periods: 503A pharmacies until April 22, 2025 and 503B outsourcing facilities until May 22, 2025.
Affects:Semaglutide
- FDA
503B grace period for compounded tirzepatide ends
FDA's enforcement discretion for 503B outsourcing facilities compounding tirzepatide ended, closing the shortage-based pathway for compounded tirzepatide.
Affects:Tirzepatide
- FDA
503A grace period for compounded semaglutide ends
FDA's enforcement discretion for 503A pharmacies compounding semaglutide ended. After this date 503A pharmacies may not compound copies of Ozempic or Wegovy on shortage grounds.
Affects:Semaglutide
- FDA
503B grace period for compounded semaglutide ends
FDA's enforcement discretion for 503B outsourcing facilities compounding semaglutide ended, closing the shortage-based pathway for compounded semaglutide.
Affects:Semaglutide
What do GLP-1 drugs cost?
| Peptide | Cash price per month | With insurance, from | Dated channels |
|---|---|---|---|
| Semaglutide | $149 to $1,349 | $25 | 6 of 6 |
| Tirzepatide | $275 to $1,112 | $25 | 6 of 6 |
| Liraglutide | $112 to $1,349 | $25 | 5 of 5 |
| Retatrutide | No current cash price | Not published | 0 of 3 |
| Dulaglutide | $389 to $1,007 | $0 | 3 of 4 |
| Exenatide | No current cash price | Not published | 0 of 3 |
Cash ranges span list, manufacturer self-pay, telehealth, and historical compounded prices without insurance; the cost pages give each channel with its source and check date. Investigational drugs (retatrutide, cagrilintide, survodutide, and mazdutide) have no lawful price because they cannot be sold for human use. The price index in our State of Peptides report compares these prices with every other peptide we track.
Can I get a GLP-1 in my state?
Approved GLP-1 drugs need a prescription from a licensed prescriber, and how you can get one depends on your state’s telehealth law. Across our 50 state records, telehealth prescribing is allowed in 50; prescribing after an asynchronous (message or questionnaire based) visit is allowed in 17, not allowed in 5, and not addressed by the state rules we checked in 28. Compounded GLP-1 access is rated limited in 50 states; the federal compounding limits above apply in every state.
Each state page names the pharmacy board, the telehealth statute or rule, and the sources: legal access by state. For how state rules shape a telehealth GLP-1 visit, see Can you get a GLP-1 through telehealth in your state?
How do the GLP-1 drugs compare head to head?
29 comparisons involve a GLP-1 or related peptide; 14 are backed by at least one published direct trial.
Two brand pairs are the same molecule and are not in the table: Zepbound and Mounjaro are both tirzepatide, and Wegovy and Ozempic are both semaglutide. Only the label differs. Zepbound vs Mounjaro explains how the approved uses, label doses, insurance coverage, and prices differ. [2] [3]
| Comparison | Verdict | Direct trials |
|---|---|---|
| Cagrilintide vs pramlintide | Verdict: it depends on the goal | 0 |
| Dulaglutide vs exenatide | Verdict: favors dulaglutide | 1 |
| Dulaglutide vs mazdutide | Verdict: it depends on the goal | 2 |
| Dulaglutide vs retatrutide | Verdict: it depends on the goal | 1 |
| Liraglutide vs cagrilintide | Verdict: it depends on the goal | 1 |
| Liraglutide vs dulaglutide | Verdict: it depends on the goal | 1 |
| Liraglutide vs exenatide | Verdict: favors liraglutide | 2 |
| Liraglutide vs setmelanotide | Verdict: it depends on the goal | 0 |
| Retatrutide vs mazdutide | Verdict: it depends on the goal | 0 |
| Retatrutide vs survodutide | Verdict: favors retatrutide | 0 |
| Semaglutide vs cagrilintide | Verdict: favors semaglutide | 1 |
| Semaglutide vs dulaglutide | Verdict: favors semaglutide | 1 |
| Semaglutide vs exenatide | Verdict: favors semaglutide | 1 |
| Semaglutide vs liraglutide | Verdict: favors semaglutide | 1 |
| Semaglutide vs mazdutide | Verdict: it depends on the goal | 1 |
| Semaglutide vs retatrutide | Verdict: favors semaglutide | 0 |
| Semaglutide vs setmelanotide | Verdict: it depends on the goal | 0 |
| Semaglutide vs survodutide | Verdict: favors semaglutide | 1 |
| Semaglutide vs tirzepatide | Verdict: it depends on the goal | 2 |
| Survodutide vs mazdutide | Verdict: favors mazdutide | 0 |
| Tirzepatide vs cagrilintide | Verdict: favors tirzepatide | 0 |
| Tirzepatide vs dulaglutide | Verdict: favors tirzepatide | 2 |
| Tirzepatide vs liraglutide | Verdict: favors tirzepatide | 0 |
| Tirzepatide vs mazdutide | Verdict: favors tirzepatide | 0 |
| Tirzepatide vs retatrutide | Verdict: favors tirzepatide | 0 |
| Tirzepatide vs survodutide | Verdict: favors tirzepatide | 0 |
| AOD-9604 vs semaglutide | Verdict: favors semaglutide | 0 |
| Tesamorelin vs retatrutide | Verdict: it depends on the goal | 0 |
| Tesofensine vs semaglutide | Verdict: favors semaglutide | 0 |
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Frequently asked questions
What is a GLP-1 drug?
A GLP-1 receptor agonist is a medicine that mimics glucagon-like peptide 1, a gut hormone released after eating. It increases insulin release when glucose is high, slows stomach emptying, and reduces appetite, which is why the class is used for type 2 diabetes and weight management. Some newer drugs add a second or third target: tirzepatide also activates the GIP receptor, and investigational drugs add the glucagon or amylin pathway. [1] [2]
Which GLP-1 drugs are FDA approved?
Semaglutide (Ozempic, Wegovy, Rybelsus), tirzepatide (Mounjaro, Zepbound), liraglutide (Victoza, Saxenda, and generics), dulaglutide (Trulicity), and exenatide (Byetta, Bydureon). Only semaglutide, tirzepatide, and liraglutide are approved for chronic weight management. Branded exenatide was discontinued in October 2024. Orforglipron, a non-peptide GLP-1 pill approved for weight management in April 2026, is outside this peptide dataset. [1] [2] [11] [16]
Is Zepbound the same as Mounjaro?
Yes, in what is inside the pen: both are tirzepatide in the same strengths, with the same starting dose and the same warnings. The difference is the FDA label. Mounjaro is approved for type 2 diabetes and for lowering cardiovascular risk in type 2 diabetes; Zepbound is approved for chronic weight management and for obstructive sleep apnea in adults with obesity. Wegovy and Ozempic are the same kind of pair for semaglutide. [1] [2] [3]
Which GLP-1 causes the most weight loss?
Among approved drugs, tirzepatide: 20.9% at 15 mg over 72 weeks in SURMOUNT-1, and 20.2% versus 13.7% for semaglutide in the direct SURMOUNT-5 trial. Among investigational drugs, retatrutide produced 28.3% at 12 mg over 80 weeks in its first phase 3 trial, according to the manufacturer's topline release; it is not approved. [19] [20] [30]
Is compounded semaglutide or tirzepatide still legal?
Only in narrow cases. FDA declared the tirzepatide shortage resolved on December 19, 2024 and the semaglutide shortage resolved on February 21, 2025. State licensed 503A pharmacies had to stop making copies by February 18, 2025 (tirzepatide) and April 22, 2025 (semaglutide), and 503B outsourcing facilities by March 19 and May 22, 2025. FDA now says compounded drugs should only be used when an approved drug cannot meet a patient's medical needs. [6] [7]
Why were compounded GLP-1s allowed in the first place?
Because both drugs were on FDA's drug shortage list, semaglutide from 2022 and tirzepatide from late 2022, and federal law lets compounders make copies of a drug while it is in shortage. When FDA removed them from the list, that allowance ended after the grace periods. [6] [9]
What safety problems has FDA reported with compounded GLP-1s?
FDA has received adverse event reports tied to compounded products, including dosing errors that led to hospitalization, and warns that salt forms such as semaglutide sodium and semaglutide acetate are different active ingredients from the approved drug. As of May 31, 2026 it listed 990 adverse event reports for compounded semaglutide and more than 730 for compounded tirzepatide. In March 2026 it sent warning letters to 30 telehealth companies over misleading marketing of compounded GLP-1s. [7] [8]
How much do GLP-1 drugs cost without insurance?
Manufacturer self-pay programs are far below list price. On 2026-09-22, semaglutide tablets for weight management started at 149 USD per month and the injectable pen at 349 USD per month after an introductory 199 USD price, while the tirzepatide KwikPen started at 299 USD for a 28 day supply at 2.5 mg. See the cost table on this page for every channel with a dated source. [13] [14]
Does Medicare cover GLP-1 drugs for weight loss?
Standard Part D plans do not cover drugs prescribed only for weight loss, but the Medicare GLP-1 Bridge, a demonstration running from July 1, 2026 to December 31, 2027, lets eligible Part D beneficiaries get semaglutide (injection or tablet), the tirzepatide KwikPen, or orforglipron for weight management for a 50 USD monthly copay with prior authorization. People with type 2 diabetes, moderate to severe sleep apnea, or fatty liver disease are excluded because their Part D plan may cover a GLP-1 instead, and the copay does not count toward the Part D deductible or out-of-pocket limit. [12] [15]
Do GLP-1 drugs reduce heart attacks and strokes?
Several do. Semaglutide cut major cardiovascular events by 20% in people with obesity and heart disease (SELECT), liraglutide by 13% (LEADER) and dulaglutide by 12% (REWIND) in type 2 diabetes, and tirzepatide matched dulaglutide in SURPASS-CVOT. Once weekly exenatide was safe in EXSCEL but did not reach a significant reduction. [23] [24] [25] [26] [27]
What are the most common side effects?
Gastrointestinal effects that peak during dose escalation: in STEP 1, 44% of people on semaglutide 2.4 mg had nausea versus 16% on placebo, and in SURMOUNT-1 up to 31% on tirzepatide 15 mg versus 10%. The labels also warn about pancreatitis, gallbladder disease, and hypoglycemia with insulin or sulfonylureas, and carry a boxed warning for thyroid C-cell tumors seen in rodents. [1] [2] [18] [19]
Are GLP-1 drugs banned in sport?
The approved GLP-1 drugs are not on the WADA Prohibited List. Investigational ones that no regulator has approved, such as retatrutide, survodutide, and cagrilintide, fall under section S0 (non-approved substances) and are prohibited at all times. [17]
Is there a GLP-1 pill?
Yes. Oral semaglutide was approved for type 2 diabetes as Rybelsus in 2019, and FDA approved semaglutide tablets for chronic weight management under the Wegovy application in December 2025. Orforglipron, approved in April 2026 for weight management, is also a daily pill, but it is a small molecule rather than a peptide; it produced 12.4% weight loss at the highest dose versus 0.9% on placebo in ATTAIN-1. [4] [5] [16]
Can I get retatrutide, CagriSema, or mazdutide?
Not lawfully in the United States outside a clinical trial. None is FDA approved or on the 503A bulks list, so none can be compounded. The cagrilintide and semaglutide combination was submitted to FDA in December 2025, and mazdutide is approved in China only. Products sold as research chemicals are not lawful for human use and are not verified for identity or purity. [7] [10] [31] [32]
How do the approved weight loss drugs compare overall?
A 2026 BMJ network meta-analysis of 262 trials estimated one year weight loss beyond lifestyle change of 14.9% for tirzepatide, 10.9% for oral semaglutide, and 9.8% for injectable semaglutide, with injectable semaglutide the only drug linked to lower all cause mortality, largely from cardiovascular outcome trials. Larger weight loss generally came with more side effects and discontinuation. [29]
Who qualifies for a GLP-1 for weight loss?
The weight management labels cover adults with obesity, or adults with overweight plus at least one weight-related condition, and Wegovy injection is also approved from age 12. The pivotal trials defined that as a BMI of 30 or more, or 27 or more with a weight-related condition. Zepbound is also approved for moderate to severe obstructive sleep apnea in adults with obesity, and Wegovy to lower cardiovascular risk in adults with established cardiovascular disease and obesity or overweight. [1] [2] [18] [19]
What happens when you stop taking a GLP-1?
Most people regain weight. In STEP 4, adults who lost weight over 20 weeks on semaglutide 2.4 mg and were then switched to placebo gained 6.9% of body weight by week 68, while those who stayed on the drug lost a further 7.9%. In SURMOUNT-4, after a mean 20.9% loss over 36 weeks on tirzepatide, switching to placebo led to a 14.0% gain by week 88, versus a further 5.5% loss with continued treatment. Both labels describe long-term use. [1] [2] [21] [22]
Who should not take a GLP-1?
The Wegovy and Zepbound labels list two contraindications: a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 (MEN 2), and a prior serious hypersensitivity reaction to the drug. They are not for use in pregnancy: the Wegovy label says to stop at least 2 months before a planned pregnancy, and the Zepbound label says to stop when a pregnancy is recognized and, for people on oral contraceptives, to switch to a non-oral method or add a barrier method for 4 weeks after starting and after each dose increase. Using two GLP-1 drugs together is not recommended. [1] [2]
Can I get a GLP-1 through telehealth in my state?
All 50 of our state records allow telehealth prescribing, but each state sets its own rules for the first visit, the prescriber's license, and whether a questionnaire-only visit is enough, so check your state's page in our legal section. Compounded versions are limited in every state by the federal rules that ended the shortage allowances in 2025. [6] [7]
Sources
Numbered citations above point to these primary sources. Tables and timelines cite the peptide, regulatory, cost, and comparison records they are built from.
- [1]FDA prescribing information for Wegovy (semaglutide) injection and tablets, via DailyMedFDA
- [2]FDA prescribing information for Zepbound (tirzepatide) injection, via DailyMedFDA
- [3]FDA prescribing information for Mounjaro (tirzepatide) injection, via DailyMed (revised September 2026)FDA
- [4]Drugs@FDA: Rybelsus (semaglutide tablets) NDA 213051FDA, 2019
- [5]Drugs@FDA: Wegovy (semaglutide) NDA 215256, including the tablet approvalFDA, 2025
- [6]FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize (shortage resolution and compounding end dates)FDA
- [7]FDA: concerns with unapproved GLP-1 drugs used for weight loss (page updated September 1, 2026)FDA, 2026
- [8]FDA warns 30 telehealth companies against illegal marketing of compounded GLP-1s (March 3, 2026)FDA, 2026
- [9]FDA drug shortages databaseFDA
- [10]FDA: Bulk drug substances used in compounding under section 503A of the FD&C ActFDA
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