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Pearls From My Specialty:�Weight Loss Medications (GLP-1)

• Sarah Iannacone, PharmD, BCACP
• Ambulatory Care Pharmacist
• May 15, 2026

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I have no financial disclosures to report. I am not sponsored nor do I receive any financial reimbursement by any company that will be discussed today.

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Any off-label content will be disclosed.

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Financial Disclosure

Common Misconceptions With GLP-1 Medications

MythBusters

Myth #1

“Compounding is the exact same”

Compounding – �when can it be done?

Act of Compounding

• Rules are overseen by the Federal Food, Drug, and Cosmetic Act
• Compounded drugs are not FDA-approved
• 503A licensed pharmacy
• Majority of independent, compounding pharmacies
• Follow USP 795/797 regulation and state laws set by the board
• 503B outsourcing facility
• Produce larger batches, often for office use or health systems
• FDA registered, must follow Current Good Manufacturing Practices (CGMP)

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Sterile Compounding

• Drug products can either be purchased as sterile or be sterilized prior to combining
• Aseptic technique, processes, and procedures must be followed for preparing any sterile medication or undergo terminal sterilization
• Beyond Use Dating (BUD)
• Compounding method
• If sterility testing is performed
• Starting component of compound
• Storage conditions
• Sporicidal disinfectant use
• Environmental monitoring
• Sterile garb, personnel qualification

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Myth #2

Beyond Use Dates are the same as Expiration Dates

• In other words:

• Before advising a patient to use a compounded product beyond its BUD, it’s worth taking a moment to reassess whether that’s the best and safest option.

Myth #3

Weight Loss = Fat Loss

Lean Body Mass

• Lean body mass accounts for 20 – 40% of weight loss with GLP-1/dual-agonist medications​
• Those at higher risk for lowered lean body mass include
• Older adults (sarcopenia)
• Individuals with low baseline muscle mass
• Inactive lifestyles
• Inadequate protein intake
• Individuals undergoing rapid/large weight loss
• Sarcopenia evaluation:
• Muscle strength: Grip strength, five-times sit-to-stand test
• Muscle mass: DEXA
• Physical performance: gait speed, 400-meter walk test, TUG test

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Lifestyle Changes

Myth #4

Once goal weight has been achieved, patients can discontinue the medication.

STEP 1 Extension

Semaglutide 2.4 mg/wk

STEP 1 Extension

Semaglutide 2.4 mg/wk

STEP 4 Trial

Semaglutide 2.4 mg/wk

SURMOUNT-4

Tirzepatide 15 mg/wk

What about lowered maintenance dosing?

Guidelines

2026 ADA Standards of Care

• Individualized treatment
• Use of lowest effective dose
• If discontinuation is necessary: ≥60 min/day of physical activity, regular self-monitoring, diet consisting of minimally processed/nutrient-dense foods
• Obesity Society Guidelines
• Anti-obesity medications should be considered a long-term medication

Retrospective Case Series

• Reduced-Frequency GLP1 Therapy Maintains Weight, Body Composition, and Metabolic Syndrome Improvements: A Case Series
• N=30
• Evaluate reduced-frequency dosing of GLP1 on weight loss after initial treatment with standard weekly therapy and reaching a plateau in weight loss.
• Defined as < 5% variation over a 3-month period

Data points collected at three points:

• Pre-GLP1
• Plateau – max observed weight loss on weekly dosing
• Maintenance – most recent follow up on reduced frequency therapy

Reduced dosing frequency was guided by patient preference but recommended frequency was every other week at current treatment dose

Retrospective Case Series

• Results: 34 patients initially
• 4 patients reverted back to standard dosing after noticing weight regain
• 30 patients:
• Every 10 - 14 days (n = 6)
• Every 2 weeks (n = 17)
• >2 weeks (n = 7) (longest 6 weeks)

Average Doses:

• Tirzepatide 10 mg
• Semaglutide 1.7 mg

Thank you!

Questions?

References

• Center for Drug Evaluation and Research. Human Drug Compounding. U.S. Food and Drug Administration. February 13, 2026. Accessed March 6, 2026. https://www.fda.gov/drugs/guidance-compliance-regulatory-information/human-drug-compounding.
• Lambert A. Understanding USP 797 beyond-use dates (buds) of compounded sterile preparations (CSPS). USP 797 BUD Updates | Simplifi 797 | Wolters Kluwer. February 28, 2025. Accessed March 6, 2026. https://www.wolterskluwer.com/en/expert-insights/usp-forum-update-beyond-use-dates-buds.
• Alissa S. Chen, John A. Batsis; Treating Sarcopenic Obesity in the Era of Incretin Therapies: Perspectives and Challenges. Diabetes 20 November 2025; 74 (12): 2179–2190.
• Mozaffarian D, Agarwal M, Aggarwal M, et al. Nutritional priorities to support GLP-1 therapy for Obesity: A Joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, The Obesity Medicine Association, and the Obesity Society. American Journal of Lifestyle Medicine. Published online May 30, 2025:1-36.
• Mehrtash F, Dushay J, Manson JE. Integrating diet and physical activity when prescribing glp-1s—lifestyle factors remain crucial. JAMA Internal Medicine. 2025;185(9):1151-1152.
• Mehrtash F, Dushay J, Manson JE. I am taking a GLP-1 weight-loss medication—what should I know? JAMA Internal Medicine. 2025;185(9):1180. Wong M, Wu A, Garhe PK, Biermann M. Reduced-Frequency GLP1 Therapy Maintains Weight, Body Composition, and Metabolic Syndrome Improvements: A Case Series. Obesity (Silver Spring). 2026 Feb 24.

References

• Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. New England Journal of Medicine. 2015;373(1):11-22.
• Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine. 2021;384(11):989-1002.
• Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine. 2022;387(3):205-216.
• Wharton S, Freitas P, Hjelmesæth J, et al. Once-weekly semaglutide 7·2 mg in adults with obesity (STEP UP): a randomised, controlled, phase 3b trial. Lancet Diabetes Endocrinol. 2025;13(11):949-963.
• Wharton S, Lingvay I, Bogdanski P, et al. Oral semaglutide at a dose of 25 mg in adults with overweight or obesity. New England Journal of Medicine. 2025;393(11):1077-1087.
• Wharton S, Aronne LJ, Stefanski A, et al. Orforglipron, an oral small-molecule GLP-1 receptor agonist for obesity treatment. New England Journal of Medicine. 2025;393(18):1796-1806.
• Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564.

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References

• Rubino D, Abrahamsson N, Davies M, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414-1425.
• Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with Tirzepatide for maintenance of weight reduction in adults with obesity. JAMA. 2024;331(1):38.
• Wong M, Wu A, Garhe PK, Biermann M. Reduced-Frequency GLP1 Therapy Maintains Weight, Body Composition, and Metabolic Syndrome Improvements: A Case Series. Obesity (Silver Spring). Published online February 24, 2026.