Important Medication Safety Information

Indications & Use

Compounded semaglutide is an injectable prescription medicine that may help adults with obesity or excess weight (overweight), who may also have weight-related medical problems, lose weight and keep it off, used with a reduced-calorie diet and increased physical activity, for people with an initial body mass index (BMI) of 27 kg/m² or higher. It is a synthetic GLP-1 receptor agonist. It should not be used with other semaglutide-containing products or any other GLP-1/GIP receptor agonist medicines.

Off-Label Use Disclosure: At lower (micro) doses, compounded semaglutide is sometimes used off-label — meaning for purposes not evaluated or approved by the FDA. Off-label uses currently under investigation include cardiovascular risk reduction and GI symptom management. References to conditions such as neurological protection, addiction, or inflammatory disease represent early-stage research only and are not established medical indications. These uses are experimental and not supported by FDA approval. Your prescribing physician will discuss whether any off-label use is appropriate for your individual circumstances.

Do Not Use If

• You or any family member have ever had medullary thyroid carcinoma (MTC), or you have MEN 2.
• You have a known allergic reaction to semaglutide or any of its components.
• You are pregnant, planning pregnancy, or breastfeeding.

Warnings & Serious Side Effects to Monitor

• Thyroid C-cell tumors (see boxed warning).
• Inflammation of the pancreas (acute pancreatitis), severe abdominal pain that does not go away, sometimes radiating to the back, with or without vomiting.
• Gallbladder problems, including gallstones, upper stomach pain, jaundice, fever, or clay-colored stools.
• Low blood sugar (hypoglycemia), especially with insulin or sulfonylureas, sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness.
• Acute kidney injury, dehydration from nausea/vomiting/diarrhea can worsen kidney problems; drink plenty of water.
• Serious allergic reactions, stop use and get help for swelling of the face/lips/tongue/throat, severe rash, very rapid heartbeat, or trouble breathing/swallowing.
• Diabetic retinopathy (in type 2 diabetes), report vision changes.
• Increased heart rate at rest; depression or suicidal thoughts, report new or worsening mood changes right away.
• Never share a vial, needle, or syringe, risk of infection.

Common Side Effects

Nausea, vomiting, diarrhea, constipation, abdominal pain, upset stomach, bloating, reflux, headache, fatigue, and dizziness. Injection-site swelling, redness, and itchiness may occur. These are typically mild and usually improve after the first several weeks.

Drug Interactions & What to Tell Your Provider

Tell your provider about all medications, including prescription, OTC, vitamins, and herbal/dietary supplements. Use caution with: diabetes medicines such as insulin or sulfonylureas; other GLP-1/GIP medicines (Wegovy®, Ozempic®, Saxenda®, Zepbound®, Mounjaro®, Victoza®, Byetta®, Bydureon®); oral medications (semaglutide delays gastric emptying and can affect absorption); and oral birth control pills (may be less effective).

How to Use

Self-administered as a subcutaneous injection in the stomach, thigh, or upper arm, once weekly on the same day, with or without food. Your provider will guide a titration schedule and may increase the dose over time. Do not change your dose or stop without discussing with your provider.

Indications & Use

Compounded tirzepatide is an injectable prescription medicine that may help adults with obesity or excess weight lose weight and keep it off, used with a reduced-calorie diet and increased physical activity, for people with a BMI of 27 kg/m² or higher. It is a dual GLP-1/GIP receptor agonist. Lower (micro) doses may be considered for the same reasons noted for semaglutide.

Do Not Use If

• You or any family member have ever had MTC, or you have MEN 2.
• You have a known allergic reaction to tirzepatide or any of its components.
• You are pregnant, planning pregnancy, or breastfeeding.

Warnings & Serious Side Effects to Monitor

Same as semaglutide: thyroid C-cell tumors, acute pancreatitis, gallbladder disease, low blood sugar (with insulin/sulfonylureas), acute kidney injury from dehydration, serious allergic reactions, diabetic retinopathy (type 2 diabetes), increased resting heart rate, and depression/suicidal thoughts. Never share a vial, needle, or syringe.

Common Side Effects

Nausea, vomiting, diarrhea, constipation, abdominal pain, upset stomach, bloating, reflux, headache, fatigue, and dizziness; injection-site reactions. Usually mild and improve after the first several weeks.

Drug Interactions & What to Tell Your Provider

Same precautions as semaglutide, diabetes medicines (insulin/sulfonylureas), other GLP-1/GIP medicines, oral medications (delayed gastric emptying), and oral birth control. Do not take two GLP-1/GIP medications at the same time.

How to Use

Injected subcutaneously in the stomach, thigh, or upper arm once weekly on the same day; rotate injection sites. Follow your provider's titration plan. Micro-dosing typically starts at 1.25 mg once or twice weekly.

Indications & Use

Estradiol is a bioidentical form of estrogen used to relieve moderate-to-severe menopausal symptoms such as hot flashes, night sweats, and vaginal dryness, and to help support bone health. If you have a uterus, estradiol is prescribed together with a progestogen (progesterone) to protect the uterine lining.

Do Not Use If

• You have known, suspected, or a history of breast cancer or another estrogen-dependent cancer.
• You have undiagnosed abnormal vaginal bleeding.
• You have active or a history of blood clots (DVT/PE), stroke, or heart attack.
• You have liver disease, a known clotting disorder (e.g., Factor V Leiden), or known hypersensitivity.
• You are or may be pregnant.

Warnings & Precautions

Increased risk of cardiovascular events and blood clots (higher with smoking, age, obesity, and immobility), gallbladder disease, high blood pressure, elevated triglycerides, and fluid retention. Tell your provider about a history of clots, cancer, liver disease, migraines, high blood pressure, or if you smoke.

Common Side Effects

Headache, breast pain or tenderness, irregular bleeding or spotting, nausea, bloating, and mood changes. Seek immediate care for signs of a clot (leg pain/swelling, sudden shortness of breath, chest pain), stroke (sudden weakness, trouble speaking, vision loss), or a severe allergic reaction.

Indications & Use

Bioidentical progesterone is used to protect the lining of the uterus (prevent endometrial hyperplasia) in women taking estrogen, and to treat certain menstrual and hormonal conditions. It is often taken at bedtime because it can promote drowsiness.

Do Not Use If

• You have a known allergy to progesterone. Note: oral micronized progesterone may be formulated in peanut oil, do not use that formulation if you are allergic to peanuts.
• You have known, suspected, or a history of breast cancer.
• You have undiagnosed vaginal bleeding, liver dysfunction, or active/history of blood clots, stroke, or heart attack.
• You are or may be pregnant (unless directed by your provider).

Warnings & Precautions

May cause drowsiness or dizziness, do not drive or operate machinery until you know how it affects you; taking it at bedtime is recommended. Use caution with a history of depression, and with cardiovascular or clotting risk factors. When combined with estrogen, there may be an increased risk of breast cancer, clots, and cardiovascular events.

Common Side Effects

Drowsiness, dizziness, breast tenderness, headache, mood changes, bloating, and spotting. Seek immediate care for signs of a clot or stroke or a severe allergic reaction.

Indications & Use

In women, low-dose testosterone is used off-label to support libido, energy, mood, and muscle strength when clinically appropriate. It is prescribed as a cream/topical or low-dose injection, most often subcutaneously. Regular blood tests and check-ups are essential to monitor your levels and adjust your dose.

Warnings & Precautions

• Transference (topical): testosterone can transfer to others through skin contact. Wash hands after applying, cover the area, and avoid skin contact with children and partners for several hours after application.
• Monitor for signs of excess androgen and estradiol conversion.
• Do not use if pregnant or breastfeeding, or with known/suspected breast cancer or hypersensitivity.

Common Side Effects

Acne, oily skin, increased body or facial hair, hair loss, mood changes, and increased estradiol levels. Higher doses can cause voice deepening or other virilizing effects. Report itching, redness, swelling, or excessive pain at the injection site.

Indications & Use

Testosterone is used to treat low testosterone (hypogonadism) with correlating symptoms. Testosterone cypionate is an injectable ester, given intramuscularly or subcutaneously, in most cases we prescribe via the subcutaneous route, typically weekly or bi-weekly. Regular blood tests and check-ups are essential to monitor levels and adjust dosing.

Contraindications

• Known or suspected prostate cancer or breast cancer in men.
• Elevated hematocrit (>54%).
• Untreated or uncontrolled sleep apnea.
• Serious cardiac, hepatic, or renal disease.
• Pregnancy or breastfeeding (partners); hypersensitivity to testosterone or any component.

Warnings & Precautions

• Monitoring: regularly check serum testosterone, hemoglobin/hematocrit, liver function, lipids, and PSA. Significant or rapid PSA rises warrant investigation.
• Fertility: testosterone therapy suppresses natural production of LH and FSH and can reduce sperm production, which may affect fertility.
• Transference: topical forms can transfer to others; wash hands and avoid skin contact with others, especially children, for several hours.
• Risk of misuse for performance enhancement, which can cause serious cardiovascular and psychiatric effects.

Common Side Effects

Acne, oily skin, increased body hair, gynecomastia (from aromatization), mood changes, hot flashes/night sweats, elevated hematocrit (polycythemia), testicular atrophy, reduced sperm production, edema, sleep changes or worsening sleep apnea, and increased blood pressure. Injection-site itching, mild redness, or a small lump can occur.

Anastrozole (an aromatase inhibitor) may be co-prescribed to reduce elevated estradiol; signs of high estrogen include hot flashes, night sweats, irritability, poor sleep, bloating/water retention, and midsection weight gain.

Indications (Off-Label) & Use

Enclomiphene is used off-label for men who have low testosterone with symptoms, who want to preserve fertility, who want to avoid testosterone injections, or who have secondary (hypogonadotropic) hypogonadism. It acts as an estrogen-receptor antagonist in the hypothalamus, increasing GnRH, LH, and FSH, which raises the body's own testosterone production and supports sperm production. Enclomiphene is not FDA-approved.

Contraindications

• Known hypersensitivity to enclomiphene or related compounds (e.g., clomiphene).
• Liver disease or hepatic dysfunction.
• Pituitary or hypothalamic tumors.
• Use caution with elevated prolactin, an MRI is usually recommended before starting.

Warnings & Monitoring

Regularly monitor testosterone and estradiol levels and semen parameters. Long-term safety data is limited, so use caution with chronic use. There is a rare but possible risk of blood clots due to estrogen-receptor modulation.

Common Side Effects

Hot flashes/night sweats, mood swings, headache, visual disturbances (such as blurred vision), nausea or abdominal discomfort, testicular discomfort, changes in erections, poor sleep, edema, and nipple sensitivity. Report visual changes promptly.

What It Is

NAD+ (nicotinamide adenine dinucleotide) is an essential coenzyme that plays a central role in energy production, DNA repair, and cellular health; levels decline with age. Eleva MD offers NAD+ as a subcutaneous injection and as a needle-free nasal/sublingual form.

Tell Your Provider Before Taking If You Have

Cancer or a family history of cancer; liver or kidney disease; diabetes or a metabolic disorder; a cardiovascular condition; a mental health condition; allergies (to NAD+ or vitamin B3); inflammatory or endocrine/thyroid tumors; or if you are pregnant or breastfeeding. Also tell your provider about insulin or blood-sugar medications, blood pressure medications, blood thinners, cancer treatments, antidepressants, and antioxidants.

Common Side Effects

Nausea, diarrhea, or other digestive issues; headaches; flushing (a warm, tingling, or itching feeling under the skin); dizziness; fatigue or difficulty sleeping; and mild increases in heart rate.

Serious Side Effects, Seek Care

• Allergic reactions, hives, rash, facial or throat swelling, difficulty breathing, or rapid heartbeat.
• Liver issues, high doses/long-term use may stress the liver; watch for jaundice, dark urine, or abdominal pain.
• Blood pressure changes, significant drops or spikes, especially with blood pressure medications.
• Persistent or severe nausea, vomiting, or headaches; low platelet counts have been reported in some studies.
• Cancer caution, some animal studies suggest high doses of NAD precursors might affect tumor progression; those with a history of cancer should consult a doctor. NAD supplements are generally not recommended during cancer treatment.

Drug Interactions

Blood-sugar-lowering medicines (insulin, metformin), blood pressure medicines (risk of hypotension), blood thinners (warfarin, monitor INR), chemotherapy, antidepressants, and lipid-lowering agents. Supplements: antioxidants (resveratrol, quercetin, CoQ10), melatonin, and other NAD precursors (NMN, NR, niacinamide) can amplify effects. This is not a complete list.

How to Use & Storage

Injection: warm to room temperature, inspect the vial, clean the site, inject at a 90° angle subcutaneously, and rotate sites; store refrigerated and protected from light, and discard 28 days after first puncture. Nasal/Sublingual: hold under the tongue for up to a minute and avoid eating, drinking, or smoking for at least 5 minutes; store at room temperature away from light. Do not exceed one dose in 24 hours. Do not share; keep away from children and pets.

What It Is & Use

Sermorelin is a growth-hormone-releasing hormone (GHRH) analog that stimulates your pituitary gland to release your body's own growth hormone. It is used off-label to support body composition, recovery, sleep, and healthy aging. It is available as a subcutaneous injection and as a fast-dissolve sublingual (Fast SL) form. Sermorelin is not FDA-approved.

Do Not Use If

• You have a known hypersensitivity to sermorelin.
• You have an active malignancy (growth hormone and IGF-1 may promote tumor growth).
• You are pregnant or breastfeeding.

Warnings & Precautions

Should not be used with an active cancer. Untreated hypothyroidism, obesity, or high blood sugar may reduce the response to therapy, and sermorelin may affect glucose metabolism. Tell your provider about thyroid conditions, diabetes, and all medications, especially thyroid hormone, glucocorticoids (steroids), and insulin or other glucose-lowering medicines.

Common Side Effects

Injection-site reactions (redness, swelling, pain, or itching), flushing, headache, dizziness, nausea, altered taste, and occasionally difficulty swallowing or hyperactivity. Stop and seek care for signs of a serious allergic reaction (swelling of the face or throat, difficulty breathing, hives).

What It Is & Use

Glutathione is the body's master antioxidant, a compound of three amino acids (cysteine, glycine, and glutamine) that helps neutralize toxins and free radicals. It is used off-label to support antioxidant and detoxification pathways and general wellness. Glutathione is not FDA-approved for these uses.

Do Not Use If

• You have a known hypersensitivity or sulfur sensitivity.
• You are pregnant or breastfeeding (insufficient safety data).
• You have asthma, inform your provider, as glutathione may, in some individuals, trigger airway reactions.

Warnings & Precautions

Generally well tolerated. Tell your provider about all medical conditions and medications. Report any signs of an allergic reaction. Skin lightening has been reported with some forms and is not a guaranteed or FDA-approved effect.

Common Side Effects

Abdominal cramping, bloating, loose stools, or, rarely, rash or allergic reaction. With injectable forms, injection-site reactions can occur. Seek care for difficulty breathing, throat or facial swelling, or hives.