Safety information

Know what you're taking.

What to watch for with the medications below. If a side effect feels serious, stop taking it and call your prescriber, or 911 in an emergency.

On this page

Prescribed something not listed here? Read the leaflet that comes with it, and ask your prescriber about anything you're unsure of.

Compounded weight-loss injection

Tirzepatide

Compounded tirzepatide is not FDA-approved. This summary follows the label of the FDA-approved form of tirzepatide.

Serious — seek care

  • Pancreatitis. Severe stomach pain that won't go away, with or without vomiting.Stop taking it and get medical help right away.
  • Serious allergic reaction. Swelling of your face, lips, tongue or throat, trouble breathing, severe rash, or fainting.Stop taking it and call 911.
  • Gallbladder problems. Pain in your upper stomach, fever, yellow skin or eyes, or clay-colored stools.Tell your prescriber right away.
  • Mood changes. New or worse depression, or thoughts of hurting yourself.Call your prescriber right away, or call or text 988.
  • Thyroid tumors (the tirzepatide label's most serious warning). A lump or swelling in your neck, trouble swallowing, hoarseness, or shortness of breath.Tell your prescriber.
  • Kidney problems. Severe vomiting or diarrhea can dehydrate you and harm your kidneys.Drink fluids and tell your prescriber.
  • Low blood sugar. If you also take insulin or a sulfonylurea (a diabetes pill such as glipizide): shakiness, sweating, confusion, or a fast heartbeat.Ask your prescriber how to spot and treat it.

Common

  • Nausea, diarrhea, vomiting or constipation, most often after starting or raising the dose
  • Stomach pain, indigestion, burping or acid reflux
  • Less appetite (the intended effect, and also a side effect)
  • Tiredness
  • Redness or itching where you inject
  • Hair loss

Before you start

  • Don't take it if you or anyone in your family has had medullary thyroid cancer, if you have MEN 2 (a rare inherited condition), or if you've had a serious allergic reaction to tirzepatide.
  • Tell your prescriber if you've had pancreatitis, gallbladder or kidney problems, diabetic eye disease, or depression.
  • Birth-control pills can work less well for 4 weeks after you start and for 4 weeks after each dose increase. For those weeks, switch to a non-pill method or add a barrier method such as condoms.
  • If you become pregnant, stop taking it and tell your prescriber.
  • Before any surgery or sedation, tell the doctor doing it that you take tirzepatide.
Compounded injection

NAD+ injection

Compounded NAD+ is not FDA-approved, and there is no FDA label for it. This list is what people commonly report, not an official label.

Serious — seek care

  • Serious allergic reaction. Hives, swelling of your face, lips or throat, or trouble breathing.Call 911.
  • Chest pain or fainting. Chest pain or tightness, or passing out.Call 911.
  • Infection where you inject. Redness that spreads, warmth, pus, or fever.Call your prescriber.

Common

  • Redness, swelling, soreness or a small welt where you inject
  • Flushing, or a feeling of warmth
  • Nausea
  • Headache
  • Tiredness or light-headedness
  • Stomach cramps

Before you start

  • NAD+ side effects are usually mild and pass within hours. They are more likely at higher doses.
  • Tell your prescriber if you're pregnant or breastfeeding. NAD+ injections haven't been studied in pregnancy.
  • Tell your prescriber about any allergies, and every medication and supplement you take.
Compounded nasal spray

NAD+ nasal spray

Compounded NAD+ is not FDA-approved, and there is no FDA label for it in any form. This list is what people commonly report with nasal sprays, not an official label.

Serious — seek care

  • Serious allergic reaction. Hives, swelling of your face, lips or throat, or trouble breathing.Call 911.
  • Sores or heavy bleeding in your nose. Painful sores inside your nose, or a nosebleed that won't stop.Stop using it and call your prescriber.

Common

  • Nose irritation, dryness, crusting or soreness
  • A runny or stuffy nose
  • Nosebleeds

Before you start

  • NAD+ nasal spray hasn't been studied the way approved medicines are, so its side effects aren't well known.
  • Tell your prescriber if you're pregnant or breastfeeding. NAD+ hasn't been studied in pregnancy.
  • Tell your prescriber about any allergies, and every medication and supplement you take.
Compounded peptide injection

Sermorelin injection

Compounded sermorelin is not FDA-approved. A form of it was once FDA-approved but has been discontinued, and its label is no longer available from the FDA, so this list is what people commonly report, not an official label.

Serious — seek care

  • Serious allergic reaction. Hives, swelling of your face, lips or throat, or trouble breathing.Call 911.
  • Itching or trouble swallowing. New itching, or trouble swallowing.Tell your prescriber right away.
  • Infection where you inject. Redness that spreads, warmth, pus, or fever.Call your prescriber.

Common

  • Pain, redness or swelling where you inject
  • Less often: flushing, headache, dizziness, sleepiness, or trouble sitting still

Before you start

  • Tell your prescriber if you have an underactive thyroid. It can stop sermorelin from working.
  • Tell your prescriber if you're pregnant or breastfeeding. There aren't enough studies of sermorelin in breastfeeding to know the risk to a baby.
  • Tell your prescriber about any allergies, and every medication and supplement you take.
Compounded peptide nasal spray

Sermorelin nasal spray

Compounded sermorelin is not FDA-approved, and no nasal spray of it has ever been FDA-approved. There is no current FDA label for sermorelin, so this list is what people commonly report with sermorelin and with nasal sprays, not an official label.

Serious — seek care

  • Serious allergic reaction. Hives, swelling of your face, lips or throat, or trouble breathing.Call 911.
  • Itching or trouble swallowing. New itching, or trouble swallowing.Tell your prescriber right away.
  • Sores or heavy bleeding in your nose. Painful sores inside your nose, or a nosebleed that won't stop.Stop using it and call your prescriber.

Common

  • Nose irritation, dryness, crusting or soreness
  • A runny or stuffy nose
  • Nosebleeds
  • Less often: flushing, headache, dizziness, sleepiness, or trouble sitting still

Before you start

  • Tell your prescriber if you have an underactive thyroid. It can stop sermorelin from working.
  • Tell your prescriber if you're pregnant or breastfeeding. There aren't enough studies of sermorelin in breastfeeding to know the risk to a baby.
  • Tell your prescriber about any allergies, and every medication and supplement you take.
Compounded peptide injection

PT-141 (bremelanotide) injection

Compounded bremelanotide is not FDA-approved. This summary follows the label of the FDA-approved form of bremelanotide.

Serious — seek care

  • Higher blood pressure and a slower heartbeat. Both happen for a while after each dose and usually settle within 12 hours. Using it more often than prescribed raises your blood pressure more, and the risk of heart problems.Never use more than your prescriber tells you to.
  • Darker patches of skin. Dark spots on your face, gums or breasts. They are more likely with darker skin or more frequent use, and may not go away after you stop.Tell your prescriber.
  • Severe nausea. Nausea that is severe or doesn't go away.Tell your prescriber.

Common

  • Nausea, most often after the first dose. It usually lasts about 2 hours and goes away on its own.
  • Flushing or hot flushes
  • Pain, redness, itching, bruising or numbness where you inject
  • Headache
  • Vomiting
  • Tiredness, dizziness or tingling
  • Cough or a stuffy nose

Before you start

  • Don't use it if you have high blood pressure that isn't controlled, or heart disease.
  • Tell your prescriber if you have high blood pressure, heart problems, or kidney or liver problems.
  • Don't use it with naltrexone taken by mouth for alcohol or opioid addiction. Bremelanotide can make the naltrexone fail.
  • Bremelanotide can slow your stomach, so pills you take by mouth, such as antibiotics or pain relievers, may work later or less well. Tell your prescriber about every medication you take.
  • If you could become pregnant, use effective birth control while you take it. If you become pregnant or think you might be, stop taking it and tell your prescriber.
Compounded peptide nasal spray

PT-141 (bremelanotide) nasal spray

Compounded bremelanotide is not FDA-approved, and no nasal spray of it has ever been FDA-approved. This summary follows the label of the FDA-approved form of bremelanotide, which is an injection, for the effects of the medicine itself, plus what nasal sprays commonly do to the nose.

Serious — seek care

  • Higher blood pressure and a slower heartbeat. Both happen for a while after each dose and usually settle within 12 hours. Using it more often than prescribed raises your blood pressure more, and the risk of heart problems.Never use more than your prescriber tells you to.
  • Darker patches of skin. Dark spots on your face, gums or breasts. They are more likely with darker skin or more frequent use, and may not go away after you stop.Tell your prescriber.
  • Severe nausea. Nausea that is severe or doesn't go away.Tell your prescriber.
  • Sores or heavy bleeding in your nose. Painful sores inside your nose, or a nosebleed that won't stop.Stop using it and call your prescriber.

Common

  • Nausea, most often after the first dose. It usually lasts about 2 hours and goes away on its own.
  • Flushing or hot flushes
  • Headache
  • Vomiting
  • Tiredness, dizziness or tingling
  • Cough
  • Nose irritation, dryness, crusting or soreness
  • A runny or stuffy nose
  • Nosebleeds

Before you start

  • Don't use it if you have high blood pressure that isn't controlled, or heart disease.
  • Tell your prescriber if you have high blood pressure, heart problems, or kidney or liver problems.
  • Don't use it with naltrexone taken by mouth for alcohol or opioid addiction. Bremelanotide can make the naltrexone fail.
  • Bremelanotide can slow your stomach, so pills you take by mouth, such as antibiotics or pain relievers, may work later or less well. Tell your prescriber about every medication you take.
  • If you could become pregnant, use effective birth control while you take it. If you become pregnant or think you might be, stop taking it and tell your prescriber.
Compounded injection

Glutathione injection

Compounded glutathione is not FDA-approved, and there is no FDA label for it. This list is what people commonly report, not an official label.

Serious — seek care

  • Serious allergic reaction. Hives, swelling of your face, lips or throat, or trouble breathing.Call 911.
  • Reaction to a contaminated batch. Fever, chills, pain, dizziness or feeling faint after an injection. In 2026 the FDA reported patients with these symptoms after compounded glutathione given by IV that was made with an ingredient not meant for injection.Get medical help right away.
  • Infection where you inject. Redness that spreads, warmth, pus, or fever.Call your prescriber.

Common

  • Redness, swelling or soreness where you inject
  • Nausea or an upset stomach
  • Flushing
  • Gas or loose stools

Before you start

  • Don't use it if you've had an allergic reaction to glutathione.
  • Tell your prescriber if you have liver or kidney disease. Glutathione's safety hasn't been worked out for people with either.
  • Tell your prescriber if you're pregnant, planning to be, or breastfeeding. It isn't known whether glutathione is safe in pregnancy, and it passes into breast milk.
  • Tell your prescriber about any allergies, and every medication and supplement you take.
Compounded nasal spray

Glutathione nasal spray

Compounded glutathione is not FDA-approved, and there is no FDA label for it in any form. This list is what people commonly report with nasal sprays, plus a known risk of breathing glutathione in, not an official label.

Serious — seek care

  • Breathing trouble. Wheezing, coughing, chest tightness or shortness of breath after you use it.Stop using it and get medical help right away.
  • Serious allergic reaction. Hives, swelling of your face, lips or throat, or trouble breathing.Call 911.
  • Sores or heavy bleeding in your nose. Painful sores inside your nose, or a nosebleed that won't stop.Stop using it and call your prescriber.

Common

  • Nose irritation, dryness, crusting or soreness
  • A runny or stuffy nose
  • Nosebleeds

Before you start

  • Tell your prescriber if you have asthma. Glutathione breathed in as a mist has tightened the airways of people with mild asthma, causing coughing and breathlessness.
  • Don't use it if you've had an allergic reaction to glutathione.
  • Tell your prescriber if you have liver or kidney disease. Glutathione's safety hasn't been worked out for people with either.
  • Tell your prescriber if you're pregnant, planning to be, or breastfeeding. It isn't known whether glutathione is safe in pregnancy, and it passes into breast milk.
  • Tell your prescriber about any allergies, and every medication and supplement you take.
Compounded vitamin injection

Vitamin B12 injection

Compounded vitamin B12 is not FDA-approved. This summary follows the label of the FDA-approved vitamin B12 injection (cyanocobalamin).

Serious — seek care

  • Serious allergic reaction. Hives, swelling of your face, lips or throat, trouble breathing, or fainting.Call 911.
  • Fluid in the lungs or heart failure. Shortness of breath, or new swelling in your legs, most often early in treatment.Get medical help right away.
  • Blood clot. Pain, swelling, warmth or redness in an arm or leg.Get medical help right away.

Common

  • Mild diarrhea that passes
  • Itching
  • A rash that passes
  • A feeling of swelling all over your body

Before you start

  • Don't take it if you're sensitive to cobalt or to vitamin B12.
  • Tell your prescriber if you have Leber's disease (an inherited condition of the eye's nerve). In people with it, vitamin B12 injections have quickly caused severe damage to the optic nerve.
  • Tell your prescriber if you have severe anemia. Treating it fast with vitamin B12 can lower your potassium enough to be life-threatening.
  • Tell your prescriber about any allergies, and every medication and supplement you take.
Compounded vitamin and lipotropic injection

Lipo-C injection

Compounded Lipo-C is not FDA-approved. For its vitamin C, this summary follows the label of the FDA-approved vitamin C injection. Its lipotropic ingredients have no FDA label, so for them it lists what is commonly reported.

Serious — seek care

  • Serious allergic reaction. Hives, swelling of your face, lips or throat, or trouble breathing.Call 911.
  • Kidney stones. Severe pain in your side or back, pain when you pee, or blood in your urine.Tell your prescriber right away.
  • Destruction of red blood cells. If you have G6PD deficiency: weakness, pale or yellow skin, yellow eyes, or dark urine.Get medical help right away.
  • Skin reaction where you inject. A hard, painful lump or inflamed skin where you inject that doesn't go away.Tell your prescriber.
  • Infection where you inject. Redness that spreads, warmth, pus, or fever.Call your prescriber.

Common

  • Pain, swelling or redness where you inject

Before you start

  • Little research has looked at the safety of lipotropic injections.
  • Tell your prescriber if you have kidney disease or have had kidney stones. Large amounts of vitamin C over a long time have damaged kidneys and caused stones.
  • Tell your prescriber if you have G6PD deficiency (an inherited blood condition). In people with it, vitamin C can destroy red blood cells.
  • Vitamin C can make blood and urine sugar tests read wrong for up to 24 hours. If you check your blood sugar, tell your prescriber.
  • Vitamin C can make some antibiotics, and amphetamine medicines, work less well.
  • Tell your prescriber about any allergies, and every medication and supplement you take.
Compounded medication

Methylene blue

Compounded methylene blue is not FDA-approved. This summary follows the label of the FDA-approved form of methylene blue, which is given into a vein.

Serious — seek care

  • Serotonin syndrome. Agitation, confusion or seeing things that aren't there, a fast heartbeat, sweating, fever, shaking, stiff or twitching muscles, or seizures, sometimes with nausea, vomiting or diarrhea.Stop taking it and get medical help right away.
  • Serious allergic reaction. Hives, swelling of your face, lips or throat, or wheezing or trouble breathing.Stop taking it and call 911.
  • Destruction of red blood cells. Weakness, tiredness, or pale or yellow skin or eyes. It can start a day or more after you take it.Tell your prescriber right away.

Common

  • Blue urine or other body fluids, or a blue tint to your skin
  • Headache
  • Nausea or diarrhea
  • Dizziness, confusion or blurred vision
  • Muscle twitches or jerks
  • Low potassium or magnesium on blood tests

Before you start

  • Don't take it if you've had a serious allergic reaction to methylene blue or a similar dye, or if you have G6PD deficiency (an inherited blood condition): it can destroy your red blood cells.
  • Don't take it with medicines that raise serotonin, including antidepressants (SSRIs, SNRIs or MAOIs), opioid pain medicines, and the cough medicine dextromethorphan. Together they can cause serotonin syndrome, which can be fatal. This is the methylene blue label's most serious warning.
  • Tell your prescriber about every medication you take, especially any for depression or migraine.
  • It may harm an unborn baby. Tell your prescriber if you're pregnant or could become pregnant.
  • Don't breastfeed while you take it, or for up to 8 days after your last dose.
  • Tell your prescriber if you have kidney or liver problems.
  • It can cause confusion, dizziness or blurred vision. Don't drive or use machines until these have passed.
  • It can make finger-clip oxygen readings and some urine tests wrong. Tell anyone testing you that you take it.
  • It can make your skin react to light. Protect your skin from strong light.
Compounded combination

Tirzepatide & sermorelin stack

Compounded tirzepatide and sermorelin are not FDA-approved. This plan combines the two, so the warnings for each apply, listed together below. The tirzepatide warnings follow the label of the FDA-approved form of tirzepatide. Sermorelin has no current FDA label, so its warnings are what people commonly report.

Serious — seek care

  • Pancreatitis. Severe stomach pain that won't go away, with or without vomiting.Stop taking it and get medical help right away.
  • Serious allergic reaction. Swelling of your face, lips, tongue or throat, trouble breathing, severe rash, or fainting.Stop taking it and call 911.
  • Gallbladder problems. Pain in your upper stomach, fever, yellow skin or eyes, or clay-colored stools.Tell your prescriber right away.
  • Mood changes. New or worse depression, or thoughts of hurting yourself.Call your prescriber right away, or call or text 988.
  • Thyroid tumors (the tirzepatide label's most serious warning). A lump or swelling in your neck, trouble swallowing, hoarseness, or shortness of breath.Tell your prescriber.
  • Kidney problems. Severe vomiting or diarrhea can dehydrate you and harm your kidneys.Drink fluids and tell your prescriber.
  • Low blood sugar. If you also take insulin or a sulfonylurea (a diabetes pill such as glipizide): shakiness, sweating, confusion, or a fast heartbeat.Ask your prescriber how to spot and treat it.
  • Itching or trouble swallowing. New itching, or trouble swallowing.Tell your prescriber right away.
  • Infection where you inject. Redness that spreads, warmth, pus, or fever.Call your prescriber.

Common

  • Nausea, diarrhea, vomiting or constipation, most often after starting or raising the dose
  • Stomach pain, indigestion, burping or acid reflux
  • Less appetite (the intended effect, and also a side effect)
  • Tiredness
  • Redness, itching, pain or swelling where you inject
  • Hair loss
  • Less often: flushing, headache, dizziness, sleepiness, or trouble sitting still

Before you start

  • Don't take it if you or anyone in your family has had medullary thyroid cancer, if you have MEN 2 (a rare inherited condition), or if you've had a serious allergic reaction to tirzepatide.
  • Tell your prescriber if you've had pancreatitis, gallbladder or kidney problems, diabetic eye disease, or depression.
  • Birth-control pills can work less well for 4 weeks after you start and for 4 weeks after each dose increase. For those weeks, switch to a non-pill method or add a barrier method such as condoms.
  • If you become pregnant, stop taking it and tell your prescriber.
  • Before any surgery or sedation, tell the doctor doing it that you take tirzepatide.
  • Tell your prescriber if you have an underactive thyroid. It can stop sermorelin from working.
  • Tell your prescriber if you're pregnant or breastfeeding. There aren't enough studies of sermorelin in breastfeeding to know the risk to a baby.
  • Tell your prescriber about any allergies, and every medication and supplement you take.
Compounded combination

Tirzepatide, NAD+ & sermorelin stack

Compounded tirzepatide, NAD+ and sermorelin are not FDA-approved. This plan combines the three, so the warnings for each apply, listed together below. The tirzepatide warnings follow the label of the FDA-approved form of tirzepatide. NAD+ and sermorelin have no current FDA label, so their warnings are what people commonly report.

Serious — seek care

  • Pancreatitis. Severe stomach pain that won't go away, with or without vomiting.Stop taking it and get medical help right away.
  • Serious allergic reaction. Swelling of your face, lips, tongue or throat, trouble breathing, severe rash, or fainting.Stop taking it and call 911.
  • Gallbladder problems. Pain in your upper stomach, fever, yellow skin or eyes, or clay-colored stools.Tell your prescriber right away.
  • Mood changes. New or worse depression, or thoughts of hurting yourself.Call your prescriber right away, or call or text 988.
  • Thyroid tumors (the tirzepatide label's most serious warning). A lump or swelling in your neck, trouble swallowing, hoarseness, or shortness of breath.Tell your prescriber.
  • Kidney problems. Severe vomiting or diarrhea can dehydrate you and harm your kidneys.Drink fluids and tell your prescriber.
  • Low blood sugar. If you also take insulin or a sulfonylurea (a diabetes pill such as glipizide): shakiness, sweating, confusion, or a fast heartbeat.Ask your prescriber how to spot and treat it.
  • Chest pain or fainting. Chest pain or tightness, or passing out.Call 911.
  • Infection where you inject. Redness that spreads, warmth, pus, or fever.Call your prescriber.
  • Itching or trouble swallowing. New itching, or trouble swallowing.Tell your prescriber right away.

Common

  • Nausea, diarrhea, vomiting or constipation, most often after starting or raising the dose
  • Stomach pain, indigestion, burping or acid reflux
  • Less appetite (the intended effect, and also a side effect)
  • Tiredness
  • Redness, itching, swelling, soreness, a small welt or pain where you inject
  • Hair loss
  • Flushing, or a feeling of warmth
  • Headache
  • Light-headedness
  • Stomach cramps
  • Less often: dizziness, sleepiness or trouble sitting still

Before you start

  • Don't take it if you or anyone in your family has had medullary thyroid cancer, if you have MEN 2 (a rare inherited condition), or if you've had a serious allergic reaction to tirzepatide.
  • Tell your prescriber if you've had pancreatitis, gallbladder or kidney problems, diabetic eye disease, or depression.
  • Birth-control pills can work less well for 4 weeks after you start and for 4 weeks after each dose increase. For those weeks, switch to a non-pill method or add a barrier method such as condoms.
  • If you become pregnant, stop taking it and tell your prescriber.
  • Before any surgery or sedation, tell the doctor doing it that you take tirzepatide.
  • NAD+ side effects are usually mild and pass within hours. They are more likely at higher doses.
  • Tell your prescriber if you're pregnant or breastfeeding. NAD+ injections haven't been studied in pregnancy.
  • Tell your prescriber about any allergies, and every medication and supplement you take.
  • Tell your prescriber if you have an underactive thyroid. It can stop sermorelin from working.
  • Tell your prescriber if you're pregnant or breastfeeding. There aren't enough studies of sermorelin in breastfeeding to know the risk to a baby.
Compounded combination

NAD+ & glutathione stack

Compounded NAD+ and glutathione are not FDA-approved. This plan combines the two, so the warnings for each apply, listed together below. Neither has an FDA label, so these are what people commonly report, not an official label.

Serious — seek care

  • Serious allergic reaction. Hives, swelling of your face, lips or throat, or trouble breathing.Call 911.
  • Chest pain or fainting. Chest pain or tightness, or passing out.Call 911.
  • Infection where you inject. Redness that spreads, warmth, pus, or fever.Call your prescriber.
  • Reaction to a contaminated batch. Fever, chills, pain, dizziness or feeling faint after an injection. In 2026 the FDA reported patients with these symptoms after compounded glutathione given by IV that was made with an ingredient not meant for injection.Get medical help right away.

Common

  • Redness, swelling, soreness or a small welt where you inject
  • Flushing, or a feeling of warmth
  • Nausea
  • Headache
  • Tiredness or light-headedness
  • Stomach cramps
  • An upset stomach
  • Gas or loose stools

Before you start

  • NAD+ side effects are usually mild and pass within hours. They are more likely at higher doses.
  • Tell your prescriber if you're pregnant or breastfeeding. NAD+ injections haven't been studied in pregnancy.
  • Tell your prescriber about any allergies, and every medication and supplement you take.
  • Don't use it if you've had an allergic reaction to glutathione.
  • Tell your prescriber if you have liver or kidney disease. Glutathione's safety hasn't been worked out for people with either.
  • Tell your prescriber if you're pregnant, planning to be, or breastfeeding. It isn't known whether glutathione is safe in pregnancy, and it passes into breast milk.
Emergency

If something feels wrong, don't wait for us.

Severe stomach pain, chest pain, trouble breathing, swelling of the face or throat, or fainting — call 911 immediately. Do not wait for our team to respond to a message.

Call 911