{
 "accessed": "2026-08-05",
 "sources": [
  {
   "id": "pi-zepbound-dailymed",
   "title": "ZEPBOUND (tirzepatide) injection \u2014 full prescribing information",
   "publisher": "DailyMed, US National Library of Medicine",
   "url": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b",
   "kind": "Regulatory labeling",
   "supports": "The dose ladder (2.5 mg initiation for four weeks, 2.5 mg increments at intervals of at least four weeks, 15 mg maximum), the statement that 2.5 mg is not approved as a maintenance dosage, injection sites and rotation, storage, contraindications (MTC and MEN 2, serious hypersensitivity), the boxed warning on rodent thyroid C-cell tumours, and the warnings on severe gastrointestinal reactions, acute kidney injury from volume depletion, gallbladder disease and pancreatitis.",
   "accessed": "2026-08-05"
  },
  {
   "id": "pi-zepbound-pdf",
   "title": "ZEPBOUND highlights of prescribing information (2026 revision, PDF)",
   "publisher": "US Food and Drug Administration, Drugs@FDA",
   "url": "https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/217806s042lbl.pdf",
   "kind": "Regulatory labeling",
   "supports": "The current approved label including the dosing schedule applying to all approved indications, and the note that routine calcitonin monitoring or thyroid ultrasound is of uncertain value for early MTC detection.",
   "accessed": "2026-08-05"
  },
  {
   "id": "fda-503a-503b",
   "title": "FD&C Act provisions that apply to human drug compounding",
   "publisher": "US Food and Drug Administration",
   "url": "https://www.fda.gov/drugs/human-drug-compounding/fdc-act-provisions-apply-human-drug-compounding",
   "kind": "Regulatory framework",
   "supports": "The distinction between section 503A compounding by a licensed pharmacist in a state-licensed pharmacy and section 503B compounding within an FDA-registered outsourcing facility, and the different requirements attaching to each.",
   "accessed": "2026-08-05"
  },
  {
   "id": "fda-503a-guidance",
   "title": "Pharmacy compounding of human drug products under section 503A \u2014 final guidance",
   "publisher": "US Food and Drug Administration",
   "url": "https://www.fda.gov/regulatory-information/search-fda-guidance-documents/pharmacy-compounding-human-drug-products-under-section-503a-federal-food-drug-and-cosmetic-act",
   "kind": "Regulatory guidance",
   "supports": "The conditions under which a compounded drug is exempt from new drug approval, current good manufacturing practice and adequate-directions-for-use requirements \u2014 that is, why a compounded preparation is lawful without being FDA-approved.",
   "accessed": "2026-08-05"
  },
  {
   "id": "fda-503b-guidance",
   "title": "Registration for human drug compounding outsourcing facilities under section 503B",
   "publisher": "US Food and Drug Administration",
   "url": "https://www.fda.gov/regulatory-information/search-fda-guidance-documents/registration-human-drug-compounding-outsourcing-facilities-under-section-503b-federal-food-drug-and",
   "kind": "Regulatory guidance",
   "supports": "What registration as an outsourcing facility involves, used on our 503A versus 503B page.",
   "accessed": "2026-08-05"
  },
  {
   "id": "fda-glp1-concerns",
   "title": "FDA's concerns with unapproved GLP-1 drugs used for weight loss",
   "publisher": "US Food and Drug Administration",
   "url": "https://www.fda.gov/drugs/drug-alerts-and-statements/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss",
   "kind": "Safety communication",
   "supports": "That compounded drugs should only be used where an FDA-approved drug cannot meet the patient's need and should be filled at a state-licensed pharmacy; FDA's import alert on GLP-1 active pharmaceutical ingredient from certain manufacturers; enforcement touching telehealth marketing of retatrutide and API distributors selling it; the existence of fraudulent compounded semaglutide and tirzepatide carrying false product information; and complaints that compounded GLP-1 shipments arrived warm or with inadequate ice packs.",
   "accessed": "2026-08-05"
  },
  {
   "id": "fda-30-letters",
   "title": "FDA warns 30 telehealth companies against illegal marketing of compounded GLP-1s",
   "publisher": "US Food and Drug Administration (press announcement)",
   "url": "https://www.fda.gov/news-events/press-announcements/fda-warns-30-telehealth-companies-against-illegal-marketing-compounded-glp-1s",
   "kind": "Enforcement",
   "supports": "That 30 warning letters were issued to telehealth companies for false or misleading claims; that the primary violations were claims implying sameness with FDA-approved products and obscuring product sourcing by branding a compounded product with the telehealth firm's own name; and FDA's statement that compounded drugs are not FDA-approved, are not reviewed for safety, effectiveness or quality before marketing, and are not the same as generic drugs.",
   "accessed": "2026-08-05"
  },
  {
   "id": "fda-api-action",
   "title": "FDA intends to take action against non-FDA-approved GLP-1 drugs",
   "publisher": "US Food and Drug Administration (commissioner's statement)",
   "url": "https://www.fda.gov/news-events/press-announcements/fda-intends-take-action-against-non-fda-approved-glp-1-drugs",
   "kind": "Enforcement",
   "supports": "FDA's stated intent to restrict GLP-1 active pharmaceutical ingredients used in non-approved compounded drugs that are mass-marketed as alternatives to approved products, and its position that promotional materials may not claim compounded products are generic versions of, the same as, or clinically proven equivalent to FDA-approved drugs.",
   "accessed": "2026-08-05"
  },
  {
   "id": "fda-shortage-resolved",
   "title": "FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize",
   "publisher": "US Food and Drug Administration",
   "url": "https://www.fda.gov/drugs/drug-alerts-and-statements/fda-clarifies-policies-compounders-national-glp-1-supply-begins-stabilize",
   "kind": "Supply status",
   "supports": "That FDA determined the tirzepatide injection shortage resolved on 2 October 2024, and the reminder of legal restrictions on compounding copies of FDA-approved drugs \u2014 the regulatory hinge behind the restructuring of the compounded market.",
   "accessed": "2026-08-05"
  },
  {
   "id": "surmount-1-nejm",
   "title": "Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1)",
   "publisher": "New England Journal of Medicine 2022;387:205-216",
   "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa2206038",
   "kind": "Randomized controlled trial",
   "supports": "The headline weight-reduction figures at 72 weeks across the 5, 10 and 15 mg arms against placebo, and the adverse-event frequencies quoted throughout the side-effect cluster.",
   "accessed": "2026-08-05"
  },
  {
   "id": "surmount-1-pubmed",
   "title": "SURMOUNT-1 \u2014 PubMed record (PMID 35658024)",
   "publisher": "PubMed, US National Library of Medicine",
   "url": "https://pubmed.ncbi.nlm.nih.gov/35658024/",
   "kind": "Bibliographic record",
   "supports": "Abstract and citation metadata for SURMOUNT-1, for readers without journal access.",
   "accessed": "2026-08-05"
  },
  {
   "id": "surmount-3-natmed",
   "title": "Tirzepatide after intensive lifestyle intervention (SURMOUNT-3)",
   "publisher": "Nature Medicine 2023",
   "url": "https://doi.org/10.1038/s41591-023-02597-w",
   "kind": "Randomized controlled trial",
   "supports": "Weight reduction achieved after a lifestyle-intervention lead-in, used where we distinguish drug effect from lifestyle effect.",
   "accessed": "2026-08-05"
  },
  {
   "id": "ctgov",
   "title": "ClinicalTrials.gov study records",
   "publisher": "US National Library of Medicine",
   "url": "https://clinicaltrials.gov/",
   "kind": "Trial registry",
   "supports": "Registration, design, population, arms and endpoint for every trial in our library. Each trial page links directly to its own registry record by NCT number.",
   "accessed": "2026-08-05"
  },
  {
   "id": "nabp-boards",
   "title": "Boards of pharmacy directory",
   "publisher": "National Association of Boards of Pharmacy",
   "url": "https://nabp.pharmacy/about/boards-of-pharmacy/",
   "kind": "Regulator directory",
   "supports": "How to reach the licensee lookup for each state regulator named on our state pages.",
   "accessed": "2026-08-05"
  },
  {
   "id": "fda-besaferx",
   "title": "BeSafeRx \u2014 safely buying prescription medicines online",
   "publisher": "US Food and Drug Administration",
   "url": "https://www.fda.gov/drugs/quick-tips-buying-medicines-over-internet/besaferx-your-source-online-pharmacy-information",
   "kind": "Consumer guidance",
   "supports": "The consumer-facing checks behind our provider red-flag and verification pages.",
   "accessed": "2026-08-05"
  }
 ],
 "trials": [
  {
   "name": "SURMOUNT-1",
   "nct": "NCT04184622",
   "doi": "10.1056/NEJMoa2206038",
   "citation": "N Engl J Med 2022;387:205-216",
   "registry_url": "https://clinicaltrials.gov/study/NCT04184622",
   "doi_url": "https://doi.org/10.1056/NEJMoa2206038"
  },
  {
   "name": "SURMOUNT-5",
   "nct": "NCT05822830",
   "doi": "10.1056/NEJMoa2416394",
   "citation": "N Engl J Med 2025;392:1929-1942",
   "registry_url": "https://clinicaltrials.gov/study/NCT05822830",
   "doi_url": "https://doi.org/10.1056/NEJMoa2416394"
  },
  {
   "name": "SURMOUNT-4",
   "nct": "NCT04660643",
   "doi": "10.1001/jama.2023.24945",
   "citation": "JAMA 2024;331:38-48",
   "registry_url": "https://clinicaltrials.gov/study/NCT04660643",
   "doi_url": "https://doi.org/10.1001/jama.2023.24945"
  },
  {
   "name": "SURMOUNT-OSA",
   "nct": "NCT05412004",
   "doi": "10.1056/NEJMoa2404881",
   "citation": "N Engl J Med 2024;391:1193-1205",
   "registry_url": "https://clinicaltrials.gov/study/NCT05412004",
   "doi_url": "https://doi.org/10.1056/NEJMoa2404881"
  },
  {
   "name": "SURPASS-2",
   "nct": "NCT03987919",
   "doi": "10.1056/NEJMoa2107519",
   "citation": "N Engl J Med 2021;385:503-515",
   "registry_url": "https://clinicaltrials.gov/study/NCT03987919",
   "doi_url": "https://doi.org/10.1056/NEJMoa2107519"
  },
  {
   "name": "SURPASS-CVOT",
   "nct": "NCT04255433",
   "doi": "10.1056/NEJMoa2500675",
   "citation": "N Engl J Med 2025 (presented ADA 2025)",
   "registry_url": "https://clinicaltrials.gov/study/NCT04255433",
   "doi_url": "https://doi.org/10.1056/NEJMoa2500675"
  },
  {
   "name": "SUMMIT",
   "nct": "NCT04847557",
   "doi": "10.1056/NEJMoa2410027",
   "citation": "N Engl J Med 2025;392:427-437",
   "registry_url": "https://clinicaltrials.gov/study/NCT04847557",
   "doi_url": "https://doi.org/10.1056/NEJMoa2410027"
  },
  {
   "name": "SURMOUNT-3",
   "nct": "NCT04657016",
   "doi": "10.1038/s41591-023-02597-w",
   "citation": "Nat Med 2023;29:2909-2918",
   "registry_url": "https://clinicaltrials.gov/study/NCT04657016",
   "doi_url": "https://doi.org/10.1038/s41591-023-02597-w"
  },
  {
   "name": "SURMOUNT-2",
   "nct": "NCT04657003",
   "doi": "10.1016/S0140-6736(23)01200-X",
   "citation": "Lancet 2023;402:613-626",
   "registry_url": "https://clinicaltrials.gov/study/NCT04657003",
   "doi_url": "https://doi.org/10.1016/S0140-6736(23)01200-X"
  },
  {
   "name": "ATTAIN-1",
   "nct": "NCT05869903",
   "doi": "10.1056/NEJMoa2511774",
   "citation": "N Engl J Med 2025 / FDA approval April 2026",
   "registry_url": "https://clinicaltrials.gov/study/NCT05869903",
   "doi_url": "https://doi.org/10.1056/NEJMoa2511774"
  },
  {
   "name": "STEP-1",
   "nct": "NCT03548935",
   "doi": "10.1056/NEJMoa2032183",
   "citation": "N Engl J Med 2021;384:989-1002",
   "registry_url": "https://clinicaltrials.gov/study/NCT03548935",
   "doi_url": "https://doi.org/10.1056/NEJMoa2032183"
  },
  {
   "name": "SELECT",
   "nct": "NCT03574597",
   "doi": "10.1056/NEJMoa2307563",
   "citation": "N Engl J Med 2023;389:2221-2232",
   "registry_url": "https://clinicaltrials.gov/study/NCT03574597",
   "doi_url": "https://doi.org/10.1056/NEJMoa2307563"
  },
  {
   "name": "STEP-8",
   "nct": "NCT03611582",
   "doi": "10.1001/jama.2021.23619",
   "citation": "JAMA 2022;327:138-150",
   "registry_url": "https://clinicaltrials.gov/study/NCT03611582",
   "doi_url": "https://doi.org/10.1001/jama.2021.23619"
  },
  {
   "name": "GIP receptor pharmacology",
   "nct": "\u2014",
   "doi": "10.1038/s41574-023-00868-7",
   "citation": "Reviews in Cell Metab / Nat Rev Endocrinol 2023\u20132025",
   "registry_url": "https://clinicaltrials.gov/study/\u2014",
   "doi_url": "https://doi.org/10.1038/s41574-023-00868-7"
  },
  {
   "name": "SURPASS-1",
   "nct": "NCT03954834",
   "doi": "10.1016/S0140-6736(21)01324-6",
   "citation": "Lancet 2021;398:143-155",
   "registry_url": "https://clinicaltrials.gov/study/NCT03954834",
   "doi_url": "https://doi.org/10.1016/S0140-6736(21)01324-6"
  },
  {
   "name": "SURPASS-3",
   "nct": "NCT03882970",
   "doi": "10.1016/S0140-6736(21)01443-4",
   "citation": "Lancet 2021;398:583-598",
   "registry_url": "https://clinicaltrials.gov/study/NCT03882970",
   "doi_url": "https://doi.org/10.1016/S0140-6736(21)01443-4"
  },
  {
   "name": "SURPASS-4",
   "nct": "NCT03730662",
   "doi": "10.1016/S0140-6736(21)02188-7",
   "citation": "Lancet 2021;398:1811-1824",
   "registry_url": "https://clinicaltrials.gov/study/NCT03730662",
   "doi_url": "https://doi.org/10.1016/S0140-6736(21)02188-7"
  },
  {
   "name": "SURPASS J-mono",
   "nct": "NCT03861052",
   "doi": "10.1016/S2213-8587(22)00188-7",
   "citation": "Lancet Diabetes Endocrinol 2022;10:623-633",
   "registry_url": "https://clinicaltrials.gov/study/NCT03861052",
   "doi_url": "https://doi.org/10.1016/S2213-8587(22)00188-7"
  },
  {
   "name": "Tirzepatide cardiovascular meta-analysis",
   "nct": "Not applicable \u2014 pre-specified meta-analysis of registered trials",
   "doi": "10.1038/s41591-022-01707-4",
   "citation": "Nat Med 2022;28:591-598",
   "registry_url": "https://clinicaltrials.gov/study/Not applicable \u2014 pre-specified meta-analysis of registered trials",
   "doi_url": "https://doi.org/10.1038/s41591-022-01707-4"
  },
  {
   "name": "Time to weight plateau (SURMOUNT-1 and -4 analysis)",
   "nct": "NCT04184622 and NCT04660643",
   "doi": "10.1111/cob.12734",
   "citation": "Clin Obes 2025",
   "registry_url": "https://clinicaltrials.gov/study/NCT04184622 and NCT04660643",
   "doi_url": "https://doi.org/10.1111/cob.12734"
  }
 ],
 "unsourced": [
  {
   "claim": "Program prices",
   "reason": "Prices are recorded from each program's own published material or, where flagged, from a named third-party review. They are commercial facts with no authoritative registry, they change without notice, and they carry a verification date rather than a citation. Where two sources disagree we publish both."
  },
  {
   "claim": "Service quality and shipping reliability",
   "reason": "We hold no measurement of these we would defend, so we do not score them and do not cite anything for them."
  },
  {
   "claim": "Local clinic pricing",
   "reason": "The $400\u2013$600 range quoted on metro pages is a market observation, not a surveyed figure. It is labeled as such rather than presented as data."
  },
  {
   "claim": "Real-world versus trial results",
   "reason": "The claim that real-world weight reduction runs below trial averages is well established across the class, but the precise gap varies by cohort and we do not attach a single number to it."
  }
 ]
}