Medical weight loss has several benefits. It promotes weight loss, it can help improve cardiovascular health, and it can make weight loss so much easier. However, it does come with its side effects. 

You’ve probably noticed one of them… fatigue. 

It’s not uncommon for people to start experiencing fatigue after starting their semaglutide therapy process. 

That is why, during the semaglutide shortage, pharmacies and telehealth clinics created a supercharged version of Ozempic or Wegovy by mixing it with vitamin B12 to give you an extra energy boost and fewer side effects. 

However, after the shortage ended, the legal and medical grounds of compounded semaglutide shifted. So, what if you are considering getting a semaglutide B12 combo? Is it still possible? Is it safe? And what are the costs? 

Here, we are going to go over this powerful combo. Learn the risks, what the evidence says, its legality, and costs. 

Fast Definition

Compounded semaglutide with B12 is a pharmacy-mixed product that combines the GLP-1 drug semaglutide with vitamin B12 (cyanocobalamin). It was marketed to give you an extra “energy” boost and to reduce the side effects often seen with this weight loss medication. 

Why Do Some Pharmacies Add B12?

The practice of adding vitamin B12 to semaglutide injections was based on a mix of marketing claims, anecdotal reports, and a weak scientific foundation. Compounding pharmacies and the clinics that sold their products promoted several key benefits. Here are some of the claims they made:

• Reduced Nausea: One of semaglutide’s most common side effects is nausea. The theory was that B12 could help reduce nausea, making the treatment more tolerable. 
• Increased Energy: Fatigue is another frequent complaint among GLP-1 users. Vitamin B12 is known for its role in energy metabolism, which is why it was positioned as a way to help combat lethargy. 
• Less Injection-Site Pain: Some formulations claimed that B12 helped reduce soreness at the injection site. 

However, does B12 actually speed up weight loss or prevent any side effects like nausea?

What the Evidence Actually Says

When it comes to semaglutide and B12 combo, currently, there is no scientific evidence to back up the claims made by compounding companies. There are currently no randomized controlled trials (RCTs) that have studied the safety or efficacy of this specific mixture. 

Now, the impressive weight-loss results that are often associated with semaglutide all come from major clinical trial programs, like the STEP trials. They studied the effects of semaglutide on weight loss. However, keep in mind that this was on semaglutide alone, not a compounded cocktail. 

The STEP 1 and STEP 8 trials, published in the New England Journal of Medicine, showed significant weight loss in those using semaglutide or liraglutide. These studies are the foundation of its FDA approval. 

However, when it comes to the combination of semaglutide and vitamin B12, the claims are only supported by anecdotal reports and the marketing materials from the clinics that sell them. 

One common concern people often have is whether B12 could interfere with the GLP-1 action. While there is no direct evidence to suggest this, mixing any substance with a powerful medication creates some uncertainty.

Without clinical trials, we don’t know if B12 could alter the absorption, stability, or mechanism of action of semaglutide. The problem is that relying on an unproven mixture means stepping outside the bounds of evidence-based medicine. 

Legal & Regulatory Status (Post-Shortage 2025)

The legal landscape for compounded semaglutide changed on February 21, 2024. On that date, the FDA updated its drug shortages list to declare that all semaglutide products were fully available. This action triggered the end of the regulatory flexibility that had allowed compounding pharmacies to mass-produce semaglutide. 

Under federal law, compounding pharmacies (both 503A and 503B facilities) can only produce copies of commercially available drugs in bulk if that particular drug is on the FDA’s shortage list. However, when the shortage is over, the permission is revoked. The FDA gave pharmacies a grace period (April 22, 2024) to wind down operations. 

Some clinics argue that adding B12 created a “clinically different” product, which would mean it was exempt from these rules. However, the FDA stated that simply mixing in a vitamin does not create a different drug. 

As reported by news outlets like ABC News, the agency is stepping up enforcement against pharmacies that continue to sell unauthorized semaglutide products. The penalties for non-compliance can be severe, including warning letters, fines, and potential shutdowns. 

So, can a doctor still request a compounded semaglutide with B12 prescription for a specific patient?

Technically, a 503A pharmacy can still compound a drug for an individual patient if they have a valid prescription. However, this means that they cannot produce in bulk semaglutide with vitamin B12. 

Salt Form Risk & Dosing Errors

One of the most significant concerns when it comes to compounded semaglutide is the form of the ingredient that is being used. During the shortage, many compounding pharmacies used different salt forms of semaglutide, specifically semaglutide sodium and semaglutide acetate (instead of the pure semaglutide base found in options like Wegovy or Ozempic). 

The FDA issued a specific alert about this issue, warning that these salt forms have different potencies and are not the same active ingredient that proved to be safe and effective in clinical trials. 

As a result, this led to reports of adverse events, including some patients receiving incorrect doses that required immediate medical attention. That is because salt forms behave differently in the body; a dose that seems equivalent on paper may have a much stronger or weaker effect.

So, how do you know if a compounded semaglutide is made with a salt base?

When you are checking the product’s label, look for the term “semaglutide base.” If it lists “semaglutide sodium” or “semaglutide acetate,” it is not the base that is approved by the FDA. In this case, it’s best to speak with your healthcare provider. 

Another important topic is the addition of vitamin B12, since it introduces another risk. Vitamin B12 is typically red, which gives the compounded solution a pink or reddish color. This can mask signs of instability in the semaglutide solution, which might otherwise appear cloudy or discolored. 

More importantly, if B12 does reduce nausea as it claims, it might mask a key warning sign that a patient’s dose is too high. This could lead to an increased dosage too quickly, raising the risks of severe side effects. 

Cost & Availability in Mid-2025

Before the shortage ended, compounded semaglutide with B12 was often priced between $250 and $500 per month. This presented a significant saving compared to the list price of brand-name options like Wegovy, which usually could cost around $1,350 per month. And, even with manufacturer coupons, the cost didn’t go down by more than $850. 

However, as of mid-2024, the availability of these compounded products started to reduce. With the increased legal scrutiny, many of the larger compounding pharmacies, like Empower Pharmacy, have ceased production. Some smaller clinics and online providers may still sell compounded options.

How to Verify a Legitimate Product

If you and your healthcare provider decide that compounded semaglutide is the best option for you, how can you know that you are getting it from a legit and safe pharmacy? Here is a checklist you can follow: 

• Pharmacy Accreditation: Make sure that the pharmacy is accredited by the National Association of Boards of Pharmacy (NABP). This indicates they meet certain quality and safety standards. 
• Ingredient on Label: The label must clearly state it has “semaglutide base,” not a salt form. 
• Separate Vials: If you want to be extra careful, you can ask to receive semaglutide and vitamin B12 in separate vials rather than a pre-mixed solution. This might ensure stability and allow for accurate dosing. 
• Certificate of Analysis: Ask the pharmacy for a certificate of analysis for their semaglutide base. This document proves the raw ingredient has been tested for purity and potency. 
• Traceable Lot Number: The vial should have a lot number that can be traced back to the pharmacy’s production records. 

Now, if the pharmacy is unwilling to provide this documentation, consider it a major red flag. You have the right to know exactly what is in the medication you are using. 

FAQs 

Is compounded semaglutide with B12 still legal in 2025?

For the most part, no. Since the FDA declared the semaglutide shortage was over in February 2024, bulk production of compounded semaglutide for general stock is no longer legal. However, there are some exceptions based on individual patients’ needs. 

Does B12 reduce Ozempic side effects?

Currently, there is no clinical evidence to support adding B12 to semaglutide to reduce side effects such as nausea or fatigue. Any claims made are based on anecdotal reports and are not supported by scientific studies. 

Can I travel with compounded GLP-1?

Yes, you can travel with compounded GLP-1 medication; however, it can be tricky. Since they are not FDA-approved, the rules may vary, especially when traveling internationally. It’s best to carry it in its original packaging with a copy of your prescription and a doctor’s note explaining its medical necessity. 

Key Takeaways & Next Steps

• No Clinical Proof: Currently, there is no evidence to support the addition of vitamin B12 to semaglutide.
• Legality is Tight: Following the end of the FDA-declared shortage, it is illegal for pharmacies to mass-produce semaglutide and vitamin B12 combos. 
• Salt-Form Risk: Many compounded products use unapproved salt forms of semaglutide, which can lead to incorrect dosing and unknown side effects. 
• Modest Savings vs. High Risk: The cost savings of compounded semaglutide versions are reducing and may not be worth the legal and health uncertainties. 
• Verification is Important: If you use any compounded drug, make sure you verify the pharmacy’s credentials and the product’s ingredients. 

Instead of chasing a product with a questionable legal and medical status, the best (and safest) path is to explore FDA-approved options. Talk to your healthcare provider about brand-name options like Wegovy. 

If you still have questions about the pricing of semaglutide, you can use our cost calculator to explore potential savings and more affordable options. Once you are ready, book a telehealth consult with one of our trusted healthcare professionals to discuss the best options based on your goals and needs

BOXED WARNING: RISK OF THYROID C-CELL TUMORS

Rodent studies have shown that semaglutide might increase the risk of thyroid C-cell tumors. It is currently unknown whether semaglutide causes thyroid C-cell tumours, including medullary thyroid carcinoma (MTC), in humans. Still, semaglutide is contraindicated in patients with a personal or family history of MTC or those with Multiple Endocrine Neoplasia syndrome type 2 (MEN-2).

Disclaimer: This blog post is for informational purposes only and does not replace medical advice. Speak to a qualified healthcare professional before making any decisions about your health or treatment.