GLP-1,
prescribed properly.

What GLP-1 receptor agonists actually do.

GLP-1 (glucagon-like peptide-1) is a hormone your gut releases in response to eating. It does several useful things at once: it tells the pancreas to release insulin (in a glucose-dependent way, so it doesn't drop you into hypoglycemia), it slows gastric emptying so meals feel longer, and it acts on hypothalamic centers to quiet hunger and food preoccupation.

Semaglutide is a GLP-1 receptor agonist. Tirzepatide is a dual agonist — GLP-1 and GIP (glucose-dependent insulinotropic polypeptide) — which is why it tends to outperform semaglutide on weight outcomes in head-to-head data.

Both compounds were originally developed for type 2 diabetes and approved on the strength of large cardiovascular outcome trials. The weight-loss indications followed. They are among the most-evidenced weight-loss pharmacologies ever developed.

Why "compounded" matters here.

The branded versions of these medications — Ozempic, Wegovy, Mounjaro, Zepbound — have been on FDA shortage lists for much of the period since 2022. While a drug is on shortage, 503A compounding pharmacies are permitted to compound the active ingredient under a valid individual prescription per FDA guidance. That's the legal pathway Pepra operates within.

As of early 2026, semaglutide is moving in and out of shortage status as manufacturer capacity expands; tirzepatide remains constrained. Pepra monitors FDA shortage list status weekly. If a compound moves off the shortage list and compounding becomes restricted, we transition affected patients to the branded product or a clinically appropriate alternative — we don't operate against current FDA guidance.

Who GLP-1 may be for.

• Adults with BMI ≥ 30, or BMI ≥ 27 with at least one weight-related comorbidity (hypertension, type 2 diabetes, sleep apnea, dyslipidemia, fatty liver).
• Adults with type 2 diabetes or pre-diabetes seeking glycemic control alongside weight loss, in coordination with their primary care or endocrinologist.
• Patients who've genuinely tried lifestyle interventions and want pharmacologic support — not as a shortcut, as a tool.

Who it's not for.

• Anyone with personal or strong family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Boxed warning. Non-negotiable.
• Patients with active or history of pancreatitis.
• Pregnancy and active breastfeeding. Pre-conception and lactation planning are part of intake.
• Patients with active eating disorders or recent severe restrictive behavior — GLP-1s amplify food avoidance and worsen outcomes here. Your prescriber screens for this.
• Anyone primarily seeking cosmetic weight loss without a medical indication. We are not a vanity service.

What 12 weeks looks like.

The Pepra GLP-1 program is structured. The titration steps are deliberate — moving up too fast is the most common reason patients stop GLP-1 therapy early.

• Weeks 1–4 — Initiation. Lowest standard starting dose. Most patients feel mild GI effects in the first 5–7 days. We expect this; we plan for it.
• Weeks 5–8 — First step up. Dose increases on a structured schedule. Monthly check-in with your prescriber covers tolerability, food relationship, energy.
• Weeks 9–12 — Maintenance evaluation. Lab refresh (HbA1c, lipids, basic metabolic panel). Decide whether to continue at current dose, step up further, or hold.
• Beyond week 12. A real plan: continued use, dose adjustment, or — when appropriate — a structured taper. We don't run patients on the highest dose forever as a default.

Side-effect profile.

• GI symptoms — nausea, mild constipation, occasional diarrhea — most common in the first 1–2 weeks of each new dose. Usually transient. We prescribe ondansetron alongside if you have a history of motion sensitivity or chemotherapy nausea.
• Reflux — particularly with larger meals. Slowing gastric emptying does what it says on the tin.
• Fatigue in the first 2–3 weeks — your body recalibrates around lower intake. Patients who hydrate aggressively and protect protein intake do best.
• Lean mass loss if protein intake drops with appetite — a real concern. Your prescriber screens for this and will recommend a protein floor.
• Gallbladder events — pancreatitis, cholelithiasis — uncommon but warrant immediate clinical review if symptoms appear. We tell you what to watch for in the dosing primer.

How Pepra GLP-1 differs from the "weight loss telehealth" pattern.

The category has earned skepticism. We are aware. The Pepra program is deliberately structured to look more like primary-care obesity medicine than a checkout flow:

• Mandatory baseline labs for every patient, ordered through Quest or Labcorp at initiation. No exceptions.
• Monthly check-ins with your prescriber, not just refill confirmations. Tolerability, food relationship, lifestyle support.
• Built-in lifestyle scaffolding — protein floor guidance, resistance training prompts, hydration reminders. Without these the protocol underperforms.
• A taper plan from day one. We talk about how you come off this medication on day one of intake.