Semaglutide base, acetate or sodium? The question almost nobody asks
FDA has repeatedly distinguished semaglutide base — the active ingredient in the approved products — from salt forms such as semaglutide sodium and semaglutide acetate, and has linked the salt forms to safety concerns. It is one of the few technical details a patient can verify before paying.
| Question | Good answer | Incomplete answer | The answer that ends it |
|---|---|---|---|
| Which form does your pharmacy compound from? | Semaglutide base, named explicitly | ‘Pharmaceutical-grade semaglutide’ | Cannot say / proprietary |
| Can I see a certificate of analysis for my lot? | Yes, provided on request | Available from the pharmacy on request | No COA process |
| Which pharmacy fills the prescription? | Named, with a state licence number | ‘A licensed 503A partner’ | Proprietary partnership |
| Is anything else in the vial? | Stated, e.g. B12, with a reason | ‘Proprietary blend’ | Not disclosed |
| What is the beyond-use date? | Printed on the vial | Roughly 28 days | Not stated |
Why the distinction matters
The approved products contain semaglutide base. A salt form is a chemically different substance with different properties, and it is not what the pivotal STEP trials studied. FDA has been explicit that salt forms are not the same active ingredient as the approved drug.
This became a live issue when the compounded market expanded rapidly during the shortage and some supply chains sourced whatever active ingredient was available.
The B12 question
Many compounders add cyanocobalamin to semaglutide. Two things are true at once: it is a formulation choice, and it is also an argument that a combination product is not essentially a copy of an approved drug, which matters for what may lawfully be compounded after the 2025 deadlines.
Programmes marketing B12 as a clinical enhancement are marketing a regulatory position as a feature. Ask what is in the vial and why, and judge the answer on whether it is specific.
What the answer tells you
A programme that answers precisely supervises its supply chain closely enough to know. One that cannot answer has told you how far its oversight extends, whatever its price says.