Oct 9, 2026 · 7 min · 6 segments
JAMA Medical News Associate Managing Editor Kate Schweitzer and Lead Senior Staff Writer Rita Rubin discuss "Unapproved GLP-1 Drugs Retatrutide and Zenagamtide Sold Online Are No Bargain." **Related…
Kate SchweitzerHost
How is it possible for anyone to market treatments that are actually not yet on the market?
[laughs] I mean, it's likely not surprising that websites have popped up selling what they claim are approved blockbuster GLP-1 receptor agonists, such as semaglutide, for weight loss.
I say claim because some of these products have been found not to contain any of the drugs they say they do.
But what is surprising is the number of websites selling investigational GLP-1 therapies that are not approved anywhere in the world, and therefore cannot legally be sold.
Many websites are trying to get around that with disclaimers saying their products are for research purposes only or not for human use.
But meanwhile, they assure customers that purchases will be plainly wrapped and shipped discreetly.
Of the unapproved GLP-1s being sold online, Eli Lilly's retatrutide, which looks highly promising in phase three trials, appears to be the most popular, in large part due to social media influencers raving about it.
Peter Warisky, who's research director for Public Citizens Health Research Group and the author of a recent report about illegal sales of retatrutide, calls it a cultural phenomenon.
Retatrutide is a triple agonist, which means it activates three different metabolic hormone receptors.
Some research suggests it leads to greater weight loss than the approved GLP-1 drugs.
But as the authors of one of those studies noted, there haven't been head-to-head comparisons of the treatments, and some people might not tolerate retatrutide as well as they would other GLP-1 therapies.
And speaking of tolerability, tell us about reports of people experiencing adverse events from using black market retatrutide.
There haven't been tons of reports, due in part to the fact that there's usually no physician overseeing people who are using retatrutide outside clinical trials, so it's up to the user to report problems to the regulatory authority in their country.
The most serious case came from Australia this past summer, where someone experienced a potentially fatal esophageal tear from uncontrolled vomiting after injecting what they thought was retatrutide.
Turns out there was no retatrutide in the product, only a massive dose of semaglutide, which was not on the label.
And retatrutide isn't the only investigational weight loss treatment being sold online, right?
One is Novo Nordisk's zanagamtide, which is a dual agonist targeting GLP-1 as well as amylin, a pancreatic beta cell peptide hormone that's involved in satiety.
The other one is almorelin tide, another amylin agonist, which Lilly is testing alone and in combination with its approved dual agonist tirzepatide, which is marketed as Zepbound.
People have been talking online about buying almorelin tide and stacking it, which is peptide user lingo for combining it with a GLP-1 receptor agonist.
How is it possible for anyone to market treatments that are actually not yet on the market?
[laughs] I mean, it's likely not surprising that websites have popped up selling what they claim are approved blockbuster GLP-1 receptor agonists, such as semaglutide, for weight loss.
I say claim because some of these products have been found not to contain any of the drugs they say they do.
But what is surprising is the number of websites selling investigational GLP-1 therapies that are not approved anywhere in the world, and therefore cannot legally be sold.
Many websites are trying to get around that with disclaimers saying their products are for research purposes only or not for human use.
But meanwhile, they assure customers that purchases will be plainly wrapped and shipped discreetly.
Of the unapproved GLP-1s being sold online, Eli Lilly's retatrutide, which looks highly promising in phase three trials, appears to be the most popular, in large part due to social media influencers raving about it.
Peter Warisky, who's research director for Public Citizens Health Research Group and the author of a recent report about illegal sales of retatrutide, calls it a cultural phenomenon.
Retatrutide is a triple agonist, which means it activates three different metabolic hormone receptors.
Some research suggests it leads to greater weight loss than the approved GLP-1 drugs.
But as the authors of one of those studies noted, there haven't been head-to-head comparisons of the treatments, and some people might not tolerate retatrutide as well as they would other GLP-1 therapies.
And speaking of tolerability, tell us about reports of people experiencing adverse events from using black market retatrutide.
There haven't been tons of reports, due in part to the fact that there's usually no physician overseeing people who are using retatrutide outside clinical trials, so it's up to the user to report problems to the regulatory authority in their country.
The most serious case came from Australia this past summer, where someone experienced a potentially fatal esophageal tear from uncontrolled vomiting after injecting what they thought was retatrutide.
Turns out there was no retatrutide in the product, only a massive dose of semaglutide, which was not on the label.
And retatrutide isn't the only investigational weight loss treatment being sold online, right?
One is Novo Nordisk's zanagamtide, which is a dual agonist targeting GLP-1 as well as amylin, a pancreatic beta cell peptide hormone that's involved in satiety.
The other one is almorelin tide, another amylin agonist, which Lilly is testing alone and in combination with its approved dual agonist tirzepatide, which is marketed as Zepbound.
People have been talking online about buying almorelin tide and stacking it, which is peptide user lingo for combining it with a GLP-1 receptor agonist.
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