GLP-1 and peptides, explained plainly.

Ziconotide

Intrathecal peptide analgesic for severe chronic pain in selected patients.

Non-opioid analgesia when other therapies are inadequate.

Severe neuropsychiatric/cognitive effects, dizziness, ataxia and infection risk; contraindicated with history of psychosis.

Icatibant and ecallantide

Peptide-pathway treatments for acute hereditary angioedema attacks.

Can shorten attacks when used promptly.

Injection reactions; ecallantide can cause anaphylaxis and requires supervised administration.

Bivalirudin and eptifibatide

Short peptide medicines used around acute coronary or catheter procedures.

Reduce procedure-related thrombosis in labeled settings.

Bleeding and thrombocytopenia; dosing depends on renal/clinical factors.

Enfuvirtide

HIV fusion-inhibitor peptide used with other antiretroviral drugs in treatment-experienced patients.

Can suppress resistant HIV as part of an effective regimen.

Frequent injection-site reactions, hypersensitivity and pneumonia signal.

Etelcalcetide

Peptide calcimimetic given during hemodialysis.

Lowers parathyroid hormone in dialysis patients.

Hypocalcemia, QT-related risk, nausea/vomiting and heart-failure concerns.

Pegcetacoplan and zilucoplan

Peptide-based complement inhibitors; indications include PNH/GA for pegcetacoplan products and generalized myasthenia gravis for zilucoplan.

Can reduce complement-mediated tissue damage in specific diseases.

Serious infection risk, especially encapsulated bacteria; injection reactions and product-specific ocular/systemic risks. Vaccination/risk plans are essential.

Motixafortide

Cyclic-peptide CXCR4 inhibitor used with filgrastim to mobilize stem cells for autologous transplant in multiple myeloma.

Improves collection of mobilized stem cells.

Injection reactions, hypersensitivity, leukocytosis and procedure-related risks.

Glatiramer acetate

Synthetic polypeptide mixture used as disease-modifying therapy.

Reduces relapse activity in labeled MS populations.

Injection reactions, lipoatrophy and immediate post-injection chest pain/flushing/dyspnea; rare serious hypersensitivity.

Romiplostim

Thrombopoietin-receptor peptibody that raises platelet production.

Can reduce bleeding risk in chronic ITP when indicated.

Excess platelets/thrombosis, marrow reticulin changes and rebound thrombocytopenia; headache/joint symptoms.

Radiolabeled somatostatin analogues

Gallium Ga-68 dotatate imaging and lutetium Lu-177 dotatate therapy target somatostatin receptors in neuroendocrine tumors.

Enable tumor imaging or receptor-targeted radiotherapy.

Radiation exposure; Lu-177 therapy can cause nausea, marrow suppression, renal/liver toxicity and secondary malignancy risk.

Secretin, sincalide and cosyntropin

Short peptide hormones/analogues used in pancreatic/biliary imaging or adrenal-function testing.

Support diagnosis under controlled clinical conditions.

Transient GI, flushing, BP/HR or hypersensitivity effects; false interpretation if protocol is wrong.

Vasopressin, terlipressin and angiotensin II

Peptide vasoactive drugs used for shock, vasodilatory states or hepatorenal syndrome in monitored settings.

Can raise perfusion pressure or improve kidney outcomes in selected critical illness.

Ischemia, arrhythmia, respiratory failure or fluid/electrolyte complications; risks are indication- and product-specific.

Macimorelin

Oral growth hormone secretagogue receptor agonist approved only for testing whether an adult has growth hormone deficiency; it is a diagnostic test, not a treatment.

Supports the diagnosis of adult growth hormone deficiency under clinical supervision.

Most common: altered taste, dizziness, headache, fatigue, nausea, hunger, diarrhea and a slow heart rate. It can prolong the QT interval; certain other medicines can make the test result wrong.

Difelikefalin

Kappa opioid receptor agonist peptide given by the dialysis team, approved for moderate-to-severe itching caused by chronic kidney disease in adults on hemodialysis.

Can reduce itching in the adults on hemodialysis it is approved for.

Most common: diarrhea, dizziness, nausea, gait problems including falls, high potassium, headache, sleepiness and changes in mental state; it may impair driving. Not studied in peritoneal dialysis.

Corticotropin (repository corticotropin injection)

Long-acting pituitary hormone (ACTH) peptide gel that makes the adrenal glands release cortisol and related hormones; approved for specialist uses such as infantile spasms (Acthar Gel), flares of multiple sclerosis and certain inflammatory diseases, depending on the product.

Can calm certain inflammatory flares in the specialist uses it is approved for; the specialist decides.

Warnings include infections, Cushing’s syndrome and adrenal insufficiency when it is stopped, high blood pressure, salt and water retention and low potassium, gastrointestinal perforation and bleeding, mood and behavior changes, eye effects, hypersensitivity, slowed growth in children and lower bone density. In infants with infantile spasms the most common reactions are infections, convulsions, high blood pressure, irritability and fever.

BPC-157 (free base/acetate)

Marketed for gut, tendon or wound healing. FDA evaluated ulcerative-colitis claims; there is no FDA-approved BPC-157 product.

Unknown human safety, immunogenicity and impurity/aggregation risk. FDA staff found insufficient characterization, safety and efficacy support; adverse reports do not prove causality.

TB-500 / thymosin-beta-4 fragments

Marketed for wound or musculoskeletal healing. TB-500 products may not be chemically identical to full thymosin beta-4.

FDA identified absence of human clinical exposure data for the nominated substances and potential injectable immunogenicity/quality risks.

KPV

Alpha-MSH-derived tripeptide marketed for inflammation, gut or skin conditions.

FDA staff found no human PK/PD, exposure or clinical studies; safety and immunogenicity are unknown.

MOTS-c

Mitochondrial-derived peptide marketed for metabolism, exercise, obesity or longevity.

FDA staff found no human clinical exposure studies for the nominated substances; systemic and long-term risks are unknown.

Semax

ACTH-derived peptide marketed for cognition, migraine or neuroprotection.

Unknown product quality and long-term safety; FDA staff noted possible antithrombotic properties as a bleeding concern and limited human PK data.

Selank

Peptide marketed for anxiety, cognition or stress; no FDA-approved product.

Human evidence, interactions, dosing reliability and long-term safety are insufficient; compounded/online quality is uncertain.

Epitalon

Tetrapeptide marketed for sleep, aging or “telomere” effects.

FDA staff found no adequate human PK or clinical safety evidence; cancer, endocrine and long-term risks are unknown.

Emideltide / DSIP

“Delta sleep-inducing peptide” marketed for sleep or withdrawal.

Reported transient headache, nausea and vertigo; hypotension occurred in older IV research. Subcutaneous safety is not established.

GHK-Cu

Copper-binding tripeptide marketed for skin/hair or wound care. FDA’s Category 1 entry applies only to non-injectable routes and means “under evaluation,” not approval.

Irritation, allergy and uncertain absorption/quality; injectable use is outside the Category 1 entry and has additional infection/immunogenicity risk.

CJC-1295 (with or without DAC)

Long-acting GHRH analogue marketed to raise growth hormone/IGF-1; chemical versions differ.

Edema, joint/carpal-tunnel symptoms, glucose intolerance, headache, possible intracranial hypertension and theoretical tumor-growth risk; product purity is uncertain.

Ipamorelin

Growth-hormone secretagogue peptide marketed for recovery, sleep or body composition.

Unknown long-term safety/quality; possible edema, headache, glucose effects, increased appetite and GH/IGF-1-related risks.

GHRP-2 and GHRP-6

GH secretagogue peptides marketed for growth, appetite, recovery or body composition.

Insufficient nomination support; possible glucose, appetite, edema and endocrine effects plus injectable quality/immunogenicity risks.

Sermorelin

GHRH analogue marketed by peptide clinics for GH deficiency, sleep or anti-aging.

GH/IGF-1-related risks, injection reactions and uncertain compounded quality; “formerly approved” is not the same as a currently approved product.

Gonadorelin

Synthetic gonadotropin-releasing hormone (GnRH) peptide; the human products once approved by the FDA are discontinued, and products sold today are not an approved medicine.

Content, purity and long-term safety of the products sold today are unknown; effects on reproductive hormones, injection reactions and hypersensitivity belong with the care team.

Hexarelin

Synthetic growth hormone–releasing peptide (research code EP-23905; FDA substance name examorelin). There is no FDA-approved product, and products sold today are not an approved medicine.

Content, purity and long-term safety of the products sold today are unknown; effects on hormones and blood sugar, injection reactions and hypersensitivity belong with the care team.

NAD+ (injection or IV infusion)

Nicotinamide adenine dinucleotide (NAD, coenzyme I), a coenzyme found widely in nature that carries electrons in many enzyme reactions; given from compounding pharmacies or clinics as an injection or IV infusion, not as an FDA-approved product. Not the same as oral NAD+ precursor supplements.

Injection and infusion reactions, sterility and quality of compounded products; any new symptom during or after an infusion belongs with the care team.

AOD-9604 / hGH fragment 176–191

Growth-hormone fragment marketed for fat loss.

Human long-term safety, endocrine effects, impurities and dosing reliability are uncertain.

IGF-1 LR3

Long-acting IGF-1 analogue marketed for muscle growth or recovery; distinct from FDA-approved mecasermin.

Potential severe hypoglycemia, edema, organ/tissue growth and tumor-related risk; product purity and potency are unknown.

MGF / PEG-MGF

IGF-1 splice-product fragments marketed for muscle/tendon repair.

Unknown systemic, growth-promoting, glucose, immunogenicity and impurity risks.

Thymosin alpha-1 / thymalfasin

Immune-modulating peptide approved in some countries and marketed for infection, cancer support or “immune optimization.”

Fever/flu-like symptoms, immune effects, interactions and injectable quality risk; long-term safety for wellness use is unclear.

Kisspeptin-10

Reproductive-neuroendocrine peptide marketed for fertility, testosterone or libido.

FDA identified significant safety concerns for compounding; endocrine overstimulation, pregnancy/fertility consequences and unknown product quality are concerns.

Ibutamoren (MK-677)

Oral ghrelin-receptor agonist often sold as a “peptide” for GH release, sleep or muscle gain.

FDA identified significant safety concerns; appetite/weight gain, edema, glucose intolerance and other GH/IGF-1-related risks are concerns.

Vasoactive intestinal peptide / aviptadil

Neuropeptide marketed or studied for pulmonary/inflammatory uses.

Low blood pressure, flushing, diarrhea, tachycardia and unknown inhaled/injectable quality or immunogenicity.

Cibinetide / ARA-290

Erythropoietin-derived tissue-protective peptide studied for neuropathy/inflammation.

Insufficient information for FDA to evaluate the compounding nomination; long-term, immune and product-quality risks are unknown.

Thymulin acetate

Thymic peptide marketed for immune or inflammatory conditions.

Insufficient supporting information; endocrine/immune, infection and injectable quality risks are unknown.

LL-37

Antimicrobial host-defense peptide marketed for infection, immunity or wound healing.

Can be pro-inflammatory/cytotoxic; systemic effects, immune reactions, impurities and dosing are not established.

Melanotan II

Melanocortin analogue sold for tanning or sexual effects; not the same as approved afamelanotide or bremelanotide products.

Nausea, flushing, spontaneous erections/priapism, BP/HR effects and darkening/changing moles; counterfeit/impurity risk.

Follistatin products / gene-peptide mixtures

Marketed to inhibit myostatin and increase muscle.

Unknown potency, immune/tumor/reproductive effects and irreversible risks for gene-based products; contamination risk.

PNC-27, humanin and FOXO4-DRI

Research peptides marketed online for cancer killing, mitochondrial health or senolysis/longevity.

Human dose, distribution, interactions, immune effects, cancer risk and manufacturing quality are unknown.

Glutathione (tripeptide), compounded routes

Antioxidant tripeptide marketed for wellness, skin lightening or respiratory uses; approved-drug status and compounding status depend on product/route.

Route-specific allergy, bronchospasm, infection/contamination and impurity risks; IV/inhaled use needs medical oversight.

Dihexa

Warning-only entry. No FDA-approved product; listed by FDA as “Dihexa acetate” among bulk drug substances for compounding that may present significant safety risks. Kept in the catalog only so that a patient can name it and Aiden can track it neutrally with its source.

FDA has not identified any human exposure data on drug products containing dihexa acetate administered via any route of administration, and lacks important information regarding any safety issues, including whether it would cause harm if administered to humans. Product purity and quality are unknown.

Ostarine / enobosarm (MK-2866)

Selective androgen receptor modulator (SARM), sold online as MK-2866 or enobosarm to build muscle mass and strength, often as a “dietary supplement” or “for research use only”. Ostarine has been authorized for investigation as a new drug, so FDA treats a product containing it as an unapproved new drug, not a dietary supplement.

FDA: life-threatening reactions, including liver injuries that required hospitalization; SARMs also have the potential to cause increased risk of heart attack or stroke, psychosis/hallucinations, sleep disturbances, sexual dysfunction, liver injury and acute liver failure, infertility, pregnancy miscarriage and testicular shrinkage. Products are often sold without any warning; content and purity are unknown.

Ligandrol (LGD-4033)

Selective androgen receptor modulator (SARM), sold online as LGD-4033 to build muscle mass and strength, often as a “dietary supplement” or “for research use only”. FDA warning letters call products marketed this way unapproved new drugs.

FDA: life-threatening reactions, including liver injuries that required hospitalization; SARMs also have the potential to cause increased risk of heart attack or stroke, psychosis/hallucinations, sleep disturbances, sexual dysfunction, liver injury and acute liver failure, infertility, pregnancy miscarriage and testicular shrinkage. Products are often sold without any warning; content and purity are unknown.

Testolone (RAD-140)

Selective androgen receptor modulator (SARM), sold online as RAD-140 to build muscle mass and strength, often as a “dietary supplement” or “for research use only”. FDA warning letters call products marketed this way unapproved new drugs.

FDA: life-threatening reactions, including liver injuries that required hospitalization; SARMs also have the potential to cause increased risk of heart attack or stroke, psychosis/hallucinations, sleep disturbances, sexual dysfunction, liver injury and acute liver failure, infertility, pregnancy miscarriage and testicular shrinkage. Products are often sold without any warning; content and purity are unknown.

Andarine (S-4)

Selective androgen receptor modulator (SARM), sold online as S-4 to build muscle mass and strength, often as a “dietary supplement” or “for research use only”. FDA warning letters call products marketed this way unapproved new drugs; FDA also found andarine in a product labeled as a dietary supplement.

FDA: life-threatening reactions, including liver injuries that required hospitalization; SARMs also have the potential to cause increased risk of heart attack or stroke, psychosis/hallucinations, sleep disturbances, sexual dysfunction, liver injury and acute liver failure, infertility, pregnancy miscarriage and testicular shrinkage. Products are often sold without any warning; content and purity are unknown.

YK-11

Substance sold online among SARMs (sellers also call it a “myostatin inhibitor”) to build muscle mass and strength, often as a “dietary supplement” or “for research use only”. FDA warning letters call products marketed this way unapproved new drugs.

FDA: life-threatening reactions, including liver injuries that required hospitalization; SARMs also have the potential to cause increased risk of heart attack or stroke, psychosis/hallucinations, sleep disturbances, sexual dysfunction, liver injury and acute liver failure, infertility, pregnancy miscarriage and testicular shrinkage. Products are often sold without any warning; content and purity are unknown. FDA tested a bodybuilding product that listed YK-11 after a report of a stroke in a person who used it; the product also contained an undeclared anabolic steroid.

Cardarine (GW501516)

Not a SARM, but sold online with them as “Cardarine GW501516” for fat loss and energy, often “for research use only”. FDA warning letters list it among products marketed as SARMs and call them unapproved new drugs; no FDA-approved product contains it.

No FDA-approved product and no FDA review of its safety. FDA lists it among products marketed as SARMs, about which FDA has safety concerns: life-threatening reactions, including liver toxicity, and a potential increased risk of heart attack and stroke. Product content and purity are unknown.