There are a variety of medications used for weight loss available in the UK. Liraglutide (also called Saxenda®), semaglutide (also called Ozempic®, Rybelsus® and Wegovy®), tirzepatide (also called Mounjaro®) and orlistat are some examples.
Orlistat works by reducing the fat absorption of the body it is available in capsule form and is licensed for weight loss. It is classified as a pharmacy medicine (P medicine) which means it can only be bought from a pharmacy either online or in-store.
Liraglutide (Saxenda®), tirzepatide (Mounjaro®) and semaglutide (Wegovy® and Ozempic®) are available in an injectable form and are also licensed for weight loss. They are medicines that can make people feel fuller and less hungry. These medicines are known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Rybelsus® tablets and Ozempic® injectable pens which contain semaglutide are licensed to treat type 2 diabetes, but they are also prescribed 'off label' for weight loss (see below for explanation regarding ‘off label’ use). Tirzepatide is available in an injectable form and is licensed for type 2 diabetes and also weight loss. Liraglutide, terzepatide and semaglutide are prescription only medicines (POMs). This means they can only be lawfully supplied when they have been prescribed for someone by an appropriate practitioner. Examples of an appropriate practitioner are a doctor, a nurse independent prescriber or a pharmacist independent prescriber.
Medicines are not ordinary items of commerce: for a member of the public to be able to obtain POMs they would need to have an appropriate consultation with a prescriber who will jointly make a decision, based on the information they provide, about whether it is appropriate to issue a prescription.
No, but it is essential that the mode of consultation is appropriate to meet the needs of the patient, and it provides the means to ensure that the prescriber has enough information to make an appropriate prescribing decision.
Prescribing practitioners should ensure that they prescribe in line with legislation and established guidance such as the RPS prescribing competency framework.
Prescribers are responsible for practising within their own scope of practice and competence, which includes having the required training, knowledge, skills and experience to prescribe.
Prescribing ‘off-label’ means prescribing a product to be used for a purpose other than what it has been licensed for by the medicines regulator (the Medicines and Healthcare products Regulatory Agency [MHRA]). This is entirely lawful and can be appropriate. Pharmacists must adhere to the GPhC Guidance for pharmacist prescribers.
We would expect a prescriber to be able to demonstrate that they have all the information they need to prescribe weight loss treatments safely. This could be (but is not limited to) carrying out ongoing monitoring of the patient, ensuring weight and height information given to them is accurate and verified, talking to the patient and not relying solely on an online questionnaire.
Prescribers must also consider the person’s wellbeing given that eating disorders, body dysmorphia and mental health issues can play a part in the reason for requesting these medicines.
Due to a national shortage, a national patient safety alert was issued for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in January 2024.
There are products containing GLP-1 RAs which are licensed for the treatment of diabetes, such as Ozempic®, Rybelsus®, Trulicity®, Victoza®, Byetta® and Bydureon®.
Some products containing GLP-1 RAs are also used for weight loss.
The alert asks prescribers not to use medicines licensed for the treatment of diabetes off-label for the management of obesity, and that existing stock be conserved for use in patients with diabetes. This is due to supply issues which have been caused by an increase in demand. Supply is not expected to return to normal until at least the end of 2024.
There is a clear expectation and obligation for pharmacy professionals and prescribers to adhere to national patient safety alerts and guidelines.
Any prescribing or supply incompatible with the Patient Safety Alert would have to be considered in context – a Patient Safety Alert does not give rise to criminal penalties. Pharmacy owners and pharmacy professionals would need to be able to account for their decision making where these have not been followed.
Our standards for registered pharmacies set out the requirements for the provision of pharmacy services at or from a registered pharmacy. Our inspectors routinely check awareness and knowledge of guidance around medicines such as Ozempic® as part of assessing whether standards are met.
Where a pharmacy fails to meet our standards, we have statutory powers to take enforcement action in order to protect patients and the public and ensure they receive safe and effective care when using pharmacy services.
When reviewing concerns raised about individuals who prescribe or supply medication ‘off-label’ and in contravention of the patient safety alert, we will take into consideration the context and quality of the decision making, including their scope of practice.
We have acted in response to emerging concerns about a small number of pharmacies (both online and bricks and mortar premises) inappropriately supplying medicines that are licensed to treat diabetes but are being used by people for weight-loss. We have taken action to stop these pharmacies supplying these medicines to potentially vulnerable people and are carrying out further targeted inspections of other online pharmacies.
We’ve also reminded all pharmacies that they need to follow our standards and guidance, and the relevant prescribing guidelines for medicines, at all times.
We’ve shared good and poor practice examples in relation to providing weight loss services that we’ve gathered from our inspections. You can find these in our online newsletter, Regulate.
We have published a guide with other UK health organisations to help people keep safe if they decide to use online services.
