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On April 1, 2026, the FDA issued a significant policy clarification targeting the most common remaining workaround: compounders and telehealth providers had been adding a secondary ingredient most commonly vitamin B12 to their semaglutide formulations and marketing them as distinct, patient-specific products not subject to the "essentially a copy" prohibition

This strongly suggests that the metabolic shock of rapid dose escalation, not the medication dose itself, drives most fatigue complaints

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