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On the generic and compounded front, most semaglutide and tirzepatide alternatives rely on imported APIs from China, India, and other countries

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Tomlinson S, Atherton J, Prasad S Case reports in cardiology 2018

Relative contraindications These are situations where the combination might be possible under very careful supervision but carry elevated risk that must be weighed against potential benefit: Controlled hypertension (even well-managed blood pressure requires closer monitoring on this combination) History of anxiety disorders (phentermine can exacerbate anxiety through CNS stimulation) History of pancreatitis (GLP-1 receptor agonists including tirzepatide carry a theoretical risk of pancreatitis) Gallbladder disease (rapid weight loss from combination therapy increases gallstone risk) Severe gastrointestinal conditions including gastroparesis (tirzepatide further slows already-compromised gastric motility) Kidney disease (dehydration risk from combined GI side effects can worsen renal function) If you fall into any of these categories, the conversation with your provider needs to be particularly thorough