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The shortage-based legal exemption that underpinned widespread compounded semaglutide availability is no longer active for either 503A pharmacies or 503B outsourcing facilities Compounded GLP-1 programs operating today must navigate a legal framework that includes restrictions on compounding drugs that are commercially available drugs - meaning the compounding pharmacy's specific formulation, documentation, and prescriber individualization process matters for legal compliance The FDA still permits compounding under 503A for individual patient-specific prescriptions that involve a prescriber-documented "significant difference" from the commercially available product - but that requires specific clinical justification, not just a standard intake form Availability of specific compounded GLP-1 formulations may be affected by FDA enforcement actions, pharmacy-specific compliance status, and ongoing regulatory developments in this space None of this means compounded GLP-1 programs are operating illegally

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In its function as a cellular caretaker, attenuation of GSTP1 expression or activity by either genetic (e.g., deletion or mutation) or epigenetic alterations may reduce cellular detoxification capacity ( Figure 2 )

Figure 1 summarizes the timeline for discovery, biomarker investigations, and toxicokinetic studies for selected mycotoxins