Every formulary change, in public.
Our formulary is a working document, not a brochure. Whenever a dose modifier changes, a compound is added, or something is removed, it appears here with the date, the reason, and (where available) the citation that drove the change.
Tirzepatide — GIPR rs1800437 modifier widened
Patients carrying Glu354Gln now permitted to escalate from 5 mg → 10 mg at 8 weeks (previously 12). Internal cohort showed faster tolerance with no AE delta.
PT-141 (bremelanotide) — added with MC4R gating
Now compoundable for HSDD indication with mandatory MC4R variant report and BP screen. Loss-of-function carriers excluded pending more data.
GHRP-6 — removed from formulary
Removed in favor of ipamorelin. Cortisol/prolactin spikes and appetite stimulation poorly aligned with our metabolic patient population.
Semaglutide — GLP1R rs6923761 starting dose split
G/G carriers now start at 0.25 mg as before; A allele carriers can begin at 0.5 mg with closer week-2 check-in. Reduces time-to-therapeutic-dose by ~3 weeks in this group.
Tesamorelin — added retinopathy contraindication note
All patients with proliferative diabetic retinopathy now require ophthalmology clearance prior to tesamorelin initiation, mirroring labeling.
MOTS-c — added as investigational, research consent required
Available only under research-use protocol with explicit consent that human evidence is preclinical. Excluded from main formulary listing.
Ipamorelin — Q-timing adjusted
Recommended dosing window moved from 'within 30 min of bedtime' to 'within 60 min' based on Phase II PK re-analysis showing similar IGF-1 AUC across the wider window.