02Reference / Safety atlas
What can actually go wrong, by compound.
The peptide market has a credibility problem because most marketing pages omit risk. This atlas is the opposite: every entry lists the common adverse events, the serious ones, the contraindications we screen for, and the monitoring labs we require — with the trial each claim came from.
Semaglutide
STEP-1 — Wilding et al., NEJM 2021Boxed warning · Risk of thyroid C-cell tumors in rodents; contraindicated with personal/family history of MTC or MEN2.
Common adverse events
- — Nausea (44%) and vomiting (24%) — peak at dose escalations
- — Diarrhea (30%), constipation (24%)
- — Injection-site reaction (<5%)
Serious risks
- — Acute pancreatitis (rare, ~0.3%)
- — Acute gallbladder disease/cholelithiasis (~2.6%)
- — Acute kidney injury secondary to volume depletion
- — Hypoglycemia when combined with insulin/sulfonylureas
Contraindications
- — Personal or family history of medullary thyroid carcinoma
- — MEN syndrome type 2
- — Pregnancy and breastfeeding
Required monitoring
- — Lipase if abdominal pain
- — Renal function during titration
- — Pregnancy status before refills
Source: STEP-1 — Wilding et al., NEJM 2021 · NCT03548935
Tirzepatide
SURMOUNT-1 — Jastreboff et al., NEJM 2022Boxed warning · Same C-cell tumor warning as GLP-1 mono-agonists.
Common adverse events
- — Nausea (29% at 15 mg)
- — Diarrhea (23%)
- — Decreased appetite (11%)
Serious risks
- — Acute pancreatitis (rare)
- — Severe GI events leading to dehydration / AKI
- — Hypersensitivity reactions
Contraindications
- — MTC / MEN2 history
- — Pregnancy
Required monitoring
- — Lipase if symptomatic
- — Renal function during titration
Source: SURMOUNT-1 — Jastreboff et al., NEJM 2022 · NCT04184622
BPC-157
No completed Phase II/III in humansCommon adverse events
- — No reliable human AE dataset — preclinical only
Serious risks
- — Unknown long-term safety in humans
- — Source-purity risk: grey-market vials commonly fail HPLC identity testing
Contraindications
- — Active malignancy (theoretical, due to angiogenic effect)
- — Pregnancy
Required monitoring
- — Liver and renal panel quarterly during use
- — Tumor markers if elevated baseline risk
Source: No completed Phase II/III in humans · Animal data only
CJC-1295 / Ipamorelin
Teichman et al., JCEM 2006Common adverse events
- — Injection site flush
- — Transient drowsiness post-injection
- — Water retention
- — Increased appetite (ipamorelin)
Serious risks
- — Sustained GH/IGF-1 elevation may worsen insulin resistance
- — Theoretical risk of accelerating occult malignancy
- — Carpal tunnel symptoms with prolonged use
Contraindications
- — Active malignancy
- — Untreated diabetic retinopathy
- — Pregnancy
Required monitoring
- — IGF-1 quarterly (target mid-reference)
- — Fasting glucose / HbA1c
- — Annual age-appropriate cancer screening
Source: Teichman et al., JCEM 2006 · Phase II CJC-1295
PT-141 (Bremelanotide)
RECONNECT — Kingsberg et al., Obstet Gynecol 2019Common adverse events
- — Nausea (40%)
- — Flushing (20%)
- — Headache (11%)
- — Transient BP elevation (~6 mmHg systolic)
Serious risks
- — Focal hyperpigmentation with repeated use
- — Severe nausea requiring discontinuation in ~13%
Contraindications
- — Uncontrolled hypertension
- — Known CV disease
Required monitoring
- — Resting BP before initiation and at follow-up
Source: RECONNECT — Kingsberg et al., Obstet Gynecol 2019 · NCT02338960
Oxytocin (intranasal, off-label)
MacDonald et al., Psychoneuroendocrinology 2011Common adverse events
- — Nasal irritation
- — Mild headache
- — Transient mood change
Serious risks
- — Hyponatremia with high IV doses (not intranasal)
- — Uterine effects — avoid in pregnancy unless indicated
Contraindications
- — Pregnancy (outside obstetric indication)
- — SIADH risk
Required monitoring
- — Sodium if used at high frequency
Source: MacDonald et al., Psychoneuroendocrinology 2011 · Multiple small RCTs
Educational reference only. Not a substitute for the prescribing information of any drug or for medical advice. Patients in the Peptiter pilot are evaluated by a licensed prescriber before any therapy is dispensed.