The peptide universe: a guide for physicians in Panama

Who this guide is for

For the Panamanian physician who wants to understand the subject with data before forming an opinion. Peptides are not a passing fad: they are one of the most successful drug classes in modern medicine, and around them the US has grown a huge market of pharmacies, clinics and informed patients¹⁵⁶. Here we summarize the essentials and link to the detailed analysis of each topic.

A proven drug class

Since insulin, almost a century ago, more than 80 peptide drugs have reached the market for diabetes, cancer, osteoporosis, multiple sclerosis, HIV and chronic pain¹. Semaglutide does more than reduce weight: in the randomized SELECT trial, with 17,604 adults with established cardiovascular disease and overweight or obesity but without diabetes, it reduced the risk of cardiovascular death, nonfatal heart attack or nonfatal stroke by 20% (HR 0.80)². Bremelanotide (PT-141) and tesamorelin are also FDA-approved for specific indications, and elamipretide (SS-31) received accelerated approval for Barth syndrome¹²¹³¹⁴.

The United States: a market that has already decided

In November 2025, 12% of US adults said they were currently using a GLP-1 and 18% had used one at some point³. According to a Gallup survey, nearly one in five users relies on a compounded version not approved by the FDA⁴. Eli Lilly had $65.179 billion in 2025 revenue, $36.5 billion from tirzepatide alone (Mounjaro and Zepbound), and projects $80–83 billion for 2026⁵; Novo Nordisk's three semaglutide products (Ozempic, Wegovy and Rybelsus) totaled about $34.6 billion⁶.

Beyond GLP-1s, research peptides are now part of the public conversation. The US Health Secretary, Robert F. Kennedy Jr., said he has used them "with really good effect on a couple of injuries"¹⁵, and in July 2026 the FDA advisory committee voted in favor of six of seven peptides for compounding. One committee member who voted yes, Dr. Haleem Mohammed, summed it up: "Our patients want peptides"⁷. Details in What the FDA actually said and The other side.

The map: what is proven and what is under study

• Metabolism and weight (GLP-1, GIP, amylin): the strongest evidence in the field, with phase 3 trials and cardiovascular outcomes. See GLP-1s: muscle, rebound, eyes and pancreas and After semaglutide.
• Growth hormone axis (CJC-1295, ipamorelin, tesamorelin): in human studies, CJC-1295 raised GH and IGF-1; tesamorelin is approved. See the GH and IGF-1 debate.
• Repair and recovery (BPC-157, TB-500): extensive animal evidence; human trials still pending. See BPC-157 and TB-500.
• Skin (GHK-Cu): topical trials with mixed results (positive in diabetic ulcers, no better than placebo in venous ulcers); the injectable route still lacks human data. See GHK-Cu.
• Sexual and reproductive health (PT-141, kisspeptin): bremelanotide approved; kisspeptin with small but rigorous IVF studies. See kisspeptin and PT-141.
• Cognition and sleep (Semax, Selank): Semax is a registered drug in Russia. See Semax, Selank and DSIP.
• Longevity (epitalon, MOTS-c, NAD+, SS-31): promising biology; SS-31 already has an accelerated approval (Barth syndrome). See longevity.

How safe are they?

It is the most important question, and the answer is nuanced. Approved peptides have safety profiles well characterized in large trials: in SELECT, 16.6% of patients on semaglutide and 8.2% on placebo stopped treatment because of adverse events². For research peptides, we found no published deaths in PubMed attributed to BPC-157, TB-500, GHK-Cu or similar research peptides; a systematic review found no clinical safety data: the problem is the lack of studies rather than a demonstrated harm signal⁸. Documented serious events are few, but they exist: in the most publicized case, RAADfest in 2025, two attendees were hospitalized in critical condition after receiving injections of peptide mixtures⁹. Both had to be intubated to assist their breathing and both have since recovered; the Nevada pharmacy board could not determine the cause, and in February 2026 it fined those who offered the injections between $5,000 and $10,000¹⁹. The FDA mentions a few serious events in studies, such as serious adverse events including a death with intravenous ipamorelin in a published gastric-motility study, with no further detail, and deaths among critically ill patients in GHRP-2 studies, with causality not established¹⁶.

The region's tragedies have a different cause. For the 8 deaths in Hermosillo, Sonora (Mexico), the health authorities' preliminary hypothesis is that the IV vitamin drips may have been contaminated with bacteria, not peptides¹⁰. And in the counterfeit "Ozempic" pens MINSA warned about in 2023 (detected in Austria), the Austrian regulator linked the hospitalizations to the insulin they presumably contained¹¹. The lesson is clear: the real risk lies in the product's origin and quality. See what is really in the vial.

What it means for practice in Panama

The demand is already here. According to MINSA, 72% of Panamanian adults have overweight or obesity¹⁷, and in 2025 MINSA investigated the use of Ozempic for weight loss, found it being sold through social media and warned about the risk of buying medicines online without a prescription¹⁸. Patients will arrive at the clinic with these questions, or with these products. The physician who knows the evidence, for and against, becomes their point of reference; if they do not find that in the clinic, they will look for it on Instagram.

Knowing the subject also means knowing the local framework. We summarize what Law 419, Executive Decree 27 and the Penal Code say in a physician's legal map in Panama.