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Setmelanotide (Imcivree)

A weight-loss drug for rare genetic forms of obesity. An MC4R agonist, FDA-approved in 2020 for obesity due to POMC, PCSK1, or LEPR deficiency and in 2022 for Bardet-Biedl syndrome; it's the educational anchor for melanocortin-pathway weight regulation.

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Setmelanotide (Imcivree): A weight-loss drug for rare genetic forms of obesity. An MC4R agonist, FDA-approved in 2020 for obesity due to POMC, PCSK1, or LEPR deficiency and in 2022 for Bardet-Biedl syndrome; it's the educational anchor for melanocortin-pathway weight regulation. Setmelanotide (sold as Imcivree) is an FDA-approved drug for a very specific kind of obesity, caused by rare genetic mutations in the leptin/melanocortin pathway.

FDA ⓘ
Approved
WADA
Not banned
Typical dose
1-3 mg sub-q daily (titrated)
Half-life ⓘ
~11 hours
Route ⓘ
Subcutaneous
Schedule
Once daily
In plain English

Setmelanotide (sold as Imcivree) is an FDA-approved drug for a very specific kind of obesity, caused by rare genetic mutations in the leptin/melanocortin pathway. It activates MC4R, the same melanocortin receptor MT-1, MT-2 and PT-141 hit. Educational reference for how the melanocortin pathway controls weight.

Status & legalityWhat do these mean? →
Natty? ⓘ
Not natty
FDA ⓘ
Approved

Approved as Imcivree (2020) for obesity due to POMC, PCSK1, or LEPR deficiency. 2022 expansion: Bardet-Biedl syndrome.

Compounding ⓘ
Approved drug

Available as an FDA-approved drug, not a compounded peptide.

WADA ⓘ
Not listed
Prescribed ⓘ

Yes, pediatric endocrinology and metabolic-disease specialists prescribe for the genetic-obesity indications.

Who it's for

  • →Patients with diagnosed monogenic obesity (POMC, PCSK1, LEPR, BBS)
  • →Educational reference for the MC4R pathway
  • →Researchers studying the melanocortin / hypothalamic appetite axis

What to expect

  1. Week 1

    Appetite drops noticeably in monogenic-obesity patients. Skin pigmentation begins to shift.

  2. Week 4

    Weight loss tracking established.

  3. Week 8

    Cumulative weight loss; pigmentation visible.

Looking at Setmelanotide (Imcivree)? Your next 3 steps

  1. 1Work out your exact dose

    Vial size + BAC water turns into the exact units to draw for Setmelanotide (Imcivree).

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  2. 2See what to stack & monitor

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  3. 3Save it & ask the Coach

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How it works (mechanism)

Selective MC4R agonist. Activates the melanocortin-4 receptor in the hypothalamus, the appetite-control hub. In patients with rare loss-of-function mutations in this pathway, restoring the signal restores appetite regulation.

Dosing protocol

Members only

Stacks well with

Members only

Side effects

01Skin hyperpigmentation (most common reaction, ~60% of patients; from off-target MC1R activation, reversible on stopping)
02Injection-site reaction
03Nausea, vomiting, diarrhea
04Spontaneous penile erections (males)
05Depression / suicidal ideation (Warnings and Precautions, monitor mood; not a boxed warning)

When NOT to use

  • ⚠Active depression or suicidal ideation
  • ⚠Pregnancy / nursing

Bloodwork to monitor

  • • Skin / mole monitoring (dermatology)
  • • Mental-health screening

Common mistakes

  • • Using it for general obesity (it's specific to monogenic obesity)
  • • Skipping the mole-map baseline (pigmentation drift is real)
  • • Underestimating the depression / suicidal-ideation monitoring requirement

Drug & supplement interactions

  • ⚠MAO inhibitors: theoretical interaction (not contraindicated, but disclose)
  • ⚠Drugs causing depression: caution, Imcivree carries a depression / suicidal-ideation warning (monitor mood)
  • ⚠MC4R activation: spontaneous erections in male patients

Community patterns

Members only
Free, no account needed

New to Setmelanotide (Imcivree)? Grab the starter checklist.

Drop your email and we'll send the one-page first-cycle starter checklist, plus a heads-up if Setmelanotide (Imcivree) changes legal status. No account needed.

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AI Coach, live sample
Members only
is 250mcg of bpc enough for a knee injury?
For a knee, 250 mcg sub-q daily is the standard working dose and a solid place to start. The trick with BPC is consistency, give it weeks, not days. Inject close to the joint, run it 4-6 weeks, and don't drop below 200 mcg, it tends to stop cracking the threshold reliably down there. If it hasn't moved at all by week 3, that's when adding TB-500 earns its place.
how much bac water for a 10mg reta vial?
3 mL is the standard play for a 10 mg reta vial. That's 3,333 mcg/mL, clean unit math across the titration: 2 mg = 60 units, 4 mg = 120 units, 6 mg = 180 units on a 100-unit insulin syringe. Run 2 mL instead if you want fewer, more concentrated shots (5,000 mcg/mL, so 2 mg = 40 units). Since most people titrate up over ~12 weeks, 3 mL keeps the numbers cleanest.
what should i track on bloodwork for tirzepatide?
Lipid panel, ALT/AST (liver enzymes), and an A1C, baseline before you start then every 3 months. If you've got metabolic-syndrome history, add fasting glucose and insulin so you can actually watch insulin sensitivity improve. You don't need a big hormone panel for a GLP-1.

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Frequently asked

What is Setmelanotide (Imcivree)?+
Setmelanotide (sold as Imcivree) is an FDA-approved drug for a very specific kind of obesity, caused by rare genetic mutations in the leptin/melanocortin pathway. It activates MC4R, the same melanocortin receptor MT-1, MT-2 and PT-141 hit. Educational reference for how the melanocortin pathway controls weight.
Is Setmelanotide (Imcivree) FDA approved?+
Approved as Imcivree (2020) for obesity due to POMC, PCSK1, or LEPR deficiency. 2022 expansion: Bardet-Biedl syndrome.
Is Setmelanotide (Imcivree) legal?+
Setmelanotide (Imcivree) is FDA-approved and legal to obtain by prescription in the US. Yes, pediatric endocrinology and metabolic-disease specialists prescribe for the genetic-obesity indications.
Is Setmelanotide (Imcivree) banned by WADA?+
Setmelanotide (Imcivree) is not currently on the WADA prohibited list.
Are you still natty after taking Setmelanotide (Imcivree)?+
No. Setmelanotide (Imcivree) is a performance-enhancing peptide and would disqualify a strict natty claim.
Do doctors prescribe Setmelanotide (Imcivree)?+
Yes, pediatric endocrinology and metabolic-disease specialists prescribe for the genetic-obesity indications.
What's the typical dose of Setmelanotide (Imcivree)?+
1-3 mg sub-q daily (titrated). Adult max 3 mg, pediatric weight-based.
What are the side effects of Setmelanotide (Imcivree)?+
Common side effects include: Skin hyperpigmentation (most common reaction, ~60% of patients; from off-target MC1R activation, reversible on stopping); Injection-site reaction; Nausea, vomiting, diarrhea; Spontaneous penile erections (males). Less common effects and full safety details are on the entry page.
How long until Setmelanotide (Imcivree) starts working?+
Appetite drops noticeably in monogenic-obesity patients. Skin pigmentation begins to shift.
What can you stack with Setmelanotide (Imcivree)?+
Common pairings: Standalone in approved indications. Full stacking protocol and timing on the entry page.
Where do people get Setmelanotide (Imcivree)?+
Setmelanotide (Imcivree) is dispensed through licensed pharmacies with a prescription. Some compounding pharmacies and telehealth services prescribe it. Pepdex is not a vendor or pharmacy. See /coa for how to verify Certificate of Analysis on any supplier.

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