{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:54:37Z","timestamp":1791381277914,"version":"4.3.3"},"reference-count":35,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,24]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>A woman in her mid-20s presented with 5\u2009days of persistent nausea, repeated vomiting, loose stools and markedly reduced oral intake. Blood tests, urinalysis, abdominal ultrasonography and cerebral MRI identified no alternative cause. Symptoms persisted despite intravenous fluids, metoclopramide, ondansetron and domperidone. Repeated, non-judgemental exposure history revealed 4\u2009once-weekly, dose-escalated subcutaneous injections of an unverified product reported to contain retatrutide, an investigational triple glucose-dependent insulinotropic polypeptide, glucagon-like peptide-1 and glucagon receptor agonist, administered in a wellness setting by a self-described life coach without medical qualification. She did not consider the injections to be medication. Symptoms improved 2\u2009days after admission and resolved within 1\u2009week. The Naranjo score (7) indicated probable causality. This case illustrates how pharmacologically active substances supplied through the wellness industry may evade routine medication history. Clinicians should ask explicitly about injections, peptides, research chemicals, online products and substances recommended by non-medical wellness practitioners.<\/jats:p>","DOI":"10.1136\/bcr-2026-276106","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:15:26Z","timestamp":1791378926000},"page":"e276106","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Emerging risks of health optimisation: refractory nausea associated with peptide injections reported to contain retatrutide"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9584-3590","authenticated-orcid":false,"given":"Raphael M","family":"Buzzi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Universit\u00e4tsSpital Z\u00fcrich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5378-4716","authenticated-orcid":false,"given":"Lars C","family":"Huber","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Universit\u00e4tsSpital Z\u00fcrich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"2026100706152202000_19.10.e276106.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2022.07.013"},{"key":"2026100706152202000_19.10.e276106.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2301972"},{"key":"2026100706152202000_19.10.e276106.3","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1981.154"},{"key":"2026100706152202000_19.10.e276106.4","unstructured":"Swissmedic . Illegal imports of medicinal products in 2025: more consignments, new products trends and increasing shipments from the EU 2026, Available: https:\/\/www.swissmedic.ch\/swissmedic\/en\/home\/humanarzneimittel\/market-surveillance\/medicinal-products-from-the-internet\/statistical-data\/illegale-arzneimittelimporte-2025.html [Accessed 14 Sep 2026]."},{"key":"2026100706152202000_19.10.e276106.5","unstructured":"US Food and Drug Administration . FDA\u2019s Concerns with Unapproved GLP-1 Drugs Used for Weight Loss. 2026. Available: https:\/\/www.fda.gov\/drugs\/drug-alerts-and-statements\/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss"},{"key":"2026100706152202000_19.10.e276106.6","doi-asserted-by":"crossref","DOI":"10.1111\/dar.70231","article-title":"Composition and Labelling Accuracy of Products Sold as Retatrutide in Australia","volume":"45","author":"Piatkowski","year":"2026","journal-title":"Drug Alcohol Rev"},{"key":"2026100706152202000_19.10.e276106.7","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.28280","article-title":"Safety and Risk Assessment of No-Prescription Online Semaglutide Purchases","volume":"7","author":"Ashraf","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026100706152202000_19.10.e276106.8","unstructured":"Federal Act on Medicinal Products and Medical Devices (Therapeutic Products Act, TPA) of 15 December 2000 (SR 812.21) 2000, Available: https:\/\/www.fedlex.admin.ch\/eli\/cc\/2001\/422\/en [Accessed 11 Sep 2026]."},{"key":"2026100706152202000_19.10.e276106.9","unstructured":"Swissmedic . Cross-agency targeted campaign \u201cPeptides 2026\u201d, 2026. Available: https:\/\/www.swissmedic.ch\/swissmedic\/en\/home\/humanarzneimittel\/market-surveillance\/medicinal-products-from-the-internet\/warnings-related-to-medicinal-products-from-the-internet\/schwerpunktaktion-peptide.html [Accessed 11 Sep 2026]."},{"key":"2026100706152202000_19.10.e276106.10","unstructured":"Swissmedic . Guideline on medicines and the internet 2020, Available: https:\/\/www.swissmedic.ch\/swissmedic\/en\/home\/humanarzneimittel\/market-surveillance\/medicinal-products-from-the-internet\/leitfaden-arzneimittel-aus-dem-internet.html [Accessed 11 Sep 2026]."},{"key":"2026100706152202000_19.10.e276106.11","unstructured":"Swissmedic . Swissmedic issues warning against falsified and misleading \u201cGLP-1\u201d weight loss products 2025, Available: https:\/\/www.swissmedic.ch\/swissmedic\/en\/home\/humanarzneimittel\/marktueberwachung\/arzneimittel-aus-dem-internet\/drug-safety-current-threats\/smc-warnt-vor-glp-1-produkten.html [Accessed 14 Sep 2026]."},{"key":"2026100706152202000_19.10.e276106.12","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.52598"},{"key":"2026100706152202000_19.10.e276106.13","doi-asserted-by":"crossref","DOI":"10.2196\/17187","article-title":"Prevalence of Health Misinformation on Social Media: Systematic Review","volume":"23","author":"Suarez-Lledo","year":"2021","journal-title":"J Med Internet Res"},{"key":"2026100706152202000_19.10.e276106.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2023-078538","article-title":"Current safeguards, risk mitigation, and transparency measures of large language models against the generation of health disinformation: repeated cross sectional analysis","volume":"384","author":"Menz","year":"2024","journal-title":"BMJ"},{"key":"2026100706152202000_19.10.e276106.15","doi-asserted-by":"publisher","DOI":"10.1111\/dom.70209"},{"key":"2026100706152202000_19.10.e276106.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2401755"},{"key":"2026100706152202000_19.10.e276106.17","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S2213-8587(23)00356-X","article-title":"Glucagon and GLP-1 receptor dual agonist survodutide for obesity: a randomised, double-blind, placebo-controlled, dose-finding phase 2 trial","volume":"12","author":"le Roux","year":"2024","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2026100706152202000_19.10.e276106.18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2411528"},{"key":"2026100706152202000_19.10.e276106.19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa072375"},{"key":"2026100706152202000_19.10.e276106.20","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1002\/rco2.9","article-title":"Growth hormone secretagogues: history, mechanism of action, and clinical development","volume":"3","author":"Ishida","year":"2020","journal-title":"JCSM Rapid Communications"},{"key":"2026100706152202000_19.10.e276106.21","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2005-1536"},{"key":"2026100706152202000_19.10.e276106.22","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1390552"},{"key":"2026100706152202000_19.10.e276106.23","doi-asserted-by":"crossref","DOI":"10.1177\/1179546817694558","article-title":"Synthetic Growth Hormone-Releasing Peptides (GHRPs): A Historical Appraisal of the Evidences Supporting Their Cytoprotective Effects","volume":"11","author":"Berlanga-Acosta","year":"2017","journal-title":"Clin Med Insights Cardiol"},{"key":"2026100706152202000_19.10.e276106.24","doi-asserted-by":"publisher","DOI":"10.1210\/en.142.12.5182"},{"key":"2026100706152202000_19.10.e276106.25","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1007\/s12178-025-09990-7","article-title":"Regeneration or Risk? A Narrative Review of BPC-157 for Musculoskeletal Healing","volume":"18","author":"McGuire","year":"2025","journal-title":"Curr Rev Musculoskelet Med"},{"key":"2026100706152202000_19.10.e276106.26","doi-asserted-by":"publisher","DOI":"10.1517\/14712598.2012.634793"},{"key":"2026100706152202000_19.10.e276106.27","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1747.1999.00708.x"},{"key":"2026100706152202000_19.10.e276106.28","doi-asserted-by":"crossref","DOI":"10.3390\/ijms19071987","article-title":"Regenerative and Protective Actions of the GHK-Cu Peptide in the Light of the New Gene Data","volume":"19","author":"Pickart","year":"2018","journal-title":"Int J Mol Sci"},{"key":"2026100706152202000_19.10.e276106.29","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2023.1120533","article-title":"MOTS-c: A promising mitochondrial-derived peptide for therapeutic exploitation","volume":"14","author":"Zheng","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2026100706152202000_19.10.e276106.30","article-title":"Humanin and Its Pathophysiological Roles in Aging: A Systematic Review","volume":"12","author":"Coradduzza","year":"2023","journal-title":"Biology (Basel)"},{"key":"2026100706152202000_19.10.e276106.31","doi-asserted-by":"crossref","first-page":"e238","DOI":"10.1212\/WNL.0000000000207402","article-title":"Efficacy and Safety of Elamipretide in Individuals With Primary Mitochondrial Myopathy: The MMPOWER-3 Randomized Clinical Trial","volume":"101","author":"Karaa","year":"2023","journal-title":"Neurology"},{"key":"2026100706152202000_19.10.e276106.32","doi-asserted-by":"crossref","DOI":"10.3390\/ijms26062691","article-title":"Overview of Epitalon-Highly Bioactive Pineal Tetrapeptide with Promising Properties","volume":"26","author":"Araj","year":"2025","journal-title":"Int J Mol Sci"},{"key":"2026100706152202000_19.10.e276106.33","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.brainres.2006.07.108","article-title":"Semax, an analog of ACTH(4-10) with cognitive effects, regulates BDNF and trkB expression in the rat hippocampus","volume":"1117","author":"Dolotov","year":"2006","journal-title":"Brain Res"},{"key":"2026100706152202000_19.10.e276106.34","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2164-15-228","article-title":"The peptide semax affects the expression of genes related to the immune and vascular systems in rat brain focal ischemia: genome-wide transcriptional analysis","volume":"15","author":"Medvedeva","year":"2014","journal-title":"BMC Genomics"},{"key":"2026100706152202000_19.10.e276106.35","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2016.00031","article-title":"Selank Administration Affects the Expression of Some Genes Involved in GABAergic Neurotransmission","volume":"7","author":"Volkova","year":"2016","journal-title":"Front Pharmacol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-276106","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:15:31Z","timestamp":1791378931000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-276106"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":35,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,7]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/bcr-2026-276106"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-276106","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}