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Peptides Explained

Growth-hormone axis

Hexarelin

A growth-hormone releaser studied in small trials in the 1990s. It is not an approved medicine.

Not an authorised medicine

Short page. This is a short page. A full page with the complete evidence review is planned for version 1.1. The grades and regulatory status below are complete and sourced.

At a glance

Is it an approved medicine?
No Not approved as a medicine in the EU, the UK or the US.
Has it been tested in people?
Some Small trials in patients. No large trials published yet.
Is it allowed in sport?
No Banned in sport at all times. Anti-doping list (WADA), section S2
What is the biggest risk?
No one knows the long-term effects. It briefly raises a stress hormone. More about the risks

Status checked on . The details and sources are further down this page.

Stop and get help if you notice

  • Chest pain, or a racing, uneven heartbeat49,50,12
  • Hot, red, swollen or painful injection site24
  • Swollen face or throat, or trouble breathing48

If it is severe, call your local emergency number.

All warning signs, further down this page Warning signs for any peptide

The 30-second version

About 5 minutes for the short version; 9 with every detail open.

  • Hexarelin is a lab-made chain of six amino acids. It makes the body release growth hormone.
  • It was tested in small studies in the 1990s. It is not an approved medicine.
  • With weeks of use, its effect on growth hormone grew weaker. It came back after stopping.
  • In rat hearts it attached to a protein called CD36. What this means for people is unclear.
  • It is banned in sport at all times. Long-term safety in people is unknown.
Class
Growth-hormone axis
Made of
Six amino acids, two of them changed in the lab
What it does
Makes the pituitary release growth hormone
Over weeks of use
The effect weakens, and returns after stopping
Studies in people
Small studies, mostly in the 1990s
Status in the EU
Not authorised
Tested in people
Some

Label facts, not dosing advice. Sources are in the sections below.

Last reviewed
Heart muscle under a microscope: long pink fibres with dark purple cell nuclei.
Heart muscle under the microscope. In rat hearts, hexarelin attached to CD36, a protein on heart cells. Photo: Berkshire Community College Bioscience Image Library, Muscle Tissue: Cardiac Muscle (Wikimedia Commons) CC0 1.0 Image details

Each section starts with the short answer. The rest is folded under “In detail”.

Evidence profile

Four separate questions. Not a score.

Human clinical evidence How far has it been tested in people?
Phase II (dose and early effect)
Preclinical volume How much laboratory and animal research exists?
Extensive
Source independence How many independent groups produced it?
A few groups
Safety characterisation How well do we know the harms in humans?
Partial
In detail Why these grades: the reason for each step
Human clinical evidence
Phase 2 on our rubric: small studies in patients, such as 8 short children treated for up to 8 months, 12 healthy older people for 16 weeks and single doses in 13 people with severe heart failure. No large or long controlled trial was published.
Preclinical volume
Extensive. On 23 October 2026 PubMed held 279 non-review records on hexarelin, 137 of them mentioning rats, mice, dogs or pigs.
Source independence
Few groups. About 40% of the records come from one group in Turin and its partners; groups in Milan and Montreal add about another 20%.
Safety characterisation
Partial. Short-term data from small studies (13 or fewer people in the studies we reviewed); no systematic or long-term safety data.

We never add these up. A compound can have a large animal literature from one laboratory and no human data at all — that is a specific situation, and a single number would hide it. How we grade evidence

In detail The molecule: amino-acid sequence and technical details
Amino-acid sequence6 amino acids

H–His-D-2-Me-Trp-Ala-Trp-D-Phe-Lys-NH2

Read from the N-terminus (start) to the C-terminus (end).

Modifications
position 2: 2-methyl-D-tryptophan: a mirror-image tryptophan with an extra methyl group on its ring
position 5: D-Phe: the mirror-image form of phenylalanine
D-form (mirror-image) amino acid
D-2MeTrp (2), D-Phe (5)
Full name
His-D-2-methyl-Trp-Ala-Trp-D-Phe-Lys-NH2
International non-proprietary name
examorelin
Also called
EP-23905, MF-6003
Class
Growth-hormone axis
Body systems
Hormones, Heart and blood vessels
Formula
C47H58N12O6
Molecular mass
887 Da

What it actually is

What is hexarelin?

A lab-made chain of six amino acids that makes the body release growth hormone.
It was tested in people long ago, but never approved. What is known about the substance sold under this name, checked on 23 October 2026.
Hexarelin (examorelin)
Made in a lab?Yes Six amino acids, two of them in a lab-changed form.1
Releases growth hormone in people?Yes Shown in healthy volunteers.2
Approved as a medicine?No No EU, Dutch or US approval found.3,4,5
Long-term safety studied?No The longest studies we found lasted up to 8 months, in 12 or fewer people.6,7,8

It belongs to the growth-hormone-releasing peptides (GHRPs), like GHRP-2 and GHRP-6; its official name is examorelin.1,9 No trial is registered on ClinicalTrials.gov.10

In detail The molecule

Hexarelin is His-D-2-Me-Trp-Ala-Trp-D-Phe-Lys-NH2. The second building block is a mirror-image tryptophan with an extra methyl group, the fifth is mirror-image phenylalanine, and the chain ends in an amide. Formula C47H58N12O6, mass 887.0 g/mol.1 A review describes it as chemically more stable than ghrelin.11

Proposed mechanism

How does it work?

It acts on the hunger-hormone receptor, so more growth hormone is released. It also binds a heart protein.
The proposed causal chain, step by step

Each step is labelled with how well the link from the previous step is established.

  1. Step 1 Binding In cells

    Switches on the ghrelin receptor

    Growth-hormone-releasing peptides such as hexarelin act through the ghrelin receptor, the same receptor that the hunger hormone ghrelin uses.

  2. Step 2 Tissue response In humans

    The pituitary releases growth hormone

    In 12 healthy young volunteers, hexarelin released growth hormone whether given into a vein, under the skin, into the nose or by mouth; much less reached the blood by the nose or mouth.

  3. Step 3 Tissue response In animals

    Binds CD36 in the heart

    In rat heart tissue it attached to CD36, a protein on heart and blood-vessel cells, and narrowed the heart's arteries in isolated hearts; this did not happen without CD36.

  4. Step 4 Effect on the body In humans

    Stronger heartbeat for an hour; long-term benefit unknown

    In 7 healthy men one dose made the heart pump harder for up to an hour, which growth hormone itself did not. Whether repeated use helps or harms the heart is unknown.

In detail What each step rests on

Hexarelin switches on the same receptor as ghrelin, the body’s hunger hormone.12,11 The growth hormone effect is measured in people.2 Like ghrelin, it also raises the stress hormone cortisol for a short time.13,14,15 Unlike ghrelin, one dose did not raise blood sugar in healthy volunteers.16 The CD36 heart finding comes from rat and mouse hearts outside the body.12

What the evidence actually shows

Does it work?

It does release growth hormone. No controlled trial has shown a lasting benefit.

With weeks of use, the effect fell by almost half

19.1 → 10.5

growth hormone released after a test dose: at the start, then after 16 weeks

Who took part Rahim 1998: 12 healthy elderly people, injections twice a day, no placebo group Sources Rahim et al. (1998); Rahim & Shalet (1998)7,8 Evidence Humans, limited

Children grew faster, but there was no comparison group

5.3 → 8.3 cm

growth per year, before and during treatment

Who took part Laron 1995: 8 short children, nasal spray for up to 8 months Source Laron et al. (1995)6 Evidence Humans, limited

Most human studies lasted hours, weeks or a few months and had no placebo group. The heart findings in people are short-term changes after a single dose.14,17

In detail Every study in one table

6 studies: 5 in humans, 1 in animals, 0 in cells, 0 reviews or other.

Studies discussed on this page
Study Species n Design Funding Research group What it found What it did not show
Ghigo et al. 1994 2 Humans 12 Phase I trial (controlled) Not disclosed Originating group In 12 healthy young volunteers, hexarelin released growth hormone by all four routes tested; given into a vein, it released about twice as much as the body's own releasing hormone (GHRH). Single doses; healthy young people; from the group that did most of the human work.
Laron et al. 1995 6 Humans 8 Open-label study (uncontrolled) Not disclosed Mixed In 8 short children given nasal hexarelin for up to 8 months, IGF-1 rose and growth speeded up from 5.3 to 8.3 cm a year. No comparison group; very small; a co-author was linked to the developer.
Rahim et al. 1998 7 Humans 12 Open-label study (uncontrolled) Not disclosed Independent group In 12 healthy elderly people injected twice a day for 16 weeks, the growth hormone response to a test dose fell by about half and recovered 4 weeks after stopping; IGF-1, body composition and bone density did not change. No placebo group; small; healthy older adults only.
Bisi et al. 1999 14 Humans 7 Phase I trial (controlled) Not disclosed Originating group In 7 men, one dose of hexarelin into a vein made the heart pump harder for up to 60 minutes; growth hormone giving similar levels did not. Cortisol also rose. Single doses in 7 healthy men; short-term measurements.
Bodart et al. 2002 12 Mixed not reported Animal experiment (controlled) Government Independent group In rat heart tissue, hexarelin bound CD36; in isolated hearts it narrowed the coronary arteries, an effect absent in hearts lacking CD36. Rat and mouse hearts outside the body; the link to people is a hypothesis.
Imazio et al. 2002 17 Humans 13 Open-label study (uncontrolled) Not disclosed Originating group In 13 people with severe heart failure, one dose raised pumping strength in those whose failure came from blocked arteries, but not in those with an enlarged, weak heart muscle. Single doses; no placebo; tiny groups.

About 40% of all hexarelin papers come from one group in Turin and its partners, and groups in Milan and Montreal add about another 20%.10 Animal studies, for example in rats after a heart attack, report better heart function, but no controlled trial tested this in people.18,11

Regulatory status

Is it legal?

It is not an approved medicine, and it is banned in sport.
Not approved as a medicine. Banned in sport. Status in the Netherlands, the EU and the US, and in sport, checked on 23 October 2026.
Netherlands and the EUUnited States
Approved as a medicine?No No EU or Dutch authorisation.3,4No No FDA-approved product.5
Legal to supply as a medicine?No Dutch law forbids supplying a medicine without a marketing authorisation.19No Not an approved drug.
Allowed in sport?No Banned at all times, named in section S2.9,20No The same worldwide rule.9
In detail Status in each country, and in sport
Regulatory status by jurisdiction
Jurisdiction Status Note Checked
European Union Not authorised Not authorised; no EMA record. 3,51
Netherlands Not authorised Not authorised. Supplying a medicine without a marketing authorisation is prohibited. 4,19
United States Not authorised Not FDA-approved; no approved product found. 5
Sport (WADA) Prohibited in sport · S2, at all times Banned at all times: named in S2 as examorelin (hexarelin), a GH-releasing peptide. 9,20

All statuses were checked on 23 October 2026. WADA names it as “examorelin (hexarelin)” among the growth-hormone-releasing peptides in section S2, banned at all times.9,20 In Germany it is listed in the Anti-Doping Act, which forbids buying, possessing or bringing into the country more than a small amount for doping in sport.21,22

Risk profile

What are the risks?

Long-term effects are unknown. It raises hormones, and the heart effects need more study.
Some effects are shown in people; the bigger questions were never studied. What small human studies and animal work show, as of 23 October 2026.
Possible harmShown in people?
Short rises in cortisol and other hormonesYes After single doses.14,15
Narrowing of the heart’s arteriesUnknown Seen in rat hearts outside the body.12
Effects of too much growth hormone, such as fluid build-up or high blood sugarUnknown Listed for growth hormone medicines; not studied for long hexarelin use.23
Infection or impurities from the productUnknown Not studied; a known risk of any unsterile injection.24
In detail Why these risks are theorised

Hexarelin raises growth hormone, and in children IGF-1 rose with it.6 For approved growth hormone medicines, the FDA lists risks including fluid retention, high blood sugar and diabetes, raised pressure in the skull, and a higher risk of tumours.23 In the 16-week study, IGF-1 did not change, so whether these risks apply is unknown.7 CD36 has been linked both to protecting the heart in animals and to narrowing the heart’s arteries in rat hearts, so its heart effects could cut both ways.11,12 See product risk.

If someone is going to do this anyway

This section exists to reduce harm. It gives no doses, schedules or sourcing advice, and it is not a recommendation to use this compound.

How can someone lower the risk?

Check the vial first, bring a doctor in, and know when to stop.

If your product did not come from a pharmacy: check before you use it

These checks can show that something is wrong. None of them can show that a product is good or free of germs.25,26,27

Tick each box when you have checked it.

  • The seal and the vial are whole

    A broken cap or seal, or a cracked vial, can let germs in. Then do not use it.28,29,30

  • The label shows the name, amount, batch number and expiry date

    In the EU, a medicine must show all four, even on a small vial. If one is missing, or the date has passed, that is a warning sign. Take a photo of the label.31,28

  • It looks right

    A liquid, or a powder after mixing, should be clear and colourless, with no bits. Is it cloudy, has it changed colour, or do you see bits? Then do not use it.32,33

  • A lab report proves little if:

    • its batch number is not the one on your vial;
    • it does not name the lab, or has no date or signature;
    • it shows only purity (HPLC), with no test of what it is, such as mass spectrometry;
    • it has no test for germs (sterility) or for toxins from germs (endotoxin).

    Even a full report covers only one sample. A report from the seller comes from someone who gains if it looks good. It cannot show that your vial is clean.34,35,36,37,38

    What a certificate of analysis shows, and what it does not

  • It was kept as the label says

    Heat, freezing and sunlight can damage a peptide. Did it arrive warm, or was it frozen? Then do not use it. Often nobody can tell you how it was kept on the way. If you cannot know, you cannot rule out damage. When in doubt, throw it out.33,39,40,30

    When to throw a vial away

  • Clean steps, and a new sterile needle and syringe every time

    Wash your hands and wipe the rubber top with alcohol. Never share a needle, a syringe or a vial.30,41,39

    Sterile technique, step by step

  • Keep the vial, its label and any papers

    Keep them, even when the vial is empty, until you know you feel well. If you need a doctor, bring them. A lab can test what was inside.42,43

    If something goes wrong

  • Tell a doctor, and agree which checks fit you

    A doctor can help you choose blood tests that fit what you use. In the Netherlands, your doctor must keep what you say private.44,45,46

    Which checks matter, and whyTalking to your doctor

  • Know the warning signs before you start

    Spreading redness, fever, a swollen face or hard breathing need help fast. If it is severe, call your local emergency number.24,47,48

    All warning signs, and how fast to act

When to stop and get help

Sources 49, 50, 24, 48, 12

Stop-now warning signs

Call your local emergency number now

  • Confusion or slurred speech, very fast breathing, or pale, blue or blotchy skin, often with fever or shivering These can be signs of sepsis: the body's reaction to an infection has started to damage its own organs.
  • Fainting and not waking up within a minute, or fainting with chest pain, a racing heart or a fit This can be a dangerous heart rhythm or a severe allergic reaction.
  • Pain at the injection spot that is much worse than it looks, or dark, purple or grey patches or blisters there This can be a rare, fast-spreading infection of the deep layers under the skin (necrotising fasciitis).
  • Swelling of the lips, tongue or throat, trouble breathing or swallowing, wheezing, a hoarse voice, or feeling faint, soon after an injection This can be a severe allergic reaction (anaphylaxis), which is life-threatening and gets worse very quickly.
  • Pain, pressure or tightness in the chest, or pain that spreads to the arm, neck, jaw or back This can be a heart attack, which needs treatment in hospital straight away.
  • Sudden, severe shortness of breath: gasping, or not able to finish a sentence This can be a serious problem with the heart, the lungs or an allergic reaction.
  • A racing, pounding or irregular heartbeat that does not settle, or that comes with chest pain, breathlessness or fainting This can be a dangerous heart rhythm.
  • A sudden, severe headache with blurred vision, chest pain, confusion or vomiting Blood pressure may be dangerously high, which can damage the brain, heart, kidneys and eyes.
  • An erection that lasts more than 3 hours, or a painful erection that will not go down Blood trapped in the penis can damage it for good if it is not treated quickly.

Get medical help today

  • Fever, shivering or feeling very ill in the days after an injection Germs from the needle, the skin or the product may have reached your blood. If you also have a fast heartbeat or fast breathing, call your local emergency number.
  • Redness, heat, swelling or pain around the injection spot that keeps growing or getting worse This can be a skin infection (cellulitis), which needs antibiotics before it spreads.
  • Red lines that run from the injection spot towards the armpit or groin The infection may be spreading along the lymph vessels, and from there into the blood. If you also have a fever with a fast heartbeat or fast breathing, call your local emergency number.
  • A painful, warm lump that fills with pus This is probably an abscess: it often needs draining by a doctor, so do not squeeze it.
  • You were pricked by a needle that someone else had used Blood on a used needle can pass on HIV and hepatitis B or C, and preventive treatment works best within hours.

Stop and contact a doctor

  • You fainted, but woke up quickly and now feel well Fainting is often harmless, but a doctor should check the cause.
  • A new mole, or a mole that changes size, shape or colour, itches or bleeds A changing mole can be skin cancer, and tanning peptides such as melanotan II have been linked to new and changing moles in case reports.
  • A lump at an injection spot that does not go away, or keeps growing A doctor should check whether it is an abscess, a reaction to the product or something else.
  • An itchy, raised rash, or puffy eyes or lips, while breathing stays normal Your body may be reacting to the product, and using it again can bring the reaction back.
  • Palpitations that keep coming back, even if they pass and you then feel well A doctor can check whether your heart rhythm is normal.
In detail Checks that make sense, and who should be careful

A doctor can help you decide which checks fit you (see talking to your doctor):

  • Blood sugar, especially with diabetes, because too much growth hormone can raise it.23
  • Your heart, if you have heart disease, because of the heart effects seen in studies.12,17
  • Cancer history, because growth hormone medicines carry a warning about tumours.23
  • Anti-doping rules, if you compete: it is banned at all times.9

For injecting, see sterile technique.

Sources

Every claim on this page links to one of these sources. Scholarly sources link to their DOI; regulatory sources to the regulator's own page.

In detail All 51 sources, numbered as in the text
  1. National Center for Biotechnology Information (2026). PubChem Compound Summary for CID 6918297, Hexarelin (examorelin). PubChem. Dataset pubchem.ncbi.nlm.nih.gov — accessed 23 October 2026 ↩
  2. Ghigo E, Arvat E, Gianotti L, Imbimbo BP, Lenaerts V, Deghenghi R, Camanni F (1994). Growth hormone-releasing activity of hexarelin, a new synthetic hexapeptide, after intravenous, subcutaneous, intranasal, and oral administration in man. The Journal of Clinical Endocrinology and Metabolism 78:693-698. Research article doi:10.1210/jcem.78.3.8126144 ↩
  3. European Medicines Agency (2026). Medicines data download (JSON report of all EPARs: authorised, refused, withdrawn and suspended medicines). Dataset ema.europa.eu — accessed 20 October 2026 ↩
  4. College ter Beoordeling van Geneesmiddelen (CBG-MEB) (2026). Geneesmiddeleninformatiebank (database of medicines authorised in the Netherlands). Regulator geneesmiddeleninformatiebank.nl — accessed 20 October 2026 ↩
  5. U.S. Food and Drug Administration (2026). openFDA Drugs@FDA queries, 23 October 2026: prezatide, GHK, copper tripeptide, AOD-9604, AOD9604, hexarelin, examorelin, nicotinamide riboside, nicotinamide mononucleotide, nadide, nicotinamide adenine dinucleotide, elamipretide. openFDA. Dataset api.fda.gov — accessed 23 October 2026 ↩
  6. Laron Z, Frenkel J, Deghenghi R, Anin S, Klinger B, Silbergeld A (1995). Intranasal administration of the GHRP hexarelin accelerates growth in short children. Clinical Endocrinology 43:631-635. Research article doi:10.1111/j.1365-2265.1995.tb02929.x ↩
  7. Rahim A, O'Neill PA, Shalet SM (1998). Growth hormone status during long-term hexarelin therapy. The Journal of Clinical Endocrinology and Metabolism 83:1644-1649. Research article doi:10.1210/jcem.83.5.4812 ↩
  8. Rahim A, Shalet SM (1998). Does desensitization to hexarelin occur?. Growth Hormone & IGF Research 8 Suppl B:141-143. Research article doi:10.1016/s1096-6374(98)80039-7 ↩
  9. World Anti-Doping Agency (2025). World Anti-Doping Code International Standard: Prohibited List 2026. Regulator wada-ama.org — accessed 20 October 2026 ↩
  10. National Library of Medicine (2026). PubMed searches for hexarelin, 23 October 2026. PubMed. Dataset pubmed.ncbi.nlm.nih.gov — accessed 23 October 2026 ↩
  11. Mao Y, Tokudome T, Kishimoto I (2014). The cardiovascular action of hexarelin. Journal of Geriatric Cardiology 11:253-258. Review doi:10.11909/j.issn.1671-5411.2014.03.007 ↩
  12. Bodart V, Febbraio M, Demers A, McNicoll N, Pohankova P, Perreault A, Sejlitz T, Escher E, Silverstein RL, Lamontagne D, Ong H (2002). CD36 mediates the cardiovascular action of growth hormone-releasing peptides in the heart. Circulation Research 90:844-849. Research article doi:10.1161/01.res.0000016164.02525.b4 ↩
  13. Takaya K, Ariyasu H, Kanamoto N, Iwakura H, Yoshimoto A, Harada M, et al. (2000). Ghrelin strongly stimulates growth hormone release in humans. The Journal of Clinical Endocrinology and Metabolism 85:4908-4911. Research article doi:10.1210/jcem.85.12.7167 ↩
  14. Bisi G, Podio V, Valetto MR, Broglio F, Bertuccio G, Del Rio G, Arvat E, Boghen MF, Deghenghi R, Muccioli G, Ong H, Ghigo E (1999). Acute cardiovascular and hormonal effects of GH and hexarelin, a synthetic GH-releasing peptide, in humans. Journal of Endocrinological Investigation 22:266-272. Research article doi:10.1007/BF03343555 ↩
  15. Rahim A, O'Neill PA, Shalet SM (1999). The effect of chronic hexarelin administration on the pituitary-adrenal axis and prolactin. Clinical Endocrinology 50:77-84. Research article doi:10.1046/j.1365-2265.1999.00609.x ↩
  16. Broglio F, Arvat E, Benso A, Gottero C, Muccioli G, Papotti M, et al. (2001). Ghrelin, a natural GH secretagogue produced by the stomach, induces hyperglycemia and reduces insulin secretion in humans. The Journal of Clinical Endocrinology and Metabolism 86:5083-5086. Clinical trial doi:10.1210/jcem.86.10.8098 ↩
  17. Imazio M, Bobbio M, Broglio F, Benso A, Podio V, Valetto MR, Bisi G, Ghigo E, Trevi GP (2002). GH-independent cardiotropic activities of hexarelin in patients with severe left ventricular dysfunction due to dilated and ischemic cardiomyopathy. European Journal of Heart Failure 4:185-191. Research article doi:10.1016/s1388-9842(01)00223-9 ↩
  18. Tivesten A, Bollano E, Caidahl K, Kujacic V, Sun XY, Hedner T, Hjalmarson A, Bengtsson BA, Isgaard J (2000). The growth hormone secretagogue hexarelin improves cardiac function in rats after experimental myocardial infarction. Endocrinology 141:60-66. Research article doi:10.1210/endo.141.1.7249 ↩
  19. Staten-Generaal / Koninkrijk der Nederlanden (2007). Geneesmiddelenwet, artikel 40 (verbod op geneesmiddelen zonder handelsvergunning, en de uitzonderingen). wetten.overheid.nl (BWBR0021505), version in force from 9 September 2025. Law wetten.overheid.nl — accessed 22 October 2026 ↩
  20. World Anti-Doping Agency (2026). World Anti-Doping Code International Standard: Prohibited List 2027 (in effect 1 January 2027). Regulator wada-ama.org — accessed 20 October 2026 ↩
  21. Bundesministerium der Justiz (2023). Gesetz gegen Doping im Sport (Anti-Doping-Gesetz – AntiDopG), Anlage (zu § 2 Absatz 3). gesetze-im-internet.de. Law gesetze-im-internet.de — accessed 20 October 2026 ↩
  22. Bundesministerium der Justiz (2026). Gesetz gegen Doping im Sport (Anti-Doping-Gesetz – AntiDopG), § 2 Unerlaubter Umgang mit Dopingmitteln. gesetze-im-internet.de. Law gesetze-im-internet.de — accessed 20 October 2026 ↩
  23. U.S. Food and Drug Administration (2024). FDA Briefing Document for CJC-1295-Related Bulk Drug Substances (CJC-1295 (free base), CJC-1295 acetate, CJC-1295 with drug affinity complex (DAC) (free base), CJC-1295 DAC acetate and CJC-1295 DAC trifluoroacetate), Pharmacy Compounding Advisory Committee meeting, 4 December 2024. Regulator fda.gov — accessed 22 October 2026 ↩
  24. NHS (England) (2024). Cellulitis. Web page nhs.uk — accessed 20 October 2026 ↩
  25. Inspectie Gezondheidszorg en Jeugd (IGJ) (2026). Online medicijnen. Regulator igj.nl — accessed 22 October 2026 ↩
  26. Ashraf AR, Mackey TK, Vida RG, Kulcsár G, Schmidt J, Balázs O, Domián BM, Li J, Csákó I, Fittler A (2024). Multifactor Quality and Safety Analysis of Semaglutide Products Sold by Online Sellers Without a Prescription: Market Surveillance, Content Analysis, and Product Purchase Evaluation Study. Journal of Medical Internet Research 26:e65440. Research article doi:10.2196/65440 ↩
  27. Smith RM, Schaefer MK, Kainer MA, Wise M, Finks J, et al. (2013). Fungal infections associated with contaminated methylprednisolone injections. The New England Journal of Medicine 369:1598-1609. Research article doi:10.1056/NEJMoa1213978 ↩
  28. U.S. Food and Drug Administration (2020). BeSafeRx: Considering an Online Pharmacy?. Regulator fda.gov — accessed 22 October 2026 ↩
  29. Hospira, Inc. / DailyMed (National Library of Medicine) (2026). Sterile Water for Injection, USP: prescribing information. Official product information dailymed.nlm.nih.gov — accessed 20 October 2026 ↩
  30. World Health Organization (2010). WHO best practices for injections and related procedures toolkit (WHO/EHT/10.02). World Health Organization, Geneva. Report who.int — accessed 20 October 2026 ↩
  31. European Parliament and Council of the European Union (2001). Directive 2001/83/EC on the Community code relating to medicinal products for human use (consolidated text). Official Journal of the European Communities, L 311. Law eur-lex.europa.eu — accessed 20 October 2026 ↩
  32. U.S. Food and Drug Administration / DailyMed (National Library of Medicine) (2026). EGRIFTA SV (tesamorelin for injection): prescribing information and instructions for use. Official product information dailymed.nlm.nih.gov — accessed 20 October 2026 ↩
  33. European Medicines Agency (2026). Wegovy (semaglutide): EPAR — overview and product information. Official product information ema.europa.eu — accessed 20 October 2026 ↩
  34. European Medicines Agency (ICH) (2000). ICH Q7 Good manufacturing practice for active pharmaceutical ingredients (CPMP/ICH/4106/00). European Medicines Agency, scientific guideline. Regulator ema.europa.eu — accessed 22 October 2026 ↩
  35. European Medicines Agency, CHMP and CVMP (2025). Guideline on the Development and Manufacture of Synthetic Peptides (EMA/CHMP/CVMP/QWP/367182/2025). European Medicines Agency. Regulator ema.europa.eu — accessed 22 October 2026 ↩
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