Patient Selection Criteria for Peptide Therapy

Introduction

Appropriate patient selection is fundamental to successful peptide therapy outcomes. This guide provides a framework for evaluating candidates and identifying contraindications.

General Assessment Framework

Medical History Review

Before initiating peptide therapy, conduct thorough review of:

Current diagnoses: Particularly malignancy history, autoimmune conditions, cardiovascular disease
Medication list: Potential interactions and contraindications
Previous peptide use: Response, adverse effects, discontinuation reasons
Allergies: Amino acid or excipient sensitivities

Physical Examination

Relevant examination elements include:

Vital signs and cardiovascular assessment
Thyroid examination
Injection site assessment (for injectable peptides)
BMI and body composition (for metabolic peptides)

Laboratory Evaluation

Baseline labs may include:

Complete metabolic panel
Lipid profile
HbA1c (for metabolic peptides)
Thyroid function tests
IGF-1 (for growth hormone secretagogues)
CBC with differential

Category-Specific Selection Criteria

Metabolic Peptides (GLP-1 Agonists, etc.)

Good candidates:

BMI ≥27 with comorbidities or BMI ≥30
Type 2 diabetes seeking improved glycemic control
Motivated for lifestyle modification alongside medication
No history of medullary thyroid carcinoma or MEN2

Relative contraindications:

Personal or family history of medullary thyroid carcinoma
History of pancreatitis
Severe gastroparesis
End-stage renal disease

Tissue Repair Peptides (BPC-157, TB-500)

Good candidates:

Acute or chronic musculoskeletal injuries
Post-surgical healing optimization
Tendinopathy or ligament injuries
Athletes with appropriate clearance

Relative contraindications:

Active malignancy (theoretical concern)
Pregnancy or nursing
Active infections at proposed injection site

Immune-Modulating Peptides (Thymosin Alpha-1)

Good candidates:

Recurrent infections
Immune support during treatment protocols
Chronic viral conditions
Appropriate oncology applications (under oncologist supervision)

Relative contraindications:

Organ transplant recipients
Active autoimmune flares
Immunosuppressive therapy

Risk Stratification

Low-Risk Candidates

Single indication for peptide use
No significant comorbidities
No contraindicated medications
Previous positive response to peptides

Moderate-Risk Candidates

Multiple comorbidities requiring coordination
Complex medication regimens
Advanced age requiring dose adjustment
Borderline contraindications

High-Risk Candidates

Multiple relative contraindications
Polypharmacy with interaction potential
History of adverse reactions to peptides
Complex medical conditions requiring specialist input

Monitoring Protocols

Initial Phase (First 4-8 Weeks)

Weekly or bi-weekly check-ins
Adverse effect monitoring
Response assessment
Dose titration as needed

Maintenance Phase

Monthly to quarterly follow-up
Laboratory monitoring per peptide protocol
Ongoing efficacy assessment
Adjustment for changing patient needs

Documentation Requirements

For each patient, document:

Clinical rationale for peptide selection
Review of contraindications
Informed consent obtained
Baseline assessment findings
Monitoring plan
Response to therapy

When to Refer

Consider specialist referral when:

Oncologic history requires clearance
Complex endocrine conditions
Significant cardiovascular disease
Uncertain diagnosis
Treatment-resistant conditions

Conclusion

Thoughtful patient selection optimizes peptide therapy outcomes while minimizing risks. A systematic approach to assessment, clear documentation, and appropriate monitoring form the foundation of responsible prescribing.

References

Wilding JPH, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021;384(11):989-1002.
Sikiric P, et al. Brain-gut Axis and Pentadecapeptide BPC 157. Curr Neuropharmacol. 2016;14(8):857-865.
Tuthill C, et al. Thymalfasin: an immune system enhancer. BioDrugs. 2000;14(3):129-135.