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Patients with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2 should avoid GLP-1 drugs entirely, and adding a DPP-4 inhibitor does not change this contraindication

Kooy A et al (2009): Long-term effects of metformin on metabolism and microvascular and macrovascular disease in patients with type 2 diabetes mellitus

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But, when a product is in shortage, licensed pharmacies and FDA-registered compounding facilities are permitted to manufacture versions of the FDA-approved product that are essentially a copy of the FDA-approved product until the shortage is resolved