Brazil’s appetite for weight-loss medications has created a lucrative market for products sold outside official channels, raising concerns among health officials and medical experts about the risks of unapproved or improperly handled injections.
The scale of the trade became clear in April, when Brazilian customs officers searching a tourist bus arriving from Paraguay found hundreds of vials of tirzepatide concealed inside jars of ‘dulce de leche’. The shipment ultimately contained more than 2,500 vials, according to Brazil’s Federal Revenue Service.
Other seizures have found weight-loss drugs hidden in motorcycle exhaust pipes and inside false shoe soles.
The medications belong to a class known as GLP-1 receptor agonists, which includes Eli Lilly’s Mounjaro and Novo Nordisk’s Wegovy. Brazil has become one of the world’s largest markets for the treatments, with usage reaching 5.5% of the population, compared with a global average of 3.7%, according to Euromonitor International.
The combination of strong demand, limited purchasing power and Brazil’s beauty-focused culture has helped drive consumers toward cheaper products obtained through unofficial channels.
Investment bank Itau BBA estimates that about 51% of Brazil’s roughly $7 billion weight-loss drug market this year will come from untracked sources, including compounded medications and products smuggled from Paraguay.
Authorities have recorded more than 3,600 complications linked to weight-loss drugs between 2018 and mid-August 2026, with more than 60% of those reports coming in 2025 and 2026. Eighty-three deaths are also under investigation.
Reuters could not independently determine how many of those deaths or complications involved unauthorized versions of the drugs.
Illegal imports surge
Brazilian seizures of illegal GLP-1 medications increased dramatically, rising from 609 units in 2024 to 60,787 in 2025, according to the Brazilian Anti-Counterfeiting Association. Seizures have continued to climb sharply this year.
The drugs are primarily smuggled from Paraguay, where less restrictive patent laws allow companies to manufacture medications that otherwise may only be available in Brazil as more expensive branded products.
One Paraguayan product, T.G., is legally sold in pharmacies in Paraguay and has been approved by the country’s health regulator, Dinavisa. Brazilian authorities, however, have not evaluated it.
Dinavisa said it and the Paraguayan government are not responsible for transporting medicines, while acknowledging that some people move them across the border irresponsibly. The manufacturer, Laboratorios Indufar Cisa, did not respond to requests for comment.
Brazil’s health regulator, Anvisa, distinguishes smuggled products from compounded medications. According to the agency, compounded drugs must comply with technical requirements and undergo local inspections, while smuggled products bypass Brazil’s regulatory evaluation.
Andreia Kohout, pharmaceutical director of the Brazilian Anti-Counterfeiting Association, said consumers frequently assume compounded medicines are equivalent to branded products. She also warned that the compounded market, which is heavily promoted by influencers, includes unreliable suppliers.
Lower prices fuel the trade
For many consumers, affordability is a decisive factor.
Brazilian authorities hope that cheaper, regulated alternatives will eventually reduce demand for illicit products. In May, Anvisa approved Ozivy, the country’s first domestically produced alternative to Novo Nordisk’s Ozempic after its patent expired. A four-week supply can cost less than $100, and Anvisa has since approved additional brands.
Doctors warn of health risks
Medical professionals are concerned not only about the number of unauthorized injections circulating in Brazil, but also about how some are manufactured, stored and transported.
Two doctors, a pharmacist and a Brazilian official told Reuters that exposure to excessive heat or improper storage can compromise injectable medications.
The approved labeling for Mounjaro and Wegovy warns of acute pancreatitis, which occurs in 0.1% to 1% of patients. One doctor also said prolonged fasting while taking the medications can cause hypoglycemia, although this is rare when the drugs are used correctly.
Anvisa has separately warned that GLP-1 drugs can increase the risk of aspiration and pneumonia during anesthesia because they slow digestion.
The regulator has also reported an increase in cases of acute pancreatitis associated with improper use of GLP-1 medications. The condition can lead to tissue and cell death and, in severe cases, can be fatal. Anvisa says the drugs should be taken as prescribed and under medical supervision.
Deaths remain under investigation
The potential consequences are illustrated by cases now being examined by Brazilian authorities.
Flavio Fabres, who heads the medical examiner’s office in João Pessoa in northeastern Paraiba state, reviewed the case of 31-year-old Jessica Ataide, who died suddenly last November while using a weight-loss medication without consulting a health professional.
Fabres said her blood sugar dropped sharply soon after she took a dose. She lost consciousness and choked after stomach contents entered her airway, ultimately causing her death by asphyxiation.
Ataide’s family declined to comment, and Reuters could not establish which weight-loss drug she had been taking.
Despite the concerns, some users say the benefits outweigh the risks.
Vitoria Braga, a 31-year-old Rio resident, said she uses a smuggled injection together with her boyfriend and three relatives. She has never consulted a doctor about the treatment.
After a recent increase in her dose, she was bedridden for four days with fever, nausea and flu-like symptoms. Braga said she does not know the identity of her supplier but chose not to seek medical advice because she feared a doctor would tell her to stop taking the drug.
Drugmakers push regulated use
Eli Lilly said it is supporting Brazilian authorities in efforts to combat the illegal market and protect patients. The company said it is also looking for ways to improve affordability while keeping treatments within legal and regulated channels.
Novo Nordisk said the growing popularity of GLP-1 medications in Brazil has expanded the market for compounded, counterfeit and illegally imported products, often sold without medical supervision or outside regulated systems.
