Q&A: Pharmacist Strategies for Optimizing GLP-1 Therapy Outcomes

Pharmacists play a crucial role in supporting patients who are taking glucagon-like peptide-1 (GLP-1) receptor agonists by providing education on injection techniques and managing gastrointestinal side effects to improve adherence. By focusing on personalized guidance and teamwork, pharmacists can help patients navigate therapy challenges and maintain successful treatment plans.

Q&A: Pharmacist Strategies for Optimizing GLP-1 Therapy Outcomes / alones - stock.adobe.com

In an interview with Drug Topics®, Lydia Newsom, PharmD, clinical associate professor of pharmacy practice at Mercer University College of Pharmacy, discussed how pharmacists can support patients in maintaining adherence to GLP-1 therapy, and how they can collaborate with other healthcare professionals to optimize patient outcomes.

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Drug Topics: How can pharmacists support patients in maintaining adherence to GLP-1 therapy, especially those who may struggle with injection techniques or gastrointestinal side effects?

Lydia Newsom, PharmD: I think many patients may discontinue these medications because of those reasons, and we've seen that in clinical studies. I think education is, to me, one of the most important pieces. When we think about administration technique, trying to educate the patient when they have the medication in front of them, they're holding the pen or they're holding the vial, and walking through that process with the patient is really important. Give them a mechanism to ask questions. If they get home and they're doing the injection, a mechanism to say, “Wait a second. I have a question.” Often I'll share a handout that goes over the injection technique, or even distribute one of the manufacturer created videos that the patient could review online if they had questions about that. I think education up front is very helpful, especially since some of our patients are now obtaining these medications in the form of a vial directly from the manufacturer. Using a vial and syringe is a little more complicated to some patients than the specific pen. Making sure that we're providing specific education for how the patient is using their specific product.

For the gastrointestinal side effects, those are also very common. Making sure patients understand the difference between a common side effect, like when we think nausea, upset stomach upset, diarrhea or constipation, maybe some vomiting, versus a severe, rare but possible, unexpected side effect that we counsel our patients on. We want them to seek medical attention, making sure they have confidence to be able to differentiate between our common upset stomach, nausea, vomiting versus our severe abdominal pain like pancreatitis or gallstones that are different and that we need to seek medical attention for. Giving them some lifestyle changes to help manage some of those common side effects. Eating small, frequent meals is really helpful. Avoiding trigger foods like alcohol, acidic foods, fatty foods or highly processed sugary foods can really help minimize some of those side effects to help them be able to maintain adherence. Often, some of those side effects with time do get better. Counseling patients that these side effects may get better with time, and if they don't, giving patients a mechanism to say, please reach back out to the pharmacy or to your health care provider to manage those if they're not improving.

Drug Topics: How can pharmacists collaborate with physicians, dietitians, and other healthcare professionals to optimize patient outcomes with GLP-1 therapy?

Newsom: I think optimizing the healthcare team and the inner workings of the team are always best for the patient. I think, as much as possible, open communication about what's going on. A pharmacist is often the one identifying barriers to the patient's adherence. Maybe it's cost and communicating that this isn't affordable based on this patient's insurance. We have some other alternatives. Thinking about maybe side effects and communicating about those. I think pharmacists can identify some of those barriers and then communicate back to the healthcare provider on what those are, as well as providing the patient counseling.

I also work closely with a dietitian in our clinic. Referring patients and making sure that they're taking advantage of our dietitians expertise when they're really trying to make some lifestyle changes. Being on a GL-1 or GIP, these drugs can reduce appetite significantly. It's a great time for our patients to really work on diet choices and become educated about healthy diets. Making sure if a patient can afford it, to go see our dietitian for support. Also, thinking about diabetes. Patients may be taking these medications for diabetes, and this is one tool in their arsenal. Thinking about treating diabetes as well. Making sure the pharmacist is thinking about all those other aspects. Are they checking their blood glucose appropriately? Are they taking their other medications appropriately? Making sure we're communicating with the patient's full health care team about that to really optimize their outcomes.

Drug Topics: Is there anything else you wanted to say?

Newsom: I do think that there's some opportunity for counseling that can be very patient specific, but may often be missed in prescribing information. We do see some of these medications are now being held around surgeries. Making sure that if a patient has an upcoming surgery, they need to communicate with their surgeon or their healthcare provider about appropriate use of this medication, because these drugs do delay gastric emptying, slowing down how fast your stomach empties. There can be some concern around surgeries. Also, one of the agents, tirzepatide, may also impact the efficacy of oral contraceptives. In women of childbearing age, it's very important that pharmacists have a conversation with patients taking tirzepatide about switching to a nonoral agent or using a barrier method. When this therapy is introduced or when we are making changes, I do think these, in addition to injection technique and adherence and costs, there are some specific things that I think pharmacists can really have high value in when we communicate to patients about those things.

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