The popularity of FDA-approved weight-loss medications has surged in recent years, and demand has reached long-term care facilities. When prescribed appropriately, these medications can improve the overall health and quality of life for residents of assisted living facilities, nursing homes, and group homes; however, their use in long-term care populations, whose members are typically of advanced age, medically frail, and/or have cognitive impairment, presents unique challenges. Pharmacists play a pivotal role in ensuring that these medications are used safely and effectively in these settings.
Medications approved for chronic weight management include semaglutide (Wegovy; Novo Nordisk), tirzepatide (Zepbound; Eli Lilly & Co.), and liraglutide (Saxenda; Novo Nordisk), which are injectable, as well as phentermine/topiramate (Qsymia; Vivus LLC), naltrexone/bupropion (Contrave; Currax Pharmaceuticals LLC), and orlistat (Xenical, Alli; H2-Pharma, GSK), which are oral drugs.1 These medications are generally indicated for patients with a body mass index (BMI) of 30 kg/m² or greater, or for patients with a BMI of 27 kg/m² or greater with at least 1 comorbidity, such as hypertension or diabetes. Semaglutide, a glucagon-like peptide (GLP)-1 receptor agonist, and tirzepatide, a dual gastric inhibitory polypeptide (GIP)/GLP-1 receptor agonist, are particularly efficacious. In clinical trials they have been shown to produce mean body-weight reductions of approximately 15% and up to 20%, respectively, from baseline.1
It is important to note that these medications are most effective when combined with lifestyle modifications, including a healthy diet and regular exercise.1
Administering weight-loss medications in long-term care introduces several challenges, including the need to assess resident appropriateness, polypharmacy, injection logistics, monitoring needs, cost barriers, and consent management in residents with cognitive impairment. Like all medications, GLP-1 and GIP/GLP-1 receptor agonists, as well as other weight-loss drugs, carry potential adverse events (AEs). Common complaints include gastrointestinal upset, such as nausea, vomiting, and diarrhea; dehydration; loss of lean body mass; hypoglycemia in patients with diabetes; and orthostatic hypotension.1
Each of these AEs poses added risk for falls and frailty in older populations and individuals with complex medical needs. Frail or undernourished residents may not tolerate appetite suppression or gastrointestinal symptoms. Appropriateness should be carefully assessed before beginning a program, and patients should be regularly monitored to ensure benefit without excessive weight loss or dehydration.
Polypharmacy, commonly defined as the concurrent use of 5 or more medications, is of particular concern in the long-term care population. According to one study, the overall percentage of US adults with polypharmacy more than doubled from about 8.2% in 1999 to 2000 to 17.1% in 2017 to 2018.2 Polypharmacy prevalence is considerably higher among the elderly and adults with diabetes and/or heart disease.2
“The majority of research suggests that polypharmacy is associated with negative clinical consequences, including nonadherence to treatment, adverse drug events (eg, falls, fractures, renal failure), drug–drug interactions, and hospitalizations. Polypharmacy is also linked to increased risks of disability, cognitive decline, and even mortality,” the study authors cautioned.2
Pharmacists are uniquely positioned to monitor drug regimens for potential interactions between weight-loss drugs and other medications and to collaborate closely with providers and insurance companies on identifying suitable alternatives where appropriate.
For injectable drugs, logistical issues are a concern. Effective programs require trained staff and consistent administration.
Cost barriers are also significant, both in the long-term care and general populations. Traditional Medicare generally does not cover drugs prescribed solely for weight loss, and Medicaid coverage varies by state. Additionally, private insurance plans differ widely. Some cover these medications for obesity, whereas others exclude them entirely or require prior authorization. Even when coverage is available, out-of-pocket costs may still be high, as many plans place these drugs on higher specialty tiers with significant copays or coinsurance.
A multidisciplinary approach is required to effectively manage these challenges, and long-term care pharmacists play a key role in screening, monitoring, and coordinating care. An effective overarching plan should include pharmacist-led appropriateness screening, dietitian coordination, careful titration, staff training for injections, prior authorization management, consent management, and individualized nutrition and exercise planning.
Frank Longo, RPh, is the president of Precision LTC Pharmacy, which serves long-term care facilities in the New York metropolitan area.
Precision LTC Pharmacy can be reached at (516) 466-7700 or info@precisionltc.com. For more information visit PrecisionLTC.com.
Facilities should establish defined monitoring intervals, such as weekly weight checks during titration, daily hydration reviews, and monthly functional assessments, based on patient status and facility policy. Gastrointestinal tolerance should be regularly tracked, and glucose levels measured in patients with diabetes. The effectiveness of patient monitoring is enhanced by clear documentation, adherence to defined stop criteria (such as excessive weight loss or dehydration), and regular communication with members of the care team and family members.
Through individualized plans, careful monitoring, and collaboration with care team members, patients, and families, pharmacists can help ensure that long-term care residents benefit from game-changing medications like semaglutide and tirzepatide while minimizing the risks of AEs.
Stay informed on drug updates, treatment guidelines, and pharmacy practice trends—subscribe to Pharmacy Times for weekly clinical insights.
