Introduction: Following aneurysmal subarachnoid hemorrhage (aSAH), approximately 30% of patients experience delayed cerebral ischemia (DCI). Nimodipine, a cerebroselective dihydropyridine calcium channel blocker, reduces this risk of DCI with <5% of patients experiencing hypotension or bradycardia. We review four patients admitted to our Neurosciences Intensive Care Unit following aSAH who developed nimodipine-induced refractory vasoplegia. We discuss these four cases and detail the interventions used to counter their bradycardia and hypotension. Methods: We performed a retrospective chart review to examine vasopressor use and interventions required to combat hypotension and bradycardia as well as patient demographics and comorbidities to identify risk factors for nimodipine-induced vasoplegia. Similar case studies were reviewed. We performed a literature search to suggest treatment options for nimodipine toxicity and assess the risk of Nimodipine dose adjustments in possibly increasing DCI occurrence. Results: Patients required 6.5 medications on average to treat vasoplegia. Transvenous pacing and intubation were required for two patients. On average, vasoplegia lasted 18 hours and patients were slowly weaned off vasopressors. Risk factors for vasoplegia include liver and kidney disease. Nimodipine formulation may contribute to vasoplegia. Dose adjustments of nimodipine may increase risk of DCI. Conclusion: In our literature review, nimodipine is generally well-tolerated and reduces DCI. Mild to moderate hypotension requiring vasopressor support should be expected. In cases of refractory vasoplegia resulting in cardiovascular collapse, we recommend cessation of nimodipine and treating as calcium channel blocker toxicity along with the use of nitric oxide scavengers given nimodipine's mechanism of action and the mechanism of vasoplegia.
Pramipexole is a dopamine agonist used for the treatment of Parkinson's disease and restless leg syndrome. Amantadine is an antiviral agent with dopaminergic action that is approved for the treatment of motor symptoms associated with Parkinson's disease. This case report describes a patient with delusional parasitosis associated with concurrent use of pramipexole and amantadine. A 71-year-old man with a history of multiple sclerosis and Parkinson's disease presented with delusional parasitosis 4 months after his dose of pramipexole was increased from 0.75 mg/day to 4.5 mg/day. He was admitted to the geriatric psychiatric unit after his stool samples were found to be negative for parasites. A pharmacist evaluated his medications and noted that pramipexole and amantadine were independently associated with delusional parasitosis. Pramipexole and amantadine were subsequently discontinued, the patient was discharged and delusions completely resolved 4 months post-discontinuation. Concomitant use of pramipexole and amantadine may have led to delusional parasitosis. A literature review suggests that delusional parasitosis may be linked to striatal dopamine transporter dysfunction. In this case, the Naranjo Probability Score indicated that a drug-induced adverse event was "probable". The effects of these medications may have been enhanced by the patient's advanced age and the administration of pramipexole at the maximum recommended dose. Delusional parasitosis can occur in patients receiving concomitant treatment with pramipexole and amantadine. Patients receiving high doses of these agents in combination with other risk factors such as advanced age and impaired renal function should be monitored for symptoms of delusional parasitosis.
Prolonged durations of hypotension during septic shock promote organ injury and mortality. Empirical evidence suggests that earlier vasopressin initiation may improve outcomes in septic shock. The objective of this study was to determine the effect of a ready-to-use vasopressin formulation availability in intensive care unit automated dispensing cabinets on outcomes in septic shock. This was a pre-post quasi experimental study of adults admitted for septic shock who received vasopressin as a second line vasopressor after norepinephrine. Inverse probability of treatment weighting with propensity scores was used to balance baseline covariates between those who received the ready-to-use vasopressin product and the traditional pharmacy-compounded vasopressin product. Outcomes included time from vasopressin order to administration, time to target mean arterial pressure, length of stay, and mortality. A total of 1104 patients with septic shock were included. After propensity score adjustment, the ready-to-use group was associated with faster time to vasopressin administration (17 vs 41 min, P < 0.001), faster time to target mean arterial pressure (hazard ratio 1.29, 95% CI 1.14 to 1.47, P < 0.001), and a shorter length of intensive care unit stay (hazard ratio 1.23, 95% CI 1.06 to 1.43, P = 0.006) as the compounded group. Mortality was not significantly different. In patients with septic shock, availability of a ready-to-use vasopressin product in the intensive care unit automated medication dispensing cabinet was associated with faster time to administration, improved time to target mean arterial pressure, and reduced duration of intensive care.
This case report describes the treatment failure of two direct oral anticoagulants (DOACs) in a patient with multiple thrombophilic conditions, including triple-positive antiphospholipid syndrome (APS) and heterozygous Factor V Leiden mutation. A 69-year-old male with a history of recurrent venous thromboembolism developed a deep vein thrombosis while receiving rivaroxaban, followed by an acute ischemic stroke while on dabigatran. Due to recurrent thrombosis despite therapeutic DOAC therapy, the patient was transitioned to warfarin with low-molecular-weight heparin bridging. After achieving a therapeutic INR, the patient remained stable without further thromboembolic or bleeding events during follow-up in a pharmacist-managed anticoagulation clinic.Current guidelines, including the 2020 ISTH Scientific and Standardization Committee guidance, recommend vitamin K antagonists over DOACs in high-risk APS, particularly in patients with triple-positive antibodies, due to the increased risk of recurrent thrombosis with DOAC therapy. This recommendation is supported by the TRAPS trial, which demonstrated a significantly higher rate of thromboembolic events with rivaroxaban compared to warfarin in triple-positive APS patients.This case supports existing guideline recommendations and highlights the limitations of targeted anticoagulation, including both factor Xa inhibitors and direct thrombin inhibitors, in patients with complex thrombophilia. In patients with high-risk APS or multiple thrombophilic conditions, warfarin has been shown to be more reliable anticoagulation compared with DOACs. The sequential failure of two mechanistically distinct DOACs in this case further underscores the importance of guideline-concordant anticoagulant selection and the role of pharmacists in identifying high-risk patients at the point of prescribing and dispensing.
Automated dispensing cabinet (ADC) overrides facilitate timely medication access but bypass standard medication-use safety checks, necessitating ongoing monitoring to identify potential risks. Many health systems rely on manual, retrospective workflows to review override activity, yet operational burden associated with these processes is not well characterized. Objectives of the evaluation were to describe the workflow, quantify the time burden, and identify limitations associated with a manual ADC override monitoring process within a large health system. This retrospective, descriptive quality improvement evaluation was conducted at a large oncology-focused health system. The existing ADC override review process was assessed over a 6-month period. Workflow steps included generation of external reports, manual alignment and manipulation of data within spreadsheets, and creation of pivot table summaries for analysis across patient care areas. Time required to complete each monthly override audit was tracked, and process limitations were documented. The mean time required to complete a monthly override audit was 1 h and 7 min, with a range of 42 min to 1 h and 55 min. The most time-intensive activities were spreadsheet construction, data manipulation, and report preparation. Additional effort was required to train and validate reviewers. Key process limitations included reliance on retrospective reporting, lack of standardized review methodologies, and challenges aggregating data to identify system-level trends. Manual ADC override monitoring is resource intensive and subject to variability due to retrospective, spreadsheet-based workflows. These findings suggest a need for optimized and standardized approaches to support medication safety surveillance and improve scalability of override review processes.
Background: Bone-health risk assessment and treatment among prostate-cancer patients on androgen-deprivation therapy (ADT) is often inadequately completed in clinical practice. Objective: To determine the impact of a population-management program on bone-health risk assessment and bisphosphonate therapy among prostate-cancer patients on ADT. Methods: We used retrospective data from a large integrated healthcare system to identify men aged 41-89 years diagnosed with prostate cancer in 2011-2024 who received ≥1 ADT dose. We compared adherence to internal guideline-recommended bone mineral density (BMD) testing, laboratory evaluation, and bisphosphonate prescriptions at baseline and during follow-up between men enrolled in the population-health program with men and men who were not enrolled (non-enrolled). Results: Among the 9934 eligible patients, 1680 (17%) were enrolled in the program and 8254 (83%) were non-enrolled. The proportion of enrolled patients completing BMD scans within 1 year before or after ADT initiation (80.6%) was substantially higher than among non-enrolled patients (23.8%, P < 0.0001). More enrolled patients were treated with antiresorptive therapy (26.4%) than among non-enrolled patients (14.1%, P < 0.0001). Overall, enrollees were more likely to have ever received any guideline-indicated intervention (78.7% vs 27.8%, P < 0.0001). The average coverage percentage for BMD screening was 24.4% among non-enrolled patients vs 81.1% among enrolled patients (P < 0.0001). Among antiresorptive-treatment-eligible patients, the average coverage percentage for bisphosphonate therapy was 35.5% among non-enrolled patients compared with 46.1% among enrolled patients (P < 0.0001). Conclusion: The population-management program significantly outperformed usual care in adherence to BMD testing, laboratory evaluation, and indicated antiresorptive osteoporosis-medication treatment among men with prostate cancer on ADT.
Diuretics are integral in fluid de-resuscitation of ICU patients following initial stabilization. While loop diuretics are commonly used, sequential nephron blockade (SNB) is an alternative diuretic strategy that combines a loop diuretic with at least one diuretic from another pharmacologic class to increase efficacy and limit adverse effects. The objective of this study was to compare the safety and efficacy of SNB to loop diuretics alone for de-resuscitation of critically ill patients. This retrospective study included adult ICU patients who received either a loop diuretic alone or combined with an aldosterone antagonist, carbonic anhydrase inhibitor, and/or thiazide diuretic on two consecutive days. The primary outcome was comparison of diuretic efficacy, assessed by urine output, on diuresis day 1. Secondary outcomes included comparison of diuretic efficacy on diuresis days 2-5 and incidence of acute kidney injury and electrolyte abnormalities on diuresis day 1. A total of 100 patients were included (SNB = 15, Loop = 85). At baseline, SNB patients had more hypernatremia (20% vs 2.4%, P = 0.023) and hyperchloremia (20% vs 2.4%, P = 0.023). Patients in the SNB group had increased urine output on diuresis day 1 (4725 vs 2215 mL, P = 0.0004). AKI did not occur in SNB patients on diuresis day 1 vs 15.5% of loop patients (P = 0.208). Hypernatremia (26.7% vs 2.4%, P = 0.004) and hyperchloremia (13.3% vs 3.5%, P = 0.161), persisted in the SNB group on diuretic day 2. In conclusion, among ICU patients requiring de-resuscitation, SNB may be associated with improved diuresis and similar safety concerns compared to loop diuretics alone.
A retrospective review of patients at a single institution who underwent isolated coronary artery bypass (CABG) surgery between 2017 and 2023 was conducted to investigate the clinical utility of pre-operatively measuring platelet inhibition as a predictor of bleeding complications, especially in the context of bypass surgery. Patients who underwent CABG procedure and were on P2Y12 inhibitors such as clopidogrel or ticagrelor preoperatively and had preoperative P2Y12 platelet reactivity unit (PRU) level measured. Patients were stratified by a PRU <200 or ≥200. In both groups, patients were divided into patients who took clopidogrel and patients who took ticagrelor. There were 189 patients included in the study. Patients with a PRU ≥200 were of similar age and comorbidities to those with a PRU <200, however, more were female. Both groups had a similar mean duration of days since last P2Y12 inhibitor dose prior to surgery. There were greater intraoperative platelet transfusions in the PRU <200 group (mean 0.7 vs 0.3 units, P = 0.001). Intraoperative red blood cell and plasma transfusion and postoperative transfusions, 24-hour chest tube output, and re-exploration for bleeding were similar between the groups. There were no differences in bleeding complications between pharmacologic agent in either group. Our findings suggest that preoperative assessment of P2Y12 PRU may have limited clinical utility at a cutoff of 200 in predicting bleeding in patients undergoing CABG. Patients with PRU <200 received higher rates of platelet transfusion, without differences in other blood products.
Etomidate is commonly used for procedural sedation in the emergency department due to its rapid onset, short duration of action, and favorable hemodynamic profile. Adverse effects are generally limited to pain at the injection site, myoclonus, nausea, and transient adrenal suppression. Paradoxical agitation following etomidate administration is rarely described. We report a case of severe, transient agitation following low-dose etomidate used for procedural sedation to facilitate electrical cardioversion in a healthy young adult presenting with new-onset atrial fibrillation.
Health-system specialty pharmacies (HSSPs) provide specialized medication therapy management to patients with complex medical conditions. HSSPs assess clinical outcomes for specialty disease states, including migraines. There are currently no studies comparing types of outcomes for patients with migraines and the impact on pharmacist intervention in HSSPs. The aim of this study was to determine if changing migraine outcome from a non-disease specific patient reported outcome measure (PROM) to a disease specific patient reported outcome (PRO) impacts the number of pharmacist interventions made on migraine regimens in a HSSP. A single-center, pre-post, retrospective chart review was conducted at a HSSP. Adult patients who received at least one abortive specialty migraine medication and/or at least three preventative specialty migraine medication fills were included in the study. The primary endpoint was the number of pharmacist interventions regarding pharmacologic migraine regimens before and after the outcome change. Key secondary endpoints included change in number of migraine days per month, change in number of missed days from school, work or planned activities, number of migraine episodes requiring hospitalization, and overall number of pharmacist interventions. There were 61 patients included in the study. The number of pharmacist interventions on migraine regimens was no difference between the migraine PROs group (15.2%) when compared to the PROM group (13.5%; P = 0.715). Utilizing either non-disease specific PROM or disease-specific PROs as a clinical outcome measure for HSSP migraine patients could be valuable, with the latter shifting pharmacist interventions toward migraine pharmacotherapy optimization.
Previous literature has demonstrated that hyperlipidemia is common post-transplant; however, low statin utilization has been seen post-liver transplant. Furthermore, assessment of statin qualification in this setting is limited. This study's objective was to evaluate the incidence of hyperlipidemia and determine the rate of qualification for and initiation of statin therapy in liver transplant recipients to better characterize the complication and associated clinical practice behaviors. This single center, retrospective cohort study included adult patients who received an isolated liver transplant between January 1, 2015 and June 30, 2019 and had lipid panels within 15 months pre- and post-transplant. The dual primary outcomes were the incidences of hyperlipidemia and statin qualification, as determined by 2012 AASLD and 2018 ACC/AHA guidance. Secondary outcomes included statin use and tolerability, hypertriglyceridemia, and immunosuppression factors. Of the 282 patients screened, 79 patients were included. Compared to pre-transplant, incidences of hyperlipidemia and statin qualification were both increased post-transplant (hyperlipidemia: 21.5% vs 49.4%, P = 0.0003; statin qualification: 46.8% vs 64.6%, P = 0.025). Of the 51 statin-qualifying patients post-transplant, twenty-two (43%) received statin therapy. One patient experienced muscle aches requiring statin discontinuation. Hypertriglyceridemia was more common post-transplant than pre-transplant (11.4% vs 60.8%, P < 0.0001). Of patients on tacrolimus, 58% qualified for statin therapy compared to 93% of patients on an mTOR inhibitor. Nearly two-thirds of liver transplant recipients qualify for statin therapy post-transplant. Despite increased rates of dyslipidemia and statin qualification post-liver transplant, statin therapy remains underutilized. Optimization of lipid management remains an area of need post-liver transplant.
Rates of unintended pregnancy continue to remain high in the United States. Pharmacist-prescribed hormonal contraception offers an accessible option for preventing mistimed or unintended pregnancies, leading to better reproductive health outcomes. Specifically in Indiana, studies show patient interest in this service, however, overall pharmacy implementation and patient awareness has been low. This project aims to explore strategies for educating pregnancy-capable people in Indiana about the availability of pharmacist-prescribed birth control. The Social Marketing Theory guided development of a focus group/interview guide to identify themes on how best to educate pregnancy-capable individuals on pharmacist-prescribed hormonal contraception. The sessions were conducted virtually by one investigator and transcripts were analyzed by three investigators using inductive thematic analysis. Four focus groups and four interviews were conducted with a total of 12 English-speaking participants. Identified themes included Prior Understanding of Pharmacy Services, Pharmacy Service Characteristics, Knowledge or Education, and Preferred Advertising Method and Content. Results showcased that there was an overall lack of knowledge about this service and that strategies for educating the community would be through social media, pharmacy flyers, campus outreach, and health fairs. Pharmacists play a key role in addressing reproductive healthcare gaps. As new services are implemented, consideration should be given as to how best to educate the community through modalities such as social media, pharmacy flyers, campus outreach, and health fairs. Strategic community engagement for pharmacist-prescribed contraception services may help to overcome access barriers and ultimately reduce the incidence of mistimed or unwanted pregnancies in Indiana.
Academic detailing (AD) can bridge the gap between evidence-based research and clinical practice to optimize patient outcomes. An up-to-date analysis of AD's impact on clinician and patient outcomes is lacking. The purpose of this review was to examine updated evidence of AD's impact on clinician knowledge, behavior, and patient outcomes. A librarian selected the keywords and designed the searches. Articles met full inclusion if they had an AD intervention and evaluated an outcome of change in clinician knowledge, behavior, and/or patient outcomes. The following data was extracted using Covidence: study design, types of outcomes, AD intervention description, number and type of learners and detailers, source of data analysis, outcome results, and if the results supported the use of AD. Forty studies were included in the final analysis. Twenty-seven percent (11 of 40) evaluated clinician knowledge change, 87.5% (35 of 40) evaluated clinician behavior change, and 17.5% (7 of 40) evaluated impact on patient care. Eighty percent of included studies (32 of 40) found a positive impact of AD on desired outcomes. There was a lack of uniform methodology and evaluation methods among the manuscripts. Pharmacists were the most common detailer type in the literature, aligning with AD topics of medication prescribing. The findings of this review reflect previous AD literature; variable interventions with less-than rigorous methodology and reporting, but an overall positive trend on desired outcomes.
A middle-aged man with a history of polysubstance abuse presented with acute hypoxemic respiratory failure following self-reported ingestion of kratom and tianeptine. Initial evaluation showed significant respiratory depression, hypoxia, bilateral pulmonary infiltrates, and acute encephalopathy. Symptomatic management, naloxone administration, and ICU-level supportive care led to gradual clinical improvement. This case highlights the potential for severe respiratory and neurological compromise with combined kratom and tianeptine toxicity.
Upon successful completion of the PharmD program at KU, exit interviews revealed limited exposure to pharmacogenomics during clinical rotations. Hence, we surveyed Kansas pharmacy preceptors to investigate why and determine the need for continuing education. In this cross-sectional study, a survey was developed through Qualtrics. CORE ELMS was used to identify active pharmacy preceptors in Kansas who provide experiential education, and the survey was disseminated by email to 319 Kansas pharmacy preceptors. Responses were recorded and subgroup analyses were conducted using the chi-square test and Welch's t-test. Sixty responses were received (18.8% response rate), and 58 were included in the analysis. Preceptors reported limited practical experiences with pharmacogenomics. Hospital preceptors reported seeing more patients with pharmacogenomics test results than community preceptors (65.0% vs. 27.3%, p = 0.0321). Overall, they demonstrated awareness of foundational pharmacogenomics concepts but limited applied confidence. Pharmacists who completed postgraduate training were more comfortable interpreting pharmacogenomics guidelines compared to those who didn't (2.5429 vs. 1.6522 out of 5, p = 0.0004317). They all showed positive attitudes toward pharmacogenomics, with 83.9% willing to use as part of standard protocols and 93% agreeing pharmacists should lead its implementation. Additionally, they expressed a desire for online (70.2%) and local training (86%). Our results show that use of pharmacogenomics in clinics has been gradually increasing, but Kansas preceptors still exhibited limited experience and confidence levels. Online or local pharmacogenomics educational programs are needed for preceptors and pharmacists to further improve education and integration in clinics.
Patients with low health literacy are at risk for comorbidities, including obesity. Pharmacists offer a unique position to improve health literacy amongst all patients, including those with obesity. The primary aim of this study was to assess change in health literacy using the HELIA assessment pre and post pharmacist intervention. A single center, prospective, pre-post cohort study was conducted at an outpatient adult primary care office from November 21, 2024, through April 15, 2025. Obese adult patients who were consulted to pharmacy care were eligible for inclusion. Pre and post raw HELIA scores were assessed approximately 4 weeks apart to assess health literacy. A third visit was optional for further measurements of weight. These appointments were completed under a preexisting collaborative practice allowing pharmacists to manage medications and labs. The primary outcome was change in pre and post raw HELIA score. Secondary outcomes include changes in weight (kg) and others focused on both health literacy and weight loss agents. The outcomes were analyzed using the Wilcoxon-Signed rank test. Twenty-two patients were included initially. Nineteen patients completed both visits. The primary outcome resulted in a significant increase of median raw HELIA scores of 137 at Visit 1 to 148 at Visit 2 ( P = 0.0004). Patients also showed a significant decrease in their median weight from Visit 1 of 109.9 kg to 108.2 kg at Visit 2 ( P = 0.0056). Pharmacist led obesity visits significantly increased health literacy scores and decreased weights between Visit 1 and Visit 2.
Background: Optimal phenobarbital serum levels for treating severe alcohol withdrawal syndrome (AWS) remain unclear. Objective: This study evaluated whether phenobarbital serum levels are associated with symptom control in patients with severe AWS admitted to a medical intensive care unit (MICU). Methods: We conducted a single-center, retrospective analysis of adult MICU patients treated with phenobarbital for severe AWS between January 2011 and December 2022. Patients were categorized into two cohorts based on symptom control status: (1) symptom controlled and (2) non-symptom controlled. The primary objective was to assess the relationship between phenobarbital serum levels and symptom control. Secondary objectives evaluated dosing regimens and safety outcomes. Results: Of 114 patients (63 symptom controlled, 51 non-symptom controlled), no significant association was found between phenobarbital levels (32.2 ± 19.9 vs 36.9 ± 16.0 mcg/mL) (mean, SD) and symptom control (P = 0.08). Phenobarbital dosing regimen, loading dose (LD) ± as needed (PRN) doses (n = 49) vs PRN only (n = 65), was not significantly associated with MICU LOS (P = 0.09). However, treatment duration was shorter in the PRN only group (median 54 vs 97 hours; P = 0.016). Endotracheal intubation and vasopressor use were more common in non-symptom controlled patients. No mortality occurred in either group. Conclusion: No significant evidence was found to suggest that phenobarbital serum levels were associated with symptom control in patients admitted to a MICU for severe AWS as defined in this study.
Although the 2016 American Thoracic Society/Infectious Diseases of America (ATS/IDSA) guidelines recommend a 7-day antibiotic course for hospital-acquired and ventilator-associated pneumonia (VAP), recent trials have challenged this recommendation, particularly for VAP caused by P. aeruginosa. The objective of this study is to provide insights into the optimal duration of antibiotic therapy for VAP caused by non-lactose-fermenting gram-negative bacilli (NF-GNB). This project is a single-center, retrospective cohort study at a community teaching hospital. Patients were included if they were hospitalized with VAP caused by NF-GNB between September 6, 2015 and December 22, 2023. Patients were divided into two groups: those receiving prolonged duration of antibiotic therapy (greater than or equal to 10 days) and those receiving short duration of antibiotic therapy (less than 10 days). The primary endpoint is 30-day mortality from the first day of pathogen-directed therapy. Secondary endpoints include pneumonia recurrence within 30 days, intensive care unit and overall hospital length of stay. The three most prevalent pathogens were Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia respectively. Both 30-day mortality and recurrence were comparable between groups (17% vs 21%; P = .50) and (26% vs 18%; P = .22) respectively. Patients in the prolonged duration group had a higher hospital length of stay with 35 days as compared to 25 days in the short duration group; P = .01. Thirty-day mortality and pneumonia recurrence rates were similar comparing short vs prolonged antibiotic duration in VAP caused by NF-GNB. Further prospective studies are needed to address the optimal duration of therapy in this group of patients.
Patient is an HLA-B*57:01 positive, 43-year-old male with a history of diabetes type II and admission 10 weeks ago at another institution for pubic symphysis osteomyelitis and associated pseudomonas. Cefepime IV was started and the patient presented with fevers, aches, agranulocytosis, thrombocytopenia and rash as a suspected side effect of cefepime after 3 weeks of treatment. Cefepime was replaced with piperacillin-tazobactam and symptoms resolved. Question to be resolved is whether an HLA-B*57:01 positive, abacavir sensitive patient could have an agranulocytosis cross reaction to cefepime.
Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists (GLP-1/GIP RAs) effectively manage type 2 diabetes mellitus (T2DM). Recent medication shortages have impacted patient access to treatment. The objectives of this study were to evaluate the effect of incretin therapy shortages on glycemic control and adverse patient outcomes. This retrospective cohort study evaluated the impact of interruptions in therapy on patients receiving maintenance doses of incretin therapy for at least three months. Patients were excluded if they were not on adequate maintenance doses, had missing hemoglobin A1c (HbA1c) levels, discontinued therapy due to side effects or cost, or had a history of chronic glucocorticoid use or organ transplant. The primary outcome was HbA1c levels before and after therapy interruption. Secondary outcomes were the incidence of gastrointestinal issues, hyperglycemia, and hypoglycemia-related hospital/clinic visits. A total of 71 patients were included. The median therapy duration was 9 months. Patients had a baseline HbA1c of 6.9%. Following interruption, 25.4% of patients had glucose-lowering therapy additions to their regimen, 35.2% dosage adjustments, and 39.4% no changes. HbA1c increased significantly to 7.2% at 12 months (P < 0.001). No significant differences were observed in adverse events or clinic/hospital visits (P = 0.571 and P = 1.00). Shortages of incretin therapy significantly increased patients' HbA1c levels up to 12 months post interruption. Long-term shortages or restrictions of these agents are likely to lead to adverse clinical outcomes. Further studies are needed to assess the outcomes of prolonged shortages or restrictions of these therapies.
