Use of GLP-1 agonists is becoming increasingly more common in the U.S. According to a 2024 poll, one in eight adults has at least tried this medication class. A brief communication published in the June Journal of Drugs in Dermatology shares concerns that could arise when a patient is concurrently on a GLP-1 agonist and isotretinoin.
I interviewed author Travis W. Blalock, MD, FAAD, FACMS, director of dermatologic surgery, Mohs micrographic surgery, and cutaneous oncology at Emory University School of Medicine.
What led you to want to raise awareness about potential issues that could develop when a patient is on a GLP-1 agonist as well as isotretinoin?
The explosion of GLP-1 agonists on the market intrigued me for numerous reasons. Not the least of them was that many of our patients suffer from obesity and our patients are already on these medications. So, the onus is on dermatologists to be aware of how our patients will respond to these medications and how it impacts skin disease.
Furthermore, knowing that these medications delay gastric emptying begs questions regarding how this class of medication influences the numerous oral medications we as dermatologists prescribe. Even if the GLP-1 agonist delay in gastric emptying does not impact many of the medications we use, I have seen numerous patients complain of nausea and vomiting while on these drugs. If patients are vomiting up their dermatologic medications, it is unlikely we are hitting therapeutic windows for some of our treatments. In short, there are many fascinating aspects of this drug, both socially and pharmaceutically, that should pique our interest. Thus, we need to be aware and thinking about such potential issues in a proactive manner.
Your brief communication provides evidence of several concerning issues. Not only does research show contraceptive compliance may be lacking in patients on isotretinoin, but patients who are concurrently on GLP-1 agonists may experience increased fertility. How alarmed should dermatologists be about these findings?
This is the million-dollar question. There are numerous questions about what causes this increase in fertility, ranging from direct hormonal impacts to their impact on more systemic diseases, like obesity, depression, or diabetes.
Dermatologists are keenly aware of the risks associated with isotretinoin, including risks of miscarriage and birth defects, not to mention the increased risk of serious pregnancy related complications. With early data suggesting that GLP-1 receptor agonists may increase likelihood of pregnancy, we could easily hypothesize higher chances of pregnancies, with resultant bad outcomes for patients on isotretinoin. It is just as easy to extrapolate this line of thinking to numerous other medications that dermatologists use with narrow therapeutic windows (i.e. warfarin).
We do not need to be alarmists about the impact of these drugs. However, tirzepatide’s package insert, for example, warns that use of this medication may reduce the efficacy of hormonal contraceptives and advocates for non-oral contraceptive methods. Alternatively, there is conflicting data indicating that some oral contraceptives are not impacted at all. So, do we need to be alarmed? Absolutely not. But we do not need to be caught off guard either.
You also point out that GLP-1 agonists decrease absorbency of medications, including isotretinoin as well as oral contraceptives. How should a dermatologist respond?
We feel that with the limited data available about the co-administration of these drugs, dermatologists should be vigilant about the possible interaction and convey that to patients. Knowing that GLP-1 receptor agonists decrease gastric emptying, we do not know definitively whether they impact the various formulations of oral contraceptives. Since we don’t know that answer, dermatologists may need to clearly state that to patients. And as I noted above, this is already on some package inserts; so, someone believes this is at least worthy of mentioning to patients to be aware of. Dermatologists could respond by advocating use of barrier methods as barrier methods are not reliant on the GI system and therefore are less likely impacted by GLP-1 agonists.
What else do you want dermatology clinicians to know about GLP-1 agonists and isotretinoin?
We have a lot to learn. We do not have a good handle on GLP-1 receptor agonists and their impact on systemic levels of oral contraceptives. We do not know the full picture of the mechanism(s) behind how GLP-1 receptor agonists increase the likelihood of pregnancy. We do not have definitive data regarding what GLP-1 receptor agonists by themselves do for acne, or other inflammatory dermatologic diseases for that matter. There is some data suggesting that acne may be exacerbated by GLP-1 agonists, while others believe that these medications may improve acne. Beyond isotretinoin, we need more data to see how GLP-1 agonists impact medications other than isotretinoin. So, we have some distance to go as we learn more about this exciting drug, but we need to be intentional and thoughtful as we counsel patients as to how it impacts skin disease.
Did you enjoy this JDD Buzz article? You can find more here.
