Background: Stroke is a major cause of morbidity and mortality worldwide. Pharmaceutical care services play a significant role in managing the risk factors associated with stroke. Aim: This study aimed to examine the effects of a one-year pharmaceutical care programme on medication adherence, quality of life and clinical outcomes of patients with stroke. Method: This study was conducted as a randomised controlled trial at the neurology clinic of a university hospital in Türkiye. Patients were randomly assigned to either an intervention group or usual care group (IG vs UCG). A simple randomization method using computer-based random numbers was used to assign participants in a 1:1 ratio. The IG received pharmaceutical care including medication reconciliation, medication review and patient education in addition to routine health services. The medication adherence, quality of life and clinical parameters of the patients were evaluated at the beginning and the end of the 12th month. Results: This study included 193 patients (89 and 104 patients in the IG and the UCG, respectively; mean age: 60.1 years), of whom 67.4% were male. At the one-year follow-up evaluation, the percentage of adherent patients (86.5% vs 47.1%, p < 0.001) and the total Stroke-Specific Quality of Life score (184.9 vs 166.0, p < 0.001) were higher in the IG than in the UCG. The stroke recurrence rate at the one-year follow-up (2.2% vs 10.6%, p = 0.044) was lower in the IG than in the UCG. Conclusion: Pharmaceutical care services improved the medication adherence, quality of life and clinical outcomes of patients with stroke. The clinical trial registration: ClinicalTrials.gov Identifier: NCT06129318; Study Registration Date: 13 November 2023.