As Told By a Pharmacist

Tag: health

  • Overdose by Algorithm: The Harsh Reality Behind TikTok’s ‘Benadryl Challenge’

    Overdose by Algorithm: The Harsh Reality Behind TikTok’s ‘Benadryl Challenge’

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    The ‘Benadryl Challenge’ started in 2020, and like most social media trends, over time, it fizzled out into cyberspace. The challenge calls for participants to record themselves taking fatal doses of Benadryl – around 300mg, which is 12 times the recommended adult dosage – in pursuit of hallucinations, or a euphoric “high”.

    Ironically, the same reasons that got Benadryl (diphenhydramine) pushed to the back of the line when selecting antihistamines, are the very reasons it has regained relevance today. In recent years, the trend has resurfaced on social media platforms, mainly TikTok. Several factors make this challenge appealing to the impressionable youth, such as “going viral”, social validation, and seeking community on the internet amongst their peers. When misused, Benadryl can lead to fatal events not limited to heart rhythm disturbances, irreversible organ damage, seizures, coma, and death.

    Benadryl blocks H1 receptors throughout the airways, heart muscles, and central nervous system (CNS), which halts common allergy symptoms and provides adequate relief. Though it is effective for allergy symptom relief, Benadryl crosses the blood brain barrier, binds to H1 receptors in the CNS, and yields unfavorable side effects like drowsiness and sedation. Additionally, Benadryl blocks muscarinic cholinergic receptors, and causes anticholinergic side effects like blurred vision, drowsiness, confusion, urinary retention, and others.

    The first report of a death linked to the Benadryl Challenge was a 15-year-old girl in Oklahoma in 2020. In September that same year, the FDA issued a statement warning the public of the dangers of the Benadryl Challenge and encouraged TikTok to remove videos of people participating in the challenge from its platform. TikTok has since barred the hashtags “Benadryl Challenge” and “Benadryl” to discourage users from participating – a responsible gesture indeed. Yet, despite these efforts, the risky challenge has since resurfaced and claimed the lives of 3 teenagers in Connecticut within the past 2 months.[1] This year, America’s Poison Centers have documented 6,179 Benadryl-related calls from teenagers between the ages of 13-19, the highest call volume since the challenge began 6 years ago.[2]

    How do we protect our youth?

    Healthcare professionals:

    • Educate yourselves on social media trends and challenges that involve Benadryl and other substances
    • Provide side effect and overdose counseling when discussing antihistamines, and other OTC medications to further educate patients

    Parents and guardians:

    • Have open conversations with your children about the dangers of the Benadryl Challenge
    • If any signs of a coma or seizure occur, call 9-1-1 immediately
    • For urgent guidance during a suspected overdose, call the Poison Control Help line at 1-800-222-1222 to be connected to a trained healthcare professional

    Ultimately, with the growing influence of social media, it is imperative that as a collective, we foster an open, judgement-free environment for our youth. One in which we can have honest conversations about peer pressure, substance misuse and the potential dangers of social media trends.

     

    [1] https://portal.ct.gov/oca/-/media/oca/oca-recent-publications/oca-statement-diphenhydramine-and-safe-storage-2026-06-10.pdf?rev=1feb34995f34436cbb121d417264c506

    [2] https://abcnews.com/GMA/Wellness/amid-social-media-challenge-calls-poison-centers-benadryl/story?id=133796755

    Leave a Reply

  • 20 States Slash HIV Funding, Leaving an Unmeasurable Cost

    20 States Slash HIV Funding, Leaving an Unmeasurable Cost

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    The present economic downturn, coupled with 20 states and counting, pulling back their government funding for HIV/AIDs assistance programs could not have been untimelier. Economic pressures and potential budgeting shortfalls are forcing states to revise their spending. As a direct result, life-saving medications and preventative care for many living with HIV/AIDs has become more costly than ever. For instance, from 2012-2018, the first-line treatment options for Antiretroviral Therapy (ART) increased by a whopping 30%, which outpaced the inflation rate by 3.5 times,[1] and have only continued to rise.  

    In an effort to ensure accessibility to comprehensive treatment and support, the Ryan White Care Act was enacted. It is the largest, federally funded program for people with HIV/AIDS in the US. Since its inception, the program has helped over 600,000 people get access to life sustaining care, which is more than half the U.S population living with AIDs. The Act dispenses funds to state programs for uninsured, underinsured, and low-income people living with HIV and higher risk individuals. The funds cover inpatient services, ART medication assistance, counseling and mental health services, case management services and more.[2]

    Part B of the program: AIDS Drug Assistance Programs (ADAPs), are responsible for providing HIV treatment and Pre-exposure Prophylaxis (PrEP) to those at the lower income level, or with limited or no health insurance at a significantly less or no cost. ADAPs can also purchase insurance for those who qualify, and provide services to ensure the safety of drug treatments.[3]

    What does less funding look like?

    Funding has been at stagnant at around $900 million since 2014[4], yet we have seen an increase in enrollments by 30% from 2022-2024. The irrefutable truth of the matter is that thousands will lose access to their life-saving medications and treatment interventions if states continue to cut ADAP funding.

    The relationship between poverty levels and HIV diagnoses has always existed— the further someone is below the poverty level, the higher incidence of HIV cases. One the most aggressive cuts so far have come from the state of Florida’s Department of Health. Despite insurance premiums rising nationwide, the Department lowered participant’s income eligibility from 400% to 130% of the federal poverty level. Meaning, only individuals earning $20,345 yearly, or less would be eligible to receive program benefits. Previously, those making $63,840 yearly or less were eligible. This change alone would result in approximately 16,000 individuals losing access to their HIV medications.[5]

    Though ADAPs are federally funded, each state determines: how funds are allocated, which medications are part of the program, waitlists for specific medications, and the program eligibility requirements. 

    Ironically, state cuts in this department don’t actually correlate to money saved in the long run. HIV transmission would rise, as would hospitalizations, emergencies, and complex treatment cases, all of which are more expensive than maintenance medications. Pre-Exposure Prophylaxis (PrEP) medications are used to prevent the transmission of HIV, and are 99% effective when used correctly in those who don’t inject drugs. An economic evaluation study concluded with a modest 3% decline in PrEP coverage yearly, about 8,618 new infections would have failed to be prevented, and would account for $3.6 billion in lifetime costs.[6]

    The soaring costs of ART alone is enough to pose a significant barrier for people living with HIV/AIDs to receive life-saving treatment. If these state-implemented cuts continue, much needed resources will be out of reach for the disadvantaged, posing a great risk to several communities. The state-sanctioned rollbacks only add fuel to the fire, and threatens decades of progress that has been made to combat the virus. 

    How to best navigate these uncertain times?

    • Brief yourself with different insurance plans in the market place, and enrollment periods
    • Familiarize yourself with your state’s HIV Care and Services
    • Ask your healthcare providers and local HIV organizations for assistance programs and resources

    [1] https://pubmed.ncbi.nlm.nih.gov/32011622/

    [2] https://www.ncbi.nlm.nih.gov/books/NBK216136/

    [3] https://ryanwhite.hrsa.gov/about/parts-and-initiatives/part-b-adap

    [4] https://stateline.org/2026/03/10/states-are-limiting-hiv-drug-assistance-programs/

    [5] https://www.aidshealth.org/2026/02/florida-health-dept-proposes-new-formal-rule-to-slash-hiv-drug-access-for-thousands/

    [6] https://pmc.ncbi.nlm.nih.gov/articles/PMC12426795/

    Leave a Reply

  • The GLP-1 Cold War: Foundayo v. Oral Wegovy

    The GLP-1 Cold War: Foundayo v. Oral Wegovy

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    What’s new in the GLP-1 market? You guessed it: the second oral GLP-1 therapy is here. On April 1, 2026, Fundayo (orforglipron) received FDA approval for weight reduction and maintenance in adults with obesity or overweight adults with one comorbid condition related to their weight. Importantly, the medication is to be used in combination with an increase in physical activity and a reduced calorie diet.[1] This announcement comes just three months after oral Wegovy started to occupy pharmacy shelves. 

    How does Fundayo compare to oral Wegovy?

    With full adherence, oral Wegovy resulted in a 16.6% mean weight loss[2], while Foundayo yielded just a 12.4% mean weight loss reduction.[3] Despite the significant variance in performance, Fundayo does have unique advantages. It can be taken without any dietary restrictions, at any time of the day. Unlike Wegovy, which must be taken in the morning, on an empty stomach, with a full glass of water followed by 30 minutes of fasting. 

    The dosing flexibility Fundayo offers would be beneficial for those who are may not want to use injectables, have less regimented schedules, or struggle with adherence. The added convenience of the oral dosage form, combined with the freedom from special storage requirements is another incentive for consumers. 

    Another advantage is in its chemical structure. Foundayo is a small molecule weighing 902g/mol about 4 times less than that of oral Wegovy.[4] The significance here is that due to the cyclical supply and demand shortage with GLP-1s, it may be cheaper, and easier to manufacture Foundayo which could ensure constant supply. Eli Lilly’s CEO even boasted, “We can make basically as much as we need”, suggesting that the company would be able to meet high demand. For providers, initiating a patient on a readily accessible therapy could provide better outcomes as it would be easier to maintain adherence. 

    What about the Disadvantages?

    Because Foundayo is metabolized by the CYP3A4 enzyme, it is advised to not be used with any strong CYP3A4 inhibitors or inducers due to clinically significant drug-drug interactions. CYP3A4 inhibitors include several commonly prescribed drugs, such as Clarithromycin, Verapamil, and Carbamazepine.

    Foundayo may also interact with certain statin drugs, which would require a thorough risk-benefit analysis. For example, if Foundayo was taken with Simvastatin, it would lead to a 2—2.5-fold increase in drug exposure, which would greatly heighten the chances of rhabdomyolysis (a painful, potentially life-threatening condition where one could experience sever muscle pains, weakness and dark colored urine).[5] Despite this interaction, Simvastatin was not listed as a contraindication. Should a patient be on  both medications, the max Foundayo dose would be 9mg, rather than the regular max dose (17.2mg) that yields the largest weight loss.[6]

    Foundayo also stimulates insulin release, and can cause hypoglycemia in those using insulin and/or insulin secretagogues like sulfonylureas and metaglinides. For these patients, they would need to consistently monitor their blood sugar and understand the manifestations of low blood sugar. 

    How Well is Foundayo Tolerated?

    During the clinical trials, about 7% of participants who received Foundayo had to discontinue the therapy due to adverse events.[7]The most common side effects are consistent with what we’ve observed with the injectable GLP-1s: gastrointestinal effects such as nausea, constipation, diarrhea, and dyspepsia ranging from mild to moderate. 

    Eli Lilly plans to launch Fundayo this Monday April, 6th. Having already anticipated insurance formulary restrictions, Eli Lilly offers a self-pay program, LillyDirect, which mirrors NovoNordisks self-pay program for oral Wegovy. Both programs price the lowest doses at $149 per month and the highest doses at $299 per month. 

    Foundayo was reviewed through the Commissioner’s National Priority Voucher (CNPV) program which is aimed at accelerating the drug approval process in order to provide therapeutic options to Americans in a timely manner. The FDA’s to approval of Foundayo just 50 days after Lilly filed for approval, makes history as the fastest drug approval in the over 2 decades. Yet, in the ever-growing wake of class action suits against GLP-1 medications, one has to wonder if 50 days was adequate to ensure patient safety. 

    [1] https://www.fda.gov/news-events/press-announcements/fda-approves-first-new-molecular-entity-under-national-priority-voucher-program

    [2] https://www.appliedclinicaltrialsonline.com/view/fda-approves-oral-wegovy-positive-oasis-trial-results?utm_source=copilot.com

    [3] https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-foundayotm-orforglipron-only-glp-1-pill

    [4] https://www.managedhealthcareexecutive.com/view/foundayo-vs-oral-wegovy-the-similarities-the-differences-and-what-you-need-to-know

    [5] https://www.uptodate.com/contents/rhabdomyolysis-clinical-manifestations-and-diagnosis

    [6] https://pi.lilly.com/us/foundayo-uspi.pdf

    [7] https://www.nejm.org/doi/full/10.1056/NEJMoa2511774

    Leave a Reply

  • AI Enters Healthcare, This Time, as a Provider

    AI Enters Healthcare, This Time, as a Provider

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    Utah is the first state to automize prescription refills through an artificial intelligence (AI)-driven platform: Doctronic. No active doctor reviewing in real time. No healthcare provider oversight. Just AI. The AI-driven platform originally went live in late 2023, but it was not until December 2025, that the state of Utah partnered with the platform to provide care to the residents of Utah.

    How Does Doctronic actually work?

    The patient completes a questionnaire regarding their symptoms and medication history; subsequently, the interface determines whether a prescription renewal is appropriate. The initial prescription must be written by a doctor, and the program is limited to 190 maintenance drugs that it can refill. Painkillers, injectables, controlled substances and substances for attention disorders are excluded. 

    What Problems Does it Aim to Solve?

    Three in four Americans navigate life trying to manage their chronic conditions.[1] Yet people can wait up to an entire month for a primary care visit in several states. This lapse in care results in delays in therapy. Indeed, it is common for a provider to see the patient for a follow up appointment when starting a new therapy, or before approving refills for a maintenance medication. Those of us working behind the counter see first-hand, the prevalence and complexity of this issue. Medication adherence is far more than a term providers lecture patients about. Medication non-adherence is the single, most preventable healthcare crisis that burdens Americans, and it is responsible for approximately 125,000 deaths and accounts for 10% of hospitalizations annually.[2]

    A common reason for non-adhearance is patients simply not understanding why they are taking the medication and its significance. This is where pharmacists can fill in the gaps and provide adequate counselling at the pharmacy counter. However, automating the prescription renewal process and removing a health care provider completely, does not foster an environment for thorough, personalized counseling. This could potentially lead to unfavorable outcomes when managing chronic conditions. How well can AI communicate the importance of medication adherence when the encounter is not even face-to-face?

    Doctronic also boasts an anonymity feature, and claims that no data is stored in their records. This could present obvious challenges, as there would be no opportunity to follow up between visits, and no access to medication history beyond what the patient provides, which often is inaccurate or incomplete. 

    Can a patient-AI relationship rival a patient-provider relationship?

    There have been legitimate concerns raised by several organizations as to the clinical soundness of this program. The Utah Academy of Family Physicians stated “[w]ithout the involvement of a trained healthcare provider, we risk the possibility of negative drug interactions…lack of clarity around how and when a patient will be referred to their physician, and the risk of misuse or abuse.” 

    The intake survey places a considerable amount of responsibility on the patient to be able to self-identify their symptoms, and to recount which medications they are currently taking as well as the appropriate dose. From my experience, the amount of patients who could independently do so, is few and far between. 

    More importantly, if Doctronic can supply up to 90-day supplies for refills, is it possible for a patient to go extended periods of time without visiting their primary care provider? Does this inclusion of AI come with the tradeoff of valuable patient-provider relationships? Is it a possible answer to the barriers people face to visit providers, or does it reinforce the growing mistrust of healthcare providers? 

    Final Thoughts: Advancing With Caution

    These questions, and several more, should be carefully considered before other states join Utah and fully integrate AI into their healthcare practices as a provider. We will continue to monitor developments and update the community accordingly. 

    [1] https://www.cdc.gov/chronic-disease/about/index.html

    [2] https://psnet.ahrq.gov/issue/hospital-admissions-associated-medication-non-adherence-systematic-review-prospective

    Leave a Reply