As Told By a Pharmacist

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  • 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

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  • School’s Out, But a New Class is in!

    School’s Out, But a New Class is in!

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    For the first time in almost 16 years, a first-in-class agent has been introduced to manage hypertension (HTN). The FDA has approved AstraZeneca’s Baxfendy (baxdrostat), an Aldosterone Synthase Inhibitor, in combination with other medications to treat adults with inadequately controlled HTN.[1]

    Prior to this announcement, the mainstay classes utilized for high blood pressure were Calcium Channel Blockers, Angiotensin Converting Enzyme (ACE) inhibitors, Angiotension II Receptor Blockers (ARBs), and Thiazide-type diuretics.

    Throughout the years, different agents in these classes have been combined into single-pill formulations. According to the American Heart Association, in 2019, over 50% of people were non-adherent to their blood pressure therapy just 1 year after initiation.[2] These single-pill, agents served as a reasonable solution to offset non-adherence by way of reducing pill burden, and improving overall outcomes. Despite the absence of innovation, these combination therapies provided an answer to one of the greatest barriers many face when trying to achieve target blood pressure goals: Adherence.

    Is Baxfendy a real game changer?

    In almost two decades, there hasn’t been an agent that introduces a different mechanistic approach to treating HTN –until now. Baxfendy being the first of this new class, shifts the landscape completely. Mechanistically, Bexfendy works on the same Renin-Aldosterone-Angiotension-System as ARBs and ACE inhibitors, but much earlier on in the pathway. It selectively inhibits Aldosterone synthase, subsequently decreasing aldosterone production.

    Although Aldosterone is a key hormone that upregulates BP by increasing blood volume through sodium retention and potassium excretion, it also increases the pressure on blood vessels. Aldosterone over production can lead to inflammation and hardening of myocardial, renal, and vascular tissues, worsening HTN and contributing to chronic kidney disease.[3]

    Who could potentially benefit the most?

    Treatment-resistant hypertension is defined as uncontrolled blood pressure on 3 or more drug therapies, usually including a diuretic, at optimal doses, or controlled BP on 4 or more medications.[4] Unfortunately, that includes approximately 12.6% of Americans that are being treated for HTN.[5] Additionally, the relationship between excess aldosterone and treatment-resistant HTN has now been linked. It is estimated that Primary Aldosteronism (PA) is responsible for 20% of treatment-resistant HTN cases.[6] The Endocrine society now recommends people with newly diagnosed HTN to screen for aldosterone levels to rule out PA as the culprit.

    How effective is Baxfendy?

    The phase 3 BaxHTN trial had 796 participants that maintained a seated systolic blood pressure (SBP) ranging from 140mmHg – 170mmHg, despite being treated with 2 antihypertensive medications, or 3 or more medications including a diuretic. The study revealed that a 2mg dose of Baxfendy reduced SBP by 15.7mmHg, and a 1mg dose by 14.7mmHg in just 12 weeks.[7]

    How easily accessible will Baxfendy be?

    Currently, a 30-day supply of the novel brand name drug will cost American consumers a hefty $910. Astrazeneca provides cost-effective assistance for the uninsured, or people with commercial insurance that does not cover the entire cost of the medication. Payment assistance through the manufacturer unfortunately does not extend to federally insured participants e.g Medicare, Medicaid, VA.

    Astrazeneca’s Baxfendy may be the answer to better managing HTN that we have been waiting almost 2 decades for.

    [1]https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.119.13616

    [2] https://www.astrazeneca.com/media-centre/press-releases/2026/Baxdrostat-MNR-2026.html

    [3]https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.115.018226

    [4] https://pmc.ncbi.nlm.nih.gov/articles/PMC4671446/

    [5]https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.125.25659

    [6] https://pmc.ncbi.nlm.nih.gov/articles/PMC7442120/

    [7] https://www.nejm.org/doi/full/10.1056/NEJMoa2507109

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  • 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/

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  • 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

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  • 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

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  • “New year, New Me!” – Wegovy 

    “New year, New Me!” – Wegovy 

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    On December 22, 2025, Novo Nordisk shocked the world with breaking news: Wegovy (semaglutide) was FDA-approved in an oral formulation at a dosage of 25mg for weight loss management. Indeed, semaglutide has long existed in an oral formulation as Rybelsus (an FDA approved medication for Type 2 Diabetes and Cardiovascular Risk Reduction dose in 7mg or 14mg). The important distinction is that the approval for the higher dosage, oral formulation is for weight management and to reduce the risk of cardiovascular events in obese individuals with heart disease.

    Who isn’t it for?

    As with all medications, there are some exemptions to therapy that include: individuals with Multiple Endocrine Neoplasia Type 2 (MEN2), or a personal or family history of Medullary Thyroid Cancer (MTC) or any allergies to the ingredients of Wegovy. Importantly, oral Wegovy should not be used concomitantly with any other GLP-1 agonists.

    OASIS Trials

    The OASIS trial was a 72 week trial used to determine the efficacy of oral Semaglutide 25mg for weight management. Week 1 was used to screen the participants, 64 weeks consisted of treatment, and the remaining 7 weeks were used for observation and follow up. Participants were randomly assigned either oral semaglutide or a placebo at a 2:1 ratio. The medications were dosed once a day in addition to lifestyle modifications.[1] The 64-week treatment for the Semaglutide group was conducted in a titrated fashion: 3mg once a day for 4 weeks; 7mg daily for 3 weeks; 14 mg for the next 4 weeks; then the target dose of 25mg once a day for the remaining 51 weeks of treatment.[2] The placebo group also received matching tablets for the same duration.  

    The estimated average change in body weight for the semaglutide group was 13.6%, and just 2.2% in the placebo group.[3] The change of Impact of Weight on Quality of life (IWQOL) is a self-reported questionnaire used to assess the impact of one’s weight on their functionality and quality of life. The IWQOL Physical function score was significantly higher in the semaglutide group (55.3.% versus the placebo group 34.8%). These findings are associated with a clinically significant improvement in quality of life and physical function.

    How Will This Affect Consumers?

    Novo Nordisk plans on rolling out the oral pill in January 5, 2026. That’s right, within days! This new formulation of such a highly sought out drug will provide consumers with a more convenient option to reach their weight loss goals and may potentially alleviate some demand for the injectable version. With commercial insurance plans, the projected cost would be $25 per one (1) month supply.[4] The Wegovy website offers self-pay plans for the initial, 1.5mg and 4mg dosages starting at $149 per month until April 15, 2026, then increasing to $199 per month. The self-pay offer for a 1-month supply of 9mg and 25mg (target/maintenance dose) would cost $299.

    [1] https://www.nejm.org/doi/full/10.1056/NEJMoa2500969

    [2] https://clinicaltrials.gov/study/NCT05564117

    [3] https://www.nejm.org/doi/full/10.1056/NEJMoa2500969

    [4] https://www.wegovy.com/about-wegovy/the-wegovy-pill.html

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  • Hypertension Guidelines Updated–Key Takeaways!

    Hypertension Guidelines Updated–Key Takeaways!

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    The American Heart Association (AHA) has spent the last eight years revamping the 2017 Hypertension Guidelines, and it shows. There have been a notable number of new recommendations and improvements with an emphasis on prevention and lifestyle modifications. The AHA has also shifted to a more collaborative treatment approach, including nuanced guidance to navigate this multifaceted disease state that burdens nearly half of adult Americans.[1]

    A New Method to Predicting the Probability of a Cardiovascular Event 

    Predicting risk of Cardiovascular (CVD) Events (PREVENT) replaces the Pooled Cohort Equations, a tool formerly used to calculate the 10-year risk of having a CVD event. PREVENT is the first of its kind that utilizes kidney, metabolic and socioeconomic factors to determine a more inclusive score. PREVENT predicts the 10- and 30-year risk for CVD events, including heart failure and Atherosclerotic CVD.[2]  Studies have shown underestimation among certain demographics, which have led to missed opportunities to intervene and begin treatment. Although in need of more fine tuning, by shifting to a more inclusive approach, PREVENT can provide a more complete baseline and improve patient outcomes. 

    Categorization of Hypertension Stages

    Historically, Prehypertension was defined as a systolic reading between 120-129 mm Hg and a diastolic reading of less than 80 mm Hg.[3] The new guidelines reclassified this simply as Hypertension or high blood pressure (BP), removing pre-hypertension all together, and prompting drug therapy initiation if the 10-year cardiovascular risk (defined by PREVENT score) is greater than, or equal to 7.5%. Hypertensive urgency is now a dated term, and is simply “hypertensive emergency”, a reading greater than180/120 mm Hg. 

    What About the Drug Therapy options?

    Same drug classes—different execution. In 2025, the AHA shifted from race-based therapy recommendations to an individualized approach. Previously, for African Americans, initial treatment options were either thiazide diuretics, or calcium channel blockers not an angiotension Enzyme Inhibitors or angiotension Receptor Blockers. Comparatively, in other demographics, all four drug classes were considered. Despite the AHA’s previous recommendations, it did not yield favorable outcomes; for example, from 2017-2020, the control rate of high blood pressure in African Americans was 18% worse than their counterparts.[4] The riddance of race-based blood pressure recommendations will hopefully encourage practitioners to create more individualized treatment plans.

    How Have the Therapy Recommendations Evolved?

    The new guidelines have introduced initiating two drugs when the patient has systolic 2 consecutive systolic readings of 130mm Hg instead of 140mm Hg (per 2017 guidelines). Fifty-percent of patients are non-adherent to their blood pressure medications one year after therapy initiation, so introducing two drugs may exacerbate this problem. What’s more, from a provider perspective, it would be difficult to pinpoint which side effect profile corresponds to which medication, thus further complicating dosage titrations. A solution to reducing pill burden would be combination products, which the guidelines encourage. However, due to the ever-changing healthcare landscape of prior authorizations and insurance formulary changes, combination medications may not be accessible for many.

    The Correlation Between High BP and Dementia: How in the World is Dementia Related to BP?

    Midlife high blood pressure is the leading risk factor for white matter abnormalities in the brain, which are markers related to cognitive decline and dementia. In the previous 2017 guidelines, there were hypotheses that controlling systolic BP may reduce the occurrence of certain types of dementia. Since then, those theories have been confirmed with various studies, and current guidance is that reaching a target goal of 130mm Hg/80mm Hg can prevent cognitive impairment. 

    More Stringent Blood Pressure Goals in Pregnancy

    Due to growing evidence that elevated BP can complicate pregnancy pre- and post-delivery, the new guidelines lowered the BP goal to 130mm Hg over 80mm Hg. The guidelines further recommend individuals that already have high blood pressure and are planning to become pregnant should be counseled on the use of aspirin to prevent preeclampsia. 

    [1] https://www.cdc.gov/high-blood-pressure/data-research/facts-stats/index.html

    [2] https://professional.heart.org/en/guidelines-and-statements/prevent-calculator

    [3] https://www.ahajournals.org/doi/10.1161/cir.0000000000000678

    [4] https://minorityhealth.hhs.gov/heart-disease-and-blackafrican-americans

    2 responses to “Hypertension Guidelines Updated–Key Takeaways!”

    1. Walt Avatar
      Walt

      very important article! Thanks for the info!

      Reply
      1. Delphine Adams Avatar
        Delphine Adams

        Thank you for reading!

        Reply

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  • The True Cost of Vaccine Hesitancy

    The True Cost of Vaccine Hesitancy

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    One of the greatest threats to public health is not another virus—it’s doubt. Vaccine hesitancy is quickly becoming a threat to global health. Pre-pandemic levels, for childhood vaccinations for Measles Mumps Rubella (MMR), Polio, DTaP (diphtheria and whooping cough), were 95% which is high enough to generate Herd Immunity (a.k.a. community immunity). This is when a significant percentage of a population is immune to a disease, making it very difficult to spread. This is the only surefire way to eradicate diseases (e.g Smallpox, which was globally eradicated in 1980).  

    Herd immunity is especially important when it comes to young children. Because it takes roughly 7-8 years for a child’s immune system to fully develop, young children are vulnerable to contracting illnesses and succumbing to them as they do not yet have strong enough immunological defenses to fight them. Vaccines also aid in strengthening young immune systems by teaching them how to recognize and defend against germs and antigens. More importantly, children that are immunocompromised, have chronic illnesses, or have allergies to specific components of vaccines are relying on Herd Immunity from their classmates to live healthy lives since they may not be able to get vaccinated. 

    In the previous school year (2024-2025), vaccine rates for DtaP, MMR and Polio dropped to 92.1%, and 92.5% respectively.1 Though these figures do not seem like a huge decrease from the previous ~95%, this trend is notable because herd immunity may be a thing of the past as we continue to move forward. By way of example, approximately 286,000 kindergartners were present at school without having documentation showing they were vaccinated against MMR. 

    In the 2023-2024 school year, the rate of exemptions from vaccines was 3.3%;2 however, last year, we saw a national increase in the percentage of exemptions to 3.6%, and 17 states reported exemptions over 5%!

    What does this actually mean? According to the CDC, as of September 23, 2025, there have been 1,514 confirmed measles cases, and 40 total outbreaks thus far. The largest demographic accounting for those cases at 39% were (you guessed it), those aged 5-19 years old. 

    Is measles really that bad? Measles is a highly contagious, airborne disease that presents as cough, fever, runny nose and a characteristic rash. In the wake of COVID, flu, and several bugs, it may be difficult for someone to deduce measles as the culprit, especially without the triage of a healthcare provider. It can also lead to several complications such as pneumonia, other infections, permanent brain damage which in turn can lead to fatal brain disease, long-term and permanent damages, or death.3 Before a measles vaccine was introduced in 1963, the majority of children were exposed and infected, and unfortunately around 400 of the annual, measles-related deaths were children.4

    In short, if we do not address vaccine hesitancy, we are putting some of our most vulnerable populations at risk, and taking a dangerous step backwards as a society. 

    Healthcare providers: this is your opportunity to combat the ever-growing misinformation that has been infiltrating our media outlets. This is a call to action to provide evidence-based recommendations, and advocate for public health by educating your patients. 

    Parents and caregivers: I urge you to consider the source of your health care information, and gather insights from reputable sources before making impactful decisions.

    Leave a Reply

    1. Centers for Disease Control and Prevention. (2025, July 31). Vaccination Coverage and Exemptions among Kindergartners — SchoolVaxView. https://www.cdc.gov/schoolvaxview/data/index.html ↩︎
    2. Centers for Disease Control and Prevention. (2025, July 31). Vaccination Coverage and Exemptions among Kindergartners — SchoolVaxView. https://www.cdc.gov/schoolvaxview/data/index.html ↩︎
    3. World Health Organization. (2024, November 14). Measles [Fact sheet]. https://www.who.int/news-room/fact-sheets/detail/measles (who.int) ↩︎
    4. Buechner, M. (2025, September 8). Americans Who Never Forget: Life Without Vaccines. UNICEF USA. https://www.unicefusa.org/stories/americans-who-never-forget-life-without-vaccines (unicefusa.org) ↩︎
  • Omeprazole + clopidogrel

    Omeprazole + clopidogrel

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    A lot of my customers are on Omeprazole (commonly used for heartburn) and Clopidogrel (for stroke and heart attack prevention), this combination gives me heartburn every time I see it (no pun intended). Clopidogrel is often prescribed without respect to Omeprazole because “the patient has been on Omeprazole for ages” and providers often leave staple drugs on.

    I’m sure you’re thinking “one stops the blood from clotting while the other treats heartburn, what’s the connection here?” Well, Clopidogrel is used for heart attack and stroke prevention. It is also a prodrug that is mainly metabolized by CYP2C19 into an active metabolite that allows the drug to stop blood from clotting together. Omeprazole stops this enzyme from working and can greatly reduce well Clopidogrel can do its job. 1This means that it may be unable to prevent another stroke or heart attack from occurring when used with Omeprazole!2

    So What Do you Do with this Informaiton?

    Speak to your doctor about alternative heart burn drugs for safe use in clopidogrel. Make sure they substitute Omeprazole with an alternative therapy right away. Just removing Omeprazole with no other alternative can result in rebound GERD, which often comes with worse symptoms than before.


    Share your story in the comments below or reach out to your local healthcare advocate.

    Leave a Reply

    1. Howden CW. Clinical pharmacology of omeprazole. Clin Pharmacokinet. 1991 Jan;20(1):38-49. doi: 10.2165/00003088-199120010-00003. PMID: 2029801 ↩︎
    2. McTavish, D., Buckley, M. M., & Heel, R. C. (1991). Omeprazole. An updated review of its pharmacology and therapeutic use in acid-related disorders. Drugs, 42(1), 138–170. https://doi.org/10.2165/00003495-199142010-00008 ↩︎

  • Major Medicare Changes in 2025: Progress and Pitfalls

    Major Medicare Changes in 2025: Progress and Pitfalls

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    Several significant changes to Medicare have reshaped how millions of Americans access and afford healthcare—especially when it comes to prescription drugs. While many of these changes aimed to improve affordability and access, they’ve, instead, presented a new set of challenges, particularly in rural and underserved communities. Here’s a closer look at key impactful updates we’ve seen so far.

    A New Cap on Out-of-Pocket Costs for Medicare Part D

    Perhaps the most widely celebrated changes this year is the reduction of the annual out-of-pocket maximum for Medicare Part D to $2,000, a significant decrease from the previous cap of $8,000. This shift has been a game changer for Medicare beneficiaries—especially those on high-cost medications who do not qualify for the Extra Help Program. Though the cap is set to rise steadily in the coming years, for now it is certainly a relief for many.

    Monthly Payment Options Through Medicare Advantage: A Double-Edged Sword

    Medicare Advantage plans have also introduced new flexibility for prescription drug payments, allowing enrollees to split their annual out-of-pocket costs into monthly payments. This can greatly improve budgeting and financial planning for patients, especially those managing multiple chronic conditions.

    But this simplification has come with unintended consequences. In rural communities, where provider options are already limited, patients are finding that their trusted doctors or specialists are no longer in-network. Take Ms. Betty, for example—a patient who has seen the same neurosurgeon for five years. Under her new plan, that doctor is no longer covered.

    What happens next?

    • The search for a new provider begins, often hours away from home
    • Access issues arise if the patient is without reliable transportation or caregiver support.
    • Delays in time-sensitive care can occur due to new referral requirements or extended wait times.

    This raises a critical concern: while payment flexibility is helpful, network limitations are leaving many patients in limbo, especially when specialist care is urgently needed.

    The Growing Burden of Prior Authorizations and Formulary Changes

    Another trend gaining attention in 2025 is the increase in prior authorization (PA) requirements, which has become a significant hurdle for both patients and healthcare providers.

    These increased PA demands have led to:

    • Interruptions in therapy for patients with complex or chronic conditions.
    • Delays in access to routine medications, sometimes taking up to two weeks for approvals.
    • Increased administrative workloads for providers and their staff, diverting time and resources away from patient care.

    Even more concerning are the frequent changes to drug formularies—especially for essential medications like insulin.

    While the Inflation Reduction Act of 2022 capped insulin copays at $35 per month, that protection doesn’t help if the insulin a patient relies on is no longer on the plan’s formulary.

    Consider Mr. J, a patient who finally stabilized his A1C levels using Humalog KwikPen after years of trial and error. When he arrives to pick up his refill, he’s told it’s no longer covered. He’s left in shock and uncertainty—with no immediate alternative in place.

    In some cases, routine medications now require a new prior authorization every month. These delays create dangerous gaps in care, eroding patient trust and undermining treatment success.

    Final Thoughts: Navigating Progress with Caution

    While the changes to Medicare in 2025 aim to improve affordability and accessibility, they have also exposed serious gaps in continuity of care, provider access, and administrative burden.

    The lowered out-of-pocket cap is a significant win, and monthly payment options may help patients better manage costs. But as provider networks shrink and drug coverage becomes more volatile, many Americans—especially those in rural or low-income communities—are finding it harder to get the care they need, when they need it.

    Moving forward, policymakers, providers, and patient advocates must work together to ensure that cost-saving reforms do not come at the expense of access or quality of care. Simplifying authorizations, expanding networks, and stabilizing formularies must be the next steps in creating a Medicare system that works for everyone.

    *The patient names and scenarios mentioned in this article are completely fictious, but are used to illustrate potential customer experiences that I have personally observed as a pharmacist of the years and those shared by my colleagues in the industry

    Have you experienced challenges or benefits from the new Medicare changes in 2025?
    Share your story in the comments below or reach out to your local healthcare advocate.

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