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In this episode of Psychiatric Pharmacy Pulse, host Megan Maroney, PharmD, BCPP, FAAPP, talks with Mary Bridgeman, PharmD, a pharmacist and clinical professor at the Ernest Mario School of Pharmacy at Rutgers, about the federal effort to move cannabis from Schedule I to Schedule III of the Controlled Substances Act. Bridgeman explains that the federal order covers FDA-approved cannabis products and those dispensed under state medical marijuana licenses. Adult-use cannabis, bulk plant material, and synthetically derived THC remain in Schedule I while the broader rescheduling goes through the hearing process. Because state rules vary so widely, Bridgeman says pharmacists in any practice setting should expect questions from patients and colleagues about cannabis use, its legal status, and its potential benefits and harms.Maroney goes over the main CYP interactions for CBD and THC and notes that smoking cannabis induces CYP1A2. Bridgeman adds that pharmacodynamic effects, such as more sedation and anticholinergic effects, matter too. Drawing on Canada’s lower-risk cannabis guidelines, Maroney outlines harm reduction counseling: avoid driving for 6 to 8 hours after inhaling and longer after oral use, delay use until after adolescence, choose lower-potency or higher CBD-to-THC products, and avoid smoking. Bridgeman cites the 2025 SAMHSA National Survey on Drug Use and Health. It estimates that 21 million Americans use cannabis daily or near daily, more than the number who drink alcohol daily, and that 19.3 million had cannabis use disorder in the past year.Maroney also covers higher-risk groups. These include people with severe mental illness, among whom cannabis use rose after recreational legalization, and people who are pregnant or trying to conceive. She cites Danish data showing that 47.4% of patients with cannabis-induced psychosis were later diagnosed with schizophrenia or bipolar disorder. On the positive side, both guests expect rescheduling to lower research barriers and improve access for patients who may benefit, such as those with chronic pain, chemotherapy-induced nausea and vomiting, or multiple sclerosis spasticity. Bridgeman’s main advice is for pharmacists to keep up with the changing federal rules and the evidence. REFERENCES US Drug Enforcement Administration. Marijuana Rescheduling Regulatory Actions. Published 2026. Accessed October 14, 2026. https://www.dea.gov/marijuana-rescheduling-regulatory-actions Public Health Agency of Canada. Canada’s Lower-Risk Cannabis Use Guidelines. Published May 10, 2019. Updated January 22, 2020. Accessed October 14, 2026. https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/resources/lower-risk-cannabis-use-guidelines.html Substance Abuse and Mental Health Services Administration. 2025 National Survey on Drug Use and Health (NSDUH) Releases. Updated August 17, 2026. Accessed October 14, 2026. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2025 VERTANICAL. FDA grants Breakthrough Therapy Designation to VERTANICAL’s VER-01, a first-in-class non-opioid investigational treatment for chronic low back pain. PR Newswire. May 18, 2026. Accessed October 14, 2026. https://www.prnewswire.com/news-releases/fda-grants-breakthrough-therapy-designation-to-vertanicals-ver-01-a-first-in-class-non-opioid-investigational-treatment-for-chronic-low-back-pain-302774621.html Hyatt AS, Flores MW, Johnson J, et al. Cannabis use among individuals with psychosis after state-level commercial cannabis legalization. JAMA Psychiatry. 2026;83(1):74-77. doi:10.1001/jamapsychiatry.2026 Kansagara D, Terry GE, Ayers CK, D’Souza DC. Cannabis and mental health: a review. JAMA Intern Med. 2026;186(5):618-628. doi:10.1001/jamainternmed.2026 Sheth S, Maroney M, Bridgeman MB. Cannabis at a crossroads: pharmacist care considerations in the context of a changing cannabis regulatory landscape. J Am Pharm Assoc (2003). 2025;65(3):102361. doi:10.1016/j.japh.2025.102361 Young-Wolff KC, Cortez CA, Alexeeff SE, et al. Adolescent cannabis use and risk of psychotic, bipolar, depressive, and anxiety disorders. JAMA Health Forum. 2026;7(2):e256839. doi:10.1001/jamahealthforum.2026.6839 Starzer MSK, Nordentoft M, Hjorthøj C. Rates and predictors of conversion to schizophrenia or bipolar disorder following substance-induced psychosis. Am J Psychiatry. 2018;175(4):343-350. doi:10.1176/appi.ajp.2017.17050535 Daniel NM, Maroney M. Rates of conversion from substance-associated psychotic disorder to bipolar or schizophrenia spectrum disorder in a community-based teaching hospital. J Clin Psychopharmacol. 2020;40(2):212-213. doi:10.1097/JCP.0000000000001187 To provide feedback or suggest topics of discussion for Psychiatric Pharmacy Pulse, please reach out to Gillian McGovern, Editor ([email protected]).

In this episode of Mind the Meds, host Erica Marini, PharmD, opens with the month's neurology pharmacy news: Novartis and Bristol Myers Squibb paused CAR T-cell trials in autoimmune diseases, including myasthenia gravis and multiple sclerosis, after safety concerns. FDA approvals included tavapadon (Juvmo; AbbVie), a selective D1/D5 dopamine agonist for Parkinson disease; apitegromab (Isembyld; Scholar Rock), an add-on myostatin inhibitor for spinal muscular atrophy; and levacetylleucine (Aqneursa; IntraBio Inc) for ataxia-telangiectasia.  FDA also granted priority review to satralizumab (Genentech) for relapsing myelin oligodendrocyte glycoprotein antibody–associated disease. Currently, it is approved for anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder under the brand name Enspryng. Marini closes the segment with positive results for ulefnersen (Ionis Pharmaceuticals, Otsuka Pharmaceutical) in FUS-ALS in the phase 3 FUSION trial (NCT04768972) and for atogepant (Qulipta; AbbVie) in menstrual migraine prevention. Marini is then joined by Caitlin S. Brown, PharmD, MPH, BCCCP, FCCM, FCCP, associate professor of pharmacy and emergency medicine at Mayo Clinic; and Brian Gilbert PharmD, MBA, FCCM, FNCS, FCCP, FASHP, FKCHP, a former emergency medicine clinical pharmacy specialist. Both are authors of the consensus recommendations on integrating clinical pharmacists into the acute stroke care team, published in the Journal of the American College of Clinical Pharmacy.1 The project grew out of the authors’ systematic reviews on pharmacist involvement in ischemic and hemorrhagic stroke. Their panel brought together emergency medicine and neurocritical care pharmacists from academic and community settings, emergency physicians, a neurologist, a librarian, and a statistician. The recommendations were endorsed by the American College of Clinical Pharmacy, the Neurocritical Care Society, the Society for Academic Emergency Medicine, and the Society of Critical Care Medicine, and affirmed by the American Academy of Neurology. Gilbert notes that this multidisciplinary support gives pharmacy leaders evidence they can bring to administrators when making the case for new full-time equivalent positions. Brown and Gilbert walk through the evidence behind both recommendations. Across 10 studies in acute ischemic stroke, pharmacist involvement cut time to thrombolytic administration by about 15 minutes and helped teams meet 45- and 60-minute door-to-needle goals more often. In 6 hemorrhagic stroke studies, pharmacist involvement shortened time to reversal agent administration. The evidence is mostly low-quality retrospective data, and there are no functional outcomes data yet, so the authors relied on time-based surrogate end points. They explain that their hope is future research will capture the full range of pharmacist interventions, that telestroke services will bring pharmacists in to support rural hospitals, and that later American Heart Association (AHA) guidelines will specifically name pharmacists as members of the stroke team. The episode ends with a look back at the January 2026 AHA ischemic stroke guidelines. Most centers had already switched to tenecteplase (TNKase; Genentech), and the guests say the bigger questions now are dosing strategy and whether to keep alteplase (Activase; Genentech) on formulary. They also discuss the extended thrombolysis window of up to 9 hours for patients with favorable imaging, which they expect to spread slowly outside academic centers. Other topics include the new guidance on alteplase for pediatric stroke, which both guests have given only once, and the caution against lowering blood pressure too far after reperfusion. REFERENCEGilbert BW, Brown CS, Acquisto NM, et al. Consensus recommendations for clinical pharmacist integration into the acute stroke care team: Endorsed by the American College of Clinical Pharmacy, Neurocritical Care Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine, and affirmed by the American Academy of Neurology. J Am Coll Clin Pharm. 2026;9(7):e70246. doi:10.1002/jac5.70246

Cindy Valencia, PhD, MPH, is director of CA Quits at UC Davis Health Center for Healthcare Policy and Research. They can be found on LinkedIn. Robin Corelli, PharmD, is a professor of clinical pharmacy in the Department of Clinical Pharmacy at the School of Pharmacy of the University of California, San Francisco. You can read their bio here.

In this episode of Psychiatric Pharmacy Pulse, host Megan Maroney, PharmD, BCPP, FAAPP, speaks with Danielle Stutzman, PharmD, BCPP, clinical assistant professor at the University of Colorado Skaggs School of Pharmacy and assistant adjunct professor at the Child and Adolescent Mental Health Division of the Department of Psychiatry at the University of Colorado School of Medicine, and member of the American Association of Psychiatric Pharmacists Board of Directors, about where centanafadine (Simtriyo; Otsuka Pharmaceutical) fits into attention-deficit/hyperactivity disorder (ADHD) pharmacotherapy. Centanafadine received FDA approval in July 2026 as a norepinephrine-dopamine-serotonin reuptake inhibitor (NDSRI) for ADHD in both pediatric and adult patients, with DEA scheduling still pending. Maroney and Stutzman note its mechanism is not entirely novel, drawing comparisons to tricyclic antidepressants, atomoxetine (Eli Lilly), and viloxazine (Qelbree; Supernus Pharmaceuticals, Inc).  A pooled meta-analysis of 4 phase 3 trials plus a phase 2b crossover study found a Hedges’ g effect size of about 0.37 for overall symptom severity versus placebo, a modest result that falls short of typical stimulant effect sizes of 0.8 to 1.0, though executive functioning outcomes on caregiver-rated scales appeared more promising. Safety data showed a nonsignificant increase in adverse effects (AEs) overall (pooled risk ratio, 1.29), with appetite suppression, nausea, and rash among the most common issues. Rash was the leading cause of study discontinuation in the youngest age group. Indirect comparisons suggested centanafadine may carry a lower risk of insomnia than methylphenidate and fewer AEs than atomoxetine and viloxazine, though lisdexamfetamine (Vyvanse; Takeda Pharmaceuticals) remained more effective. A boxed warning for suicidal ideation applies, which is consistent with other ADHD medications. Practical advantages discussed include a lack of reliance on cytochrome P450 metabolism, lower drug interaction risk than atomoxetine or viloxazine, and capsules that can be opened and sprinkled on applesauce, yogurt, or orange juice. Centanafadine did increase caffeine exposure roughly 2-fold, warranting patient counseling. Both Maroney and Stutzman positioned the drug as a potential second-line option for patients who are not candidates for stimulants or who have not tolerated or responded to first-line therapies.To provide feedback or suggest topics of discussion for Psychiatric Pharmacy Pulse, please reach out to Gillian McGovern, Editor ([email protected]).REFERENCES1. Mattingly GW, Turkoglu O, Chang D, Ward C, Skubiak T, Zhang Z, Cutler AJ. 52-week open-label safety and tolerability study of centanafadine sustained release in adults with attention-deficit/hyperactivity disorder. J Clin Psychopharmacol. 2025;45(5):454-462. doi:10.1097/JCP.00000000000020202. Otsuka Pharmaceutical Development & Commercialization, Inc; Otsuka Pharmaceutical Co, Ltd. Otsuka receives FDA approval for first-in-class SIMTRIYO (centanafadine) for the treatment of attention-deficit/hyperactivity disorder. Otsuka US. July 24, 2026. Accessed September 16, 2026. https://www.otsuka-us.com/otsuka-shares-fda-review-update-for-centanafadine3. Adler LA, Adams J, Madera-McDonough J, et al. Efficacy, safety, and tolerability of centanafadine sustained-release tablets in adults with attention-deficit/hyperactivity disorder: results of 2 phase 3, randomized, double-blind, multicenter, placebo-controlled trials. J Clin Psychopharmacol. 2022;42(5):429-439. doi:10.1097/JCP.00000000000015754. Muneer MA, Naveed M, Amjad M, et al. Efficacy and safety of centanafadine in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis of randomized controlled trials. Psychopharmacol Bull. 2026;56(3):47-65. https://pubmed.ncbi.nlm.nih.gov/42267239/5. Schein J, Cloutier M, Gauthier-Loiselle M, et al. Assessment of centanafadine in adults with attention-deficit/hyperactivity disorder: a matching-adjusted indirect comparison vs lisdexamfetamine dimesylate, atomoxetine hydrochloride, and viloxazine extended-release. J Manag Care Spec Pharm. 2024;30(6):528-540. doi:10.18553/jmcp.2024.30.6.5286. Stein MA. Editorial: centanafadine for adolescents with attention-deficit/hyperactivity disorder: is a broader mechanism of action better? J Am Acad Child Adolesc Psychiatry. 2026;65(6):764-765. doi:10.1016/j.jaac.2025.10.0207. Ward CL, Childress AC, Jin N, et al. Centanafadine for attention-deficit/hyperactivity disorder in adolescents: a randomized clinical trial. J Am Acad Child Adolesc Psychiatry. 2026;65(6):805-817. doi:10.1016/j.jaac.2025.06.023

This episode of Mind the Meds features guest Patti Yager-Stone, PharmD, BCPS, a clinical pharmacist in neurology at the Veterans Affairs Medical Center in Portland, Oregon, who oversees infusion management and vaccine coordination for about 120 neurology patients. Yager-Stone explains that immunomodulating and immunosuppressant therapies both increase infection risk and can blunt vaccine response, making pretreatment vaccination and timing central to her practice. When vaccination history is incomplete, she recommends avoiding live vaccines in patients on many of these therapies and stresses using serologies and thorough documentation review, instead of patient recall alone. For pneumococcal vaccination, she highlights the CDC's PneumoRecs VaxAdvisor tool for navigating vaccine selection based on patient age and risk conditions. For Yager-Stone’s institution, the 20-valent pneumococcal conjugate vaccine is favored over the 21-valent option for those who are immunocompromised because the latter excludes serotype 4, which is responsible for more than 30% of invasive pneumococcal disease cases in Oregon and several other western states.Marini and Yager-Stone discuss a recent cohort study that eased longstanding concerns about live vaccines, particularly the measles, mumps, and rubella vaccine, triggering relapses in those with multiple sclerosis, a finding both say has reinforced their practice of offering the measles, mumps, and rubella vaccine to patients without documented immunity amid current measles activity. They also note that immunosuppressed patients with measles may present atypically, without the characteristic rash. The conversation also touches on the newly approved mRNA influenza vaccine for patients aged 50 years and older, which showed superior relative efficacy against influenza-like illness compared with standard-dose vaccine in trials; however, higher rates of reactogenic side effects such as fatigue were observed with the vaccine.The episode closes on emerging observational evidence linking several vaccines, most notably the recombinant zoster vaccine, along with respiratory syncytial virus, influenza, and tetanus-diphtheria-acellular pertussis vaccines, to reduced dementia risk, including a large study of skilled nursing facility residents showing a 24% relative risk reduction among those who received the zoster vaccine. Yager-Stone also flags an underrecognized risk with complement inhibitors, which increase meningitis risk substantially, and points to updated guidance suggesting concurrent antimicrobial prophylaxis alongside vaccination for these patients.

Sara Scott, PharmD, BCOP, Emma Uchida, PharmD, MBA, BCOP, and Rebecca Gonzalez, PharmD, BCOP, gather for a roundtable on the rare, delayed toxicities associated with ciltacabtagene autoleucel in relapsed/refractory multiple myeloma.

Megan Maroney, PharmD, BCPP, FAAPP: Hello, I'm Megan Maroney, and this is Psychiatric Pharmacy Pulse, a monthly podcast where we talk about hot topics in psychiatric pharmacy. I'm a clinical associate professor at the Ernest Mario School of Pharmacy at Rutgers University, and a clinical psychiatric pharmacist at Monmouth Medical Center. I am also a board-certified psychiatric pharmacist and a fellow of the American Association of Psychiatric Pharmacists. So, this podcast is really just a chance to talk about hot topics in psychiatry, new literature coming out, new drugs coming out, things that are coming down the pipeline. We also are going to have guests on the show to discuss these topics. Some of the upcoming episodes we have are on the new [attention-deficit hyperactivity disorder] drug centanafadine (Simtriyo; Otsuka Pharmaceutical) and the rescheduling of cannabis and what that means in terms of pharmacy practice. So, I hope you'll join me for these podcasts and feel free to write in with your ideas for topics and things that you want to hear about and give us feedback. We'd love to hear it. If there’s a topic you want to come on the podcast and talk about, let us know. [I would be] happy to cover things that everyone wants to hear about. To provide feedback or suggest topics of discussion for Psychiatric Pharmacy Pulse, please reach out to Gillian McGovern, Editor ([email protected]).

Matthew Lei, PharmD, BCOP, a clinical oncology pharmacist at Massachusetts General Hospital, joins Pharmacy Focus: Oncology Edition to break down the FDA approval of subcutaneous isatuximab-irfc via the CirCLIQ on-body injector, covering the IRAKLIA trial's noninferiority data, the device's practical rollout challenges, and how the agent positions against subcutaneous daratumumab in an increasingly crowded anti-CD38 landscape.

In this episode of Mind the Meds, host Erica Marini, PharmD, MS, BCPS, welcomes Jenelle Hall Montgomery, PharmD, BCACP, CPP, a clinical pharmacist practitioner with Duke Neurological Disorders Clinic at Duke University Hospital, to discuss highlights from the Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting in Charlotte, North Carolina, where Montgomery was recognized as a Giant of Multiple Sclerosis. Before the CMSC discussion, Marini runs through a roundup of recent neurology news, including approval of at-home initiation dosing for lecanemab-irmb (Leqembi; Eisai, Biogen), fast track designation for remlifanserin (Acadia Pharmaceuticals) in Alzheimer disease psychosis, approval of the oral PCSK9 inhibitor enlicitide (Lipfendra; Merck), and phase 3 data on tavapadon (AbbVie) for Parkinson disease showing a lower rate of impulse control disorders than traditional dopamine agonists.The pharmacists then turn to CMSC sessions on off-label and evolving areas of MS care. They discuss growing interest in neurofilament light chain as a biomarker for tracking subclinical disease progression over time, along with the ongoing debate over when it is safe to discontinue disease-modifying therapy (DMT) in older, stable patients. Both note their practices generally begin this conversation around 60 to 65 years of age, factoring in radiographic and clinical stability over the preceding decade, and describe strategies such as tapering dosing frequency or switching to lower-efficacy agents rather than abrupt discontinuation.The conversation closes with an update on family planning in MS, where new data presented at CMSC reinforce the safety of anti-CD20 therapies during pregnancy and breastfeeding. Montgomery and Marini review a 10-year dataset of about 5000 pregnancies on ocrelizumab (Ocrevus; Genentech), a large safety analysis of ofatumumab (Kesimpta; Novartis Pharmaceuticals) showing no increase in birth malformations, and early transfer-into-breastmilk data on ublituximab (Briumvi; TG Therapeutics). They also touch on the limited but growing evidence for GLP-1 receptor agonists in patients with MS, noting no known drug interactions with DMTs and possible indirect benefit through weight-related disease modulation, though neither pharmacist currently prescribes GLP-1s for an MS indication. Key Takeaways:1. Neurofilament light chain is emerging as a useful, though not yet mainstream, biomarker in MS. Rather than a single value, tracking neurofilament light chain over time alongside clinical status may help identify subclinical disease progression, particularly in patients without clear relapses.2. DMT discontinuation in older, stable patients remains individualized, with most practices starting the conversation around 60 to 65 years of age. Clinicians weigh 10-year clinical and radiographic stability, and some patients opt for a gradual step-down in dosing frequency or a switch to a lower-efficacy agent rather than outright discontinuation.3. New pregnancy and breastfeeding safety data continue to support anti-CD20 therapies as a preferred family planning strategy in MS. A 10-year, 5000-pregnancy dataset on ocrelizumab, reassuring malformation data on ofatumumab, and early breastmilk transfer data on ublituximab are strengthening patient counseling conversations around conception, pregnancy, and postpartum DMT resumption.

Holistic, integrative, functional, precision—the labels are everywhere, but few patients or clinicians know where one ends and the next begins.

To open the episode, Erica Marini, PharmD, discussed a roundup of FDA and research updates in neurology. She covered the shifting accelerated-approval pathway for AMT-130 (uniQure), a gene therapy for Huntington disease, and a similar back-and-forth for a Hunter syndrome gene therapy. She also noted an expanded indication for olezarsen (Tryngolza; Ionis Pharmaceuticals) in severe hypertriglyceridemia, a UK study linking hypotension to Alzheimer risk, and data suggesting shingles vaccination may lower dementia risk in Medicare beneficiaries. From the American Headache Society meeting, she highlighted phase 2b data on the TRPM8 agonist elismotrep (Kallyope), and the anti-PACAP antibody bocunebart (Lundbeck) for migraine, along with retrospective findings tying CGRP monoclonal antibodies to increased fracture risk and higher odds of spontaneous abortion in early pregnancy.The core interview featured Adrian Wong, PharmD, MPH, BCCCP; and Cayley Krkljes, PharmD, BCPS, of Beth Israel Deaconess Medical Center who discussed a systematic review published in Pharmacotherapy of clinically significant drug-drug interactions with phenobarbital and primidone. Wong and Krkljes described growing use of phenobarbital for alcohol withdrawal and note that health care professionals often underappreciate its interaction potential despite it being a well-known enzyme inducer. Key findings included an induction onset of 24 hours to 30 days and an offset of 2 to 8 weeks, findings that carry particular weight for transitions of care since inpatient dosing effects can persist well after discharge. The most clinically impactful interactions involved anticoagulants (warfarin and direct oral anticoagulants [DOACs]), methadone, and immunosuppressants, with approximately 85% of reviewed studies reporting some outcome impact. They also pushed back on recent social media claims that phenobarbital-DOAC interactions are not clinically relevant, pointing out methodological limitations in the studies behind that claim.The conversation moved into practical risk stratification: The guests described considering a patient's individual risk factors—such as recent thrombosis, transplant status, or opioid use disorder treatment with methadone or buprenorphine—before choosing phenobarbital over benzodiazepines for alcohol withdrawal. They outlined next steps for research, including studying real-world outcomes in high-risk medication combinations and surveying health care professional awareness of these interactions to identify education gaps. The episode closed with career advice for pharmacists interested in research—start small, find mentors, and leverage institutional resources. Key Takeaways: Phenobarbital's interaction risk is widely underrecognized. Despite growing use for alcohol withdrawal, phenobarbital's enzyme-inducing effects can persist for weeks after the last dose (onset 24 hours to 30 days; offset 2 to 8 weeks), making transitions of care a critical window for catching interactions—especially with anticoagulants, methadone, and immunosuppressants, which accounted for the most clinically impactful outcomes in the review. Not all "reassuring" data holds up under scrutiny. Wong and Krkljes challenged circulating social media claims that phenobarbital-DOAC interactions aren't clinically relevant, noting the studies behind those claims had methodological limitations, emphasizing the importance of evaluating primary literature rather than secondhand interpretations. Risk stratification should guide phenobarbital use. Individual patient factors (eg, recent thrombosis, transplant status, or opioid use disorder treatment with methadone or buprenorphine) should inform whether phenobarbital or a benzodiazepine is the safer choice for alcohol withdrawal management.

Updated ASTCT infectious disease guidelines are reshaping how BMT and cellular therapy pharmacists approach prophylaxis, treatment thresholds, and drug–drug interactions across a range of opportunistic infections.

Find out more information about the Psychedelic Pharmacists Foundation (PPF) & Psychedelic Pharmacists Association (PPA):PPF: https://www.psychedelicpharmacistsfoundation.org/PPA: https://psychedelicpharmacist.org/