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.

Have a question, feedback, or an idea for a future episode? Contact YFP Wealth at [email protected]. To learn more about fee-only financial planning services for pharmacists, visit yfpwealth.com.This podcast is for informational purposes only and should not be considered investment or financial advice. Visit yfpwealth.com/disclaimer for more information.

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.