Pharmacy Focus

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.

REFERENCE
Gilbert 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]).

REFERENCES
1. 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.0000000000002020
2. 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-centanafadine
3. 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.0000000000001575
4. 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.2024.30.6.528
6. 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.2025.10.020
7. 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

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]).

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.