Overview

In 2025, the average first-time pass rate for the Multistate Pharmacy Jurisprudence Examination (MPJE) was 73.6%. This is lower than the pass rate of 2024 (74.8%), but higher than the average in 2023 (71.5%). As of 2026, the UMPJE has been released. This new exam has slowly been transitioned in, and only some states have adopted it thus far. Many pharmacy students find the law exam to be intimidating. For example, the questions are often phrased in a way where there could potentially be multiple right answer choices, but you have to carefully think about what the best answer is. In this blog, we will break down the MPJE/UMPJE and several strategies for students and pharmacists preparing for the exam.

MPJE or UMPJE: What is the Difference?

The MPJE was adopted in 1998 and is an exam that is taken by a pharmacist seeking licensure.  This test is delivered based on jurisdiction and includes statutes and regulations of one specific state that a candidate is seeking licensure in. Additionally, the MPJE also covers federal law. In 2026, the National Board of Pharmacy (NABP) released the UMPJE, which covers a more universal law approach in which the content is applicable to all jurisdictions. The states that have switched from the MPJE to the UMPJE starting April 1^st, 2026, include Arizona, Florida (effective June 1^st, 2026), Iowa, Kansas, Maryland (effective June 1^st, 2026), North Carolina, Ohio, and Rhode Island. More states can be expected to follow suit in the future. At the end of this blog, you can find an interactive map that lists states that will be adopting this new exam. The UMPJE was designed to allow pharmacists to practice in multiple states while reducing the burden of preparing for multiple tests, reducing costs, and allowing a faster time to licensure. The features of the exams are quite similar with some small variations which are described in the chart below.

Breaking Down the Content Areas:

The UMPJE and MPJE have slightly different focus areas. NABP breaks down each exam into these 4 different areas that encompass the exam. In addition, the organization also relays what percentage of the content will come from each domain. Below is a brief breakdown of the different content areas between the exams.

MPJE:

• Licensure/Personnel – makes up 22% of the total exam
  • Covers pharmacist responsibilities and other duties related to pharmacists as well as non-pharmacist workers
• Pharmacist Practice – makes up 33% of the total exam
  • Covers information on issuing medications, drug administration, counseling, pharmacy related agencies, and reusing medications
• Dispensing Requirements – makes up 24% of the total exam
  • Covers the evaluation of prescription orders, transfer of prescriptions, drug utilization reviews, dispensing exceptions, labeling/packing of medications, distribution/dispensing of products
• Pharmacy Operations – makes up 21% of the total exam
  • Covers ordering medications, recordkeeping, drug delivery, product selection, compounding, central-fill pharmacies, requirements of a pharmacy related setting

UMPJE:

• Pharmacy and Pharmacist Practice – makes up 30% of the exam
  • Covers scope of pharmacy, non-pharmacist workers, adulteration/misbranding drugs, federal standards, compounding, patient protected health information
• Medication Use Process – makes up 30% of the exam
  • Covers requirements of issuing orders, dispensing, and the administration of medications
• Regulatory Authority and Legal Obligations – makes up 20% of the exam
  • Covers regulatory authorities, controlled medications, and liability
• Pharmacy operations – makes up 20% of the exam
  • Covers licenses, technology, and the storage/security and handling of medications

Understanding Question Architecture

The MPJE/UMPJE questions are formatted in 3 different ways: multiple choice, select all that apply, and K-type multiple choice. Multiple choice questions give 4 to 5 possible answer choices, and you have to choose the one that is most correct. These can be challenging in that multiple responses may seem correct, but you have to pick the best response. The next type of question format is select all that apply. This structure can also be difficult for test takers as there is no partial credit. Even if you miss 1 response, the entire question will be marked wrong. Lastly, the exam will consist of K-type questions. The question will include statements which are labeled with roman numerals, and you answer the question by choosing a combination of the statements, or by strictly choosing just one of the statements. A word of advice while answering these types of questions – treat the roman numeral labeled statements as if they were true/false statements. If you rule out one of the statements, then you may be able to disregard multiple potential answers given for the question.

On another note, it is important to go slow and read the entirety of the question. The exam frequently includes statements such as “which does not apply” or “all of the following apply, except.” It is also important to understand the difference between “must,” “shall,” and “may” as these words also frequent on the exam. Be sure to check out our online courses to get practice with all these types of questions!

Study Strategies for Success

When starting to study for this exam, try to focus on active learning rather than just reading through the laws and regulations. Strictly reading the material may not work as well as active learning – writing things down, underlining, flash cards. Apply what you have read to real-life examples. Below are some big topics that frequently appear on the exam and are often the most difficult for students:

• Controlled Substances – any topic surrounding controlled substance is frequently asked
• Dispensing medications – prescription requirements, labeling requirements, and counseling are big topics
• Record keeping – identifying how long you need to keep records, storage of medications, etc.
• Non-pharmacist personnel – the role of technicians/interns in the pharmacy as well as the ratio of technicians to pharmacists
• Licensure – this could include continuing education hours, how to renew licenses, malpractice, and more
• Compounding – topics related to sterile, non-sterile, and hazardous compounding
• Pharmacist In Charge (PIC) – responsibilities and duties related to operation

When studying for the UMPJE, it is important to keep in mind that the questions are based on a universal approach – topics that are applicable to multiple jurisdictions. If you are taking this exam, it is still important to know your specific state requirements as well. Alternatively, the MPJE is focusing on federal and state law. Occasionally, the state will differ from the federal law. Keep in mind that you should follow the stricter law and answer the question based on that. Listed below are some study tips for you to consider during the study process:

• Formulate a study plan – create a study plan to follow. You could include what topics to focus on each day, when you will do practice questions, and save the practice exam for when you are getting close to the exam. It is okay to change your plan when you find out what you need more practice with.
• Designate a set amount of time – give yourself enough time to prepare! Many students find that studying for 3-6 weeks is a good duration to study. Base this off of what works for you!
• Enroll in an online course – find an online course that includes lectures, study guides, practice quizzes, and practice exams. Check out our state-specific MPJE courses here and our new UMPJE course here!
• Create a self-care routine – when studying, it is important to still give yourself time to decompress and do things for yourself. This will help prevent study burnout!

Your Plan for Test Day

Many different emotions can occur on your test day for the MPJE/UMPJE. Some may find themselves anxious and/or stressed prior to taking the exam, but may have relief when getting this intimidating exam out of the way. To get through this day, here are some test day tips that you can follow:

• Prepare what you bring – NABP requires you to bring a valid form of ID (such as a driver’s license, passport, etc.) Ensure that your ID is not expired!
• Plan to arrive early – Show up at least 30 minutes before your testing time to allow enough time to go through the check-in process. Being late will only add to stress/anxiety on the day of the exam.
• Perform with focus during the exam
  • Read each question thoroughly and carefully
  • Answer the question with a pharmacist mindset – not a “test-taking” mindset
  • Use the process of elimination as stated previously! Treat each statement as if it were a true/false question
  • Follow your gut – think about what both the right and cautious thing is to do
  • Pace yourself as you have about 1 minute and 25 seconds per question
• Proceed with confidence after the test – Pat yourself on the back for being done with the exam! Try not to stress about the results during the waiting period.

Study Smart and Pass Confidently

Approaching the MPJE/UMPJE with an intentional and strategy-driven study mindset can help make this process manageable. Stay up to date with what your state requires in regard to the law exam to help guide your studying – is it the federal & state law (MPJE) or is it the uniform and universal approach to law (UMPJE)? To set yourself up for success, create a personalized plan with deadlines, costs, study materials, and test-day concepts. Guide your focus on real-world applications rather than strictly memorizing the law. Remember, this exam is testing your knowledge to practice safe and competent duties as a pharmacist. Be consistent, trust yourself, and approach test day knowing you have built the skills needed to navigate the pharmacy law.

Olivia Johnson, PharmD

RxPharmacist Uniform MPJE Adoption Tracker

References:

1. Multistate Pharmacy Jurisprudence examination passing … Accessed April 3, 2026. https://nabp.pharmacy/wp-content/uploads/MPJE-Pass-Rates.pdf.
2. Pharmacy Law Examination Preparation Guide. Accessed April 3, 2026. https://www.ashp.org/-/media/assets/new-practitioner/docs/2025/Pharmacy-Law-Examination-Preparation-Guide_ASHP-NPF.pdf
3. Competency Statements | Multistate Pharmacy Jurisprudence Examination. National Association of Boards of Pharmacy. https://nabp.pharmacy/programs/examinations/mpje/competency-statements/
4. Multistate Pharmacy Jurisprudence Examination (MPJE) | NABP. National Association of Boards of Pharmacy. https://nabp.pharmacy/programs/examinations/mpje/
5. Understanding the Uniform MPJE for Pharmacy Licensure | MPJE. National Association of Boards of Pharmacy. Published May 15, 2025. https://nabp.pharmacy/programs/examinations/mpje/uniform-mpje/
6. Uniform Multistate Pharmacy Jurisprudence Content Outline. Accessed April 3, 2026. https://nabp.pharmacy/wp-content/uploads/Uniform-MPJE-Content-Outline.pdf.
7. Section 1 | Welcome. Nxtbook.com. Published 2026. Accessed April 3, 2026. https://read.nxtbook.com/nabp/bulletin/naplex_mpje_bulletin/welcome.html

Overview

In 2020, in terms of our aging population in the United States, there were approximately 47 million adults ages 65-84 and 7 million adults ages 85 and older. In 2040, the number of adults that are 85 and older is expected to double with about 15 million people falling into this category and ages 65-84 continuing to increase to approximately 65 million adults.

With this aging population, we can expect to see an increase in health conditions such as dementia, chronic obstructive pulmonary disease (COPD), urinary incontinence, depression, sleep disorders, and more. To treat these conditions, medications are commonly prescribed with the thought to improve the functions of daily living. Unfortunately, many of the medications that are prescribed have anticholinergic properties and may result in adverse effects in the elderly population. These side effects could potentially contribute to a patient’s physical and mental decline. Pharmacists play an important role in recognizing high-risk medications and recommending alternative pharmacological and non-pharmacological agents that could be safer in the elderly patient population.

Understanding Anticholinergic Medications

Acetylcholine is a neurotransmitter that allows communication between neurons in the body and contributes to muscle movement, memory, learning, glandular secretion, and more.  Anticholinergic medications work by blocking acetylcholine from binding primarily to the muscarinic receptors and to a small degree, nicotinic receptors. Medications with anticholinergic effects result in relaxation of smooth muscles as well as reducing the production of bodily secretions. Below are some frequently prescribed anticholinergic medications.

While not explicitly stated in the Beers Criteria, we also frequently see medications that are used for overactive bladder and urinary incontinence being prescribed in older adults. These include medications such as oxybutynin, tolterodine, and solifenacin, just to name a few. As previously explained, these medications relax the smooth muscle of the bladder to cause urinary retention.

The Beers Criteria Explained

The Beers Criteria is a list created by the American Geriatrics Society (AGS) on potentially inappropriate medications in adults who are 65 and older. The aim is to help guide practitioners in choosing safe medications for older adults. It is important to keep in mind that this is just a general list – it is not patient specific. Practitioners must use their clinical judgement when recommending and prescribing medications on the Beers Criteria in a patient-centered approach. This list is updated every 3 years, with the most recent update being in 2023. As of today, the AGS has not yet released the 2026 version.

Recognizing the Anticholinergic Risk

Anticholinergic medications affect the central nervous system (CNS). These central effects can lead to confusion, delirium, cognitive dysfunction, memory issues, dizziness, and sedation. This is of big concern with our older population because it puts the patients at risk of falls and potential memory problems. In addition to affecting the CNS, anticholinergic medications also impact the peripheral nervous system. The peripheral effects can lead to “drying” effects as we commonly describe to patients. This includes urinary retention, constipation, blurry vision, and dry mouth. These effects are often bothersome to most patients.

Some patients may be on multiple high-risk medications. This can lead to something called an “anticholinergic burden”. If patients are on these kinds of medications long-term, it could also lead to an “anticholinergic burden”. A tool has been created to assess a patient’s risk of this effect, and it is called the “ACB Scale”. If a patient scores 3 or higher, then this puts them at higher risk of mortality and cognitive impairment.

What Makes Older Adults So Vulnerable?

As people age, the body starts to make less acetylcholine, and due to the mechanism of action described above, this results in a higher proportion of acetylcholine being blocked with anticholinergic medications. This leads to more potent effects in the elderly population. Additionally, a reduction in metabolism and excretion through the liver and kidney occurs as people age which can cause accumulation of anticholinergic medications and increasing effects. Lastly, the blood brain barrier becomes more permeable with age, resulting in the CNS effects described previously.

Potential Dementia Risks

While a direct link between anticholinergic medications and dementia has not been found, several studies have noted an association between patients who take anticholinergic medications and developing dementia. One study in Harvard Health Publishing found that a patient taking an anticholinergic medication long-term was associated with a 54% higher risk of developing dementia. It is important to note that the increased risk is associated with longer durations and higher doses, leading to an increased exposure – often referred to as the anticholinergic burden. However, other studies have not found a link between these kinds of medications and dementia. These other studies identified that the underlying conditions may actually put one at risk of developing dementia, not the medications themselves. Evidence suggests that the cognitive dysfunction that may occur with anticholinergic medication may be reversible after discontinuation of the offending agent, although this can’t be guaranteed, especially with an increased exposure. More data is needed to draw a conclusion about the long-term dementia risk that has been casually associated with anticholinergic medications.

Alternatives to Anticholinergics

At this point, one may be asking, “if not an anticholinergic, then what?” Well, there are other options that have been shown to be safer and still effective in older adults. Below is a chart similar to the one above that describes alternative pharmacologic options. These medications have been identified to have a lower anticholinergic risk than others in the same class.

Anticholinergic medications may still be deemed necessary in some patients. It is important to use clinical judgement and treat each patient individually in a patient-centered approach. As long as the benefits outweigh the risks, then these medications may still be used.

Additionally, non-pharmacological strategies may also play a role in reducing the reliance on anticholinergic medications. For example, patients with allergies may benefit from approaches such as allergen avoidance – keeping windows closed during pollen seasons or washing bedding regularly. In the management of depression, cognitive behavioral therapy (CBT) has demonstrated to be effective. For musculoskeletal discomfort, alternatives such as massage therapy or heat (e.g., heating pad) may reduce the need for muscle relaxants. Lastly, older adults experiencing overactive bladder or incontinence may find pelvic floor training a helpful tool to avoid anticholinergic medications and improve bladder control.

Pharmacist Considerations

Pharmacists play a vital role in identifying patients at risk for adverse effects associated with anticholinergic medications. Through careful medication review, pharmacists are well positioned to recognize individuals who may be susceptible to these effects. Deprescribing, as clinically indicated, is another key responsibility that pharmacists can engage in to reduce anticholinergic burden. In addition to educating patients, pharmacists can also guide providers by recommending safer, evidence-based alternatives. Services such as medication therapy management (MTM) further support this effort, especially for pharmacists who practice under collaborative practice agreements (CPAs) and have the ability to prescribe/deprescribe medications. By using this interprofessional collaboration, pharmacists can make meaningful impacts on patients’ health, ultimately improving safety, outcomes, and quality of life.

The Big Picture

As the U.S. population continues to age, the risks associated with anticholinergic medications become increasingly important to recognize and address. These agents are frequently used and are often effective, but their potential to contribute to cognitive dysfunction, falls, and decreased quality of life – specifically in older adults – is something to be talked about. Clinicians can make more informed prescribing decisions after understanding how these medications work and applying tools such as the Beers Criteria and ACB scale to help guide their decisions. Pharmacists are in a position to identify anticholinergic burden, recommend appropriate changes, and use interprofessional collaboration, along with patient input, to optimize therapy. Ultimately, careful medication management can minimize one’s anticholinergic exposure. Small changes may make big impacts on cognition and quality of life.

Olivia Johnson, PharmD

References:

1. From The American Geriatrics Society. https://thecarepartnerproject.org/wp-content/uploads/The-Beers-List.pdf
2. Ghossein N, Kang M, Lakhkar AD. Anticholinergic medications. PubMed. Published 2023. https://www.ncbi.nlm.nih.gov/books/NBK555893/
3. Urban Institute. The US population Is aging. Urban Institute. Published December 12, 2019. https://www.urban.org/policy-centers/cross-center-initiatives/program-retirement-policy/projects/data-warehouse/what-future-holds/us-population-aging
4. Mayo Clinic. Bladder control: Medications can relieve urinary problems. Mayo Clinic. Published 2017. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220
5. King R, Rabino S. ACB Calculator. www.acbcalc.com. Published December 17, 2023. https://www.acbcalc.com/
6. Ruscin JM, Linnebur SA. Aging and Medications. Merck Manual Consumer Version. Published April 6, 2025. https://www.merckmanuals.com/home/older-people-s-health-issues/aging-and-medications/aging-and-medications#Benefits-and-Risks-of-Prescription-Medications_v838778
7. Harvard. Common anticholinergic drugs like Benadryl linked to increased dementia risk – Harvard Health. Harvard Health. Published January 28, 2015. https://www.health.harvard.edu/blog/common-anticholinergic-drugs-like-benadryl-linked-increased-dementia-risk-20150128812
8. Hanlon JT, Semla TP, Schmader KE. Alternative Medications for Medications in the Use of High-Risk Medications in the Elderly and Potentially Harmful Drug-Disease Interactions in the Elderly Quality Measures. Journal of the American Geriatrics Society. 2015;63(12):e8-e18. doi:https://doi.org/10.1111/jgs.13807
9. Deglow B. Pharmacist-Driven Deprescribing to Reduce Anticholinergic Burden in Veterans With Dementia. Federal Practitioner. 2024;41(12). doi:https://doi.org/10.12788/fp.0539

Overview

Patients with type 2 diabetes mellitus (T2DM) requiring insulin therapy currently have multiple options to choose from between bolus (short-acting) insulin, basal (long-acting) insulin, and premixed (long-acting and rapid/intermediate). Studies have reported the number of patients with T2DM using insulin have continued to increase with approximately 109,974 users in 2002 and reaching 348,254 users in 2019. No matter which type of insulin a patient is on, daily injections are still required.

When initiating insulin therapy in T2DM patients, the American Diabetes Association recommends starting patients on basal insulin alone before transitioning to a basal/bolus regimen. In order for insulin injections to be effective, patients must be adherent to their dosing schedule. A post-hoc analysis published in the Diabetes Research and Clinical Practice reported that the weekly averages of T2DM patients being adherent to their basal insulin regimen ranged from 70.6% to 79.3%. A recently approved once-weekly injection could not only promote adherence, but it could also reduce the burden of daily injections associated with basal insulin as well as providing patients with the potential for stable, long-lasting glucose control.

The Arrival of a New Era in Insulin Therapy

On March 26^th, 2026, the US Food and Drug Administration (FDA) approved Awiqli® (insulin icodec-abae), a novel once-weekly basal insulin for the treatment of type 2 diabetes. Awiqli® is to be injected every 7 days, on the same day each week, offering a more convenient dosing schedule compared to current once daily basal insulins. Trials from the ONWARD program demonstrated non-inferiority and, in some cases, superiority when compared to the standard insulin degludec and glargine. The primary outcome measured included a reduction in hemoglobin A1c. The insulin icodec group had a reduction of 8.6% to 7.0% meanwhile the insulin degludec group had a reduction of 8.5% to 7.2%.

The Science Behind Once-Weekly Control

Awiqli® mimics the natural insulin that the body produces and binds to human insulin receptors. The insulin is highly protein bound (>99%) resulting in a half-life of approximately 7 days which allows for the once-weekly dosing. Once bound, a depot is formed in the bloodstream which allows the insulin to be slowly released over time and results in gradual and consistent glucose control. Steady state is reached after a couple of weeks of injections and will further maintain a continuous, steady equilibrium.

Although this insulin has many promising factors, there are some instances where a clinician may want to proceed with caution in recommending this product for a patient. Due to the long half-life, this medication remains in the body for a longer period of time. If the medication is dosed too high, the patient could experience more frequent hypoglycemic episodes. The same can be said if a patient experiences an allergic reaction. It will take longer for the body to excrete this medication compared to the current basal insulin therapies.

The Art of Dosing Once-Weekly Insulin

Awiqli® is formulated into a pre-filled pen that contains 700 units/mL. The pen is designed to deliver doses rounded to the nearest 10-unit increment (e.g. 70 units, 80 units, 90 units, and so on).

The manufacturer, Novo-Nordisk, recommends starting patients on 70 units once weekly if the patient is basal insulin naïve, then titrating as necessary. Alternatively, if the patient is switching from a daily basal insulin to Awiqli®, the first week dose is calculated by multiplying the patient’s current daily basal dose by 1.5 then further multiplying this by 7 and rounding to the closest 10 units. For the second week, take the patient’s previous total daily dose of basal insulin, multiply this by 7, and round to the closest 10 units. After the second week, it is recommended to continue titrating as clinically indicated.

Practice Pearls for Pharmacists

Although a once-weekly injection sounds like the ideal insulin regimen, it may not be the best choice for all patients. With the recent FDA approval, it was only approved for patients with T2DM. Patients with type 1 diabetes mellitus (T1DM) were included in studies, but it was not approved in this patient population due to an increased risk of hypoglycemia. Furthermore, it was only studied in adults aged 18 and older, so therefore, it is not approved in children.

A patient that could be a good candidate for this novel basal insulin therapy may be one who struggles with adherence, varying glucose control, or someone just overwhelmed with daily injections. With the once-weekly dosing, pharmacists play a key role in educating patients on Awiqli®. Some important considerations include:

• Emphasizing a once-a-week injection rather than daily – the dose is much higher than standard daily dosing so an administration error of injecting the prescribed dose daily could result in extreme episodes of hypoglycemia.
• Educating on how to combat hypoglycemia – since this medication sticks around longer in the body, if the dose is too high (especially if the patient is taking other anti-glycemic medications), then hypoglycemic episodes could potentially last longer and/or occur more frequently.
• Monitoring daily blood glucose levels – when the patient is starting out on Awiqli®, the dose may need to be titrated, so having current and accurate blood glucose readings will help guide these dose changes.
• Missing doses – if a patient misses a dose, it is best to take the dose as soon as possible if it is within 4 days of the injection date. If it has been more than 4 days, it is best to wait until the next scheduled injection date.

The Patient Experience with Once-Weekly Insulin

As stated previously, patient adherence to prescribed anti-glycemic therapy is important in maintaining blood glucose control and preventing hyperglycemic episodes that could lead to a wide array of health complications. The novel once-weekly mechanism provides an option for patients who are struggling with adherence resulting in varying glucose control. It also has a role for patients who are just overwhelmed with the burden associated with managing their T2DM and daily basal insulin injections.

Patients can expect to see this medication being available in the coming months of 2026. The cost of Awiqli® is still not readily available. Due to this being a new medication and with recent FDA approval, it could be expected to be on the more expensive end. It will also be interesting to see what insurance coverage looks like in the coming months. Will insurances require a prior authorization? Will step therapy be required? Access to this medication will determine if patients will actually be able to benefit from it.

Is Weekly the Future of Diabetes Care?

While the number of patients with T2DM using insulin therapy continue to rise, we continue to see poor adherence leading to poor glucose control among this patient population. The newly FDA approved medication Awiqli® (insulin icodec-abae), could help target this specific patient population with providing the possibility of better adherence and decreased injection burden due to the medication’s once-weekly dosing. In addition, it could benefit patients who have varying glucose control with the mechanism of action of forming a depot in the bloodstream to provide a slow, constant, and steady release of insulin. This medication is not without its challenges. Dosing has to be just right because if it is too high, the patient could experience prolonged hypoglycemic episodes. Patient access to this medication in regard to cost and insurance coverage still remains a topic of discussion. What comes next is still up in the air. Practitioners could expect to see changes in diabetes guidelines in the future which could potentially impact the standards of care in patients with T2DM. This may be the end of a chapter for previous therapies, but this is a promising start of a new era in basal insulin therapy.

Olivia Johnson, PharmD

References:

1. Highlights of prescribing information. Accessed March 31, 2026. https://www.novo-pi.com/awiqli.pdf
2. Pharmacytimes.com. Published 2026. Accessed March 31, 2026. https://www.pharmacytimes.com/view/fda-approves-insulin-icodec-abae-first-once-weekly-basal-insulin-for-adults-with-t2d
3. Home: Awiqli. Awiqli.ca. Published 2026. https://awiqli.ca/en/
4. Ajmc.com. Published 2026. https://www.ajmc.com/view/fda-approves-novel-weekly-basal-insulin-for-t2d
5. Awiqli | European Medicines Agency. www.ema.europa.eu. https://www.ema.europa.eu/en/medicines/human/EPAR/awiqli
6. Weekly insulin found safe, effective for Type 2 diabetes. Utsouthwestern.edu. Published July 12, 2023. https://www.utsouthwestern.edu/newsroom/articles/year-2023/july-weekly-insulin-found-safe.html
7. Park J, Kim G, Kim BS, et al. Insulin Fact Sheet in Type 1 and 2 Diabetes Mellitus and Trends of Antidiabetic Medication Use in Insulin Users with Type 2 Diabetes Mellitus: 2002 to 2019. Diabetes & Metabolism Journal. Published online February 7, 2023. doi:https://doi.org/10.4093/dmj.2022.0346
8. American Diabetes Association. Insulin Basics | ADA. diabetes.org. Published 2024. https://diabetes.org/health-wellness/medication/insulin-basics
9. Toft J, Kronborg T, Jensen MH, Rana P, Vestergaard P, Stine Hangaard. Assessment of basal insulin adherence in people with type 2 diabetes in telemonitoring: Post-hoc analysis of novel data modalities including insulin injection data. Diabetes Research and Clinical Practice. Published online April 1, 2025:112191-112191. doi:https://doi.org/10.1016/j.diabres.2025.112191
10. Miller K. Awiqli, a Once-a-Week Insulin Shot for Type 2 Diabetes, Gets FDA Approval. EverydayHealth.com. Published 2026. Accessed March 31, 2026. https://www.everydayhealth.com/diabetes/once-a-week-insulin-shot-is-a-game-changer-for-type-2-diabetes/

Introduction

Anaphylaxis is a serious, systemic hypersensitivity reaction characterized by rapid onset and the potential for life-threatening progression within minutes. In many cases, symptoms escalate in seconds, turning an ordinary moment at a restaurant, school event, or family gathering into a medical emergency. If left untreated, anaphylaxis may lead to loss of consciousness, cardiac arrest, or death. According to the Allergy and Asthma network, approximately 1 in 20 Americans have experienced anaphylaxis. Among individuals with food allergies, 42% of children and 51% of adults report a history of severe reactions. The economic burden is also substantial, with an estimated $1.2 billion in annual direct medical costs in the United States, including roughly $294 million attributed to epinephrine prescriptions alone. Anaphylaxis is associated with approximately 225 deaths per year in the U.S., and notably, about half of all episodes occur at home.

Epinephrine remains the only medication capable of reversing the life-threatening symptoms of anaphylaxis and is universally recognized as the cornerstone of management. In theory, that makes the solution sound straight forward—recognize symptoms and administer epinephrine immediately. In practice, it’s more complicated. Despite clear guideline recommendations, epinephrine continues to be underutilized. In a nationwide survey conducted by Wood and colleagues, 52% of patients who had previously experienced anaphylaxis had never received a prescription for an epinephrine auto-injector (EAI), and 60% did not have one currently available. Barriers include needle phobia, fear and anxiety surrounding device use, lack of confidence in administration technique, and misconceptions that a prescription is unnecessary. Delayed administration is associated with more severe outcomes, including biphasic reactions and increased risk of fatality. When it comes to anaphylaxis, hesitation can be costly—timely epinephrine use is strongly correlated with improved survival.

This gap between what should happen and what actually happens has fueled interest in alternative delivery systems. Anaphylm, an investigational sublingual epinephrine film developed by Aquestive Therapeutics, is being studied as a potential alternative to injectable epinephrine products.The film is small and lightweight, designed to dissolve under the tongue without the need for water or swallowing, and is packaged in a compact, weather-resistant format. While still under regulatory review, the concept raises important questions for pharmacists—Could a needle-free option improve willingness to carry epinephrine? Would simpler administration reduce delays in real-world emergencies? As the landscape of anaphylaxis treatment evolves, pharmacists will play a critical role in evaluating emerging therapies and translating new options into safe, practical patient care.

Overview of Anaphylaxis

Hypersensitivity reactions are immune-mediated responses that result in tissue injury and clinical symptoms. They are classified into four types (I-IV) based on their underlying immunologic mechanism and timing of presentation. The chart below outlines the key features and common examples of each type.

As a type I hypersensitivity reaction, anaphylaxis represents the most acute and potentially life-threatening immune response. The table below highlights common triggers and causes that pharmacists should be aware of.

Recognizing and responding to anaphylaxis is a critical skill for all healthcare personnel. Prompt anaphylaxis treatment should be considered when a patient presents with generalized symptoms such as hives, or more serious, potentially life-threatening signs including hypotension, respiratory distress, significant swelling of the lips or tongue, or involvement of more than one body system. Other common clinical manifestations of anaphylaxis include:

• Respiratory—Sensation of throat closing, stridor (high-pitched sound while breathing), shortness of breath, wheezing, or cough
• Gastrointestinal—Nausea or vomiting, diarrhea, abdominal pain
• Cardiovascular—Dizziness or fainting, tachycardia, hypotension
• Skin mucosal—Generalized hives, itching, swelling of lips, face or throat
• Neurological—agitation, convulsions, acute change in mental status, sensation of impending doom

If a patient exhibits any of these signs, especially when multiple systems are involved, immediate recognition and intervention is essential. Prompt action can be lifesaving and prevents progression to severe or fatal outcomes. Here is what to do when anaphylaxis is suspected:

1. Assess airway, breathing, and circulation (ABCs)
2. Administer epinephrine immediately
3. Call emergency medical services
4. Place the patient in supine position

Current Epinephrine Options

When anaphylaxis occurs, epinephrine is the lifesaving first-line treatment, and timely administration is critical. The current FDA-approved epinephrine options are:

• Neffy® nasal spray by ARS Pharma
• EpiPen® / EpiPen Jr® or their generics
• Auvi-Q® Auto-Injector
• Authorized generic of Adrenaclick® by Amneal Pharmaceuticals
• Generic of EpiPen® / EpiPen Jr® by Teva Pharmaceuticals
• EpiPen® / EpiPen Jr® and authorized generics by Viatris (formerly Mylan)

Even with multiple options on the market, no form of epinephrine has been shown to be more or less effective than another. In practice, insurance coverage often determines which option a patient receives. Most auto-injectors and the nasal spray come in two packs to ensure a backup dose is available in case a second injection is needed or in case the first device malfunctions. The table below shows a comparison between the auto-injector and nasal spray version of epinephrine.

Despite the availability of multiple epinephrine options, there are several challenges to consider. Patients and caregivers may become confused when faced with different devices or administration instructions, and fear of needles can lead to hesitation or improper use. In fact, a study from the National Institute of Health found that EAIs are used incorrectly 35-45% of the time. Access and insurance coverage can also be limiting factors, particularly for nasal spray options, which are less widely covered.

While epinephrine can be lifesaving, it is important for patients and healthcare providers to be aware of potential side effects and what to expect after administration. Side effects include:

• Tachycardia
• Arrhythmias
• Palpitations
• Hypertension
• Headache
• Tremor, weakness
• Pallor, sweating
• Nausea and vomiting
• Nervousness and anxiety
• Pain, redness at the injection site
• Tissue necrosis (if extravasated)

What is Sublingual Epinephrine?

For decades, epinephrine has been the frontline defense against anaphylaxis, now it is getting a needle-free upgrade. A new oral form of epinephrine is currently in clinical development, representing the first and only oral delivery option for Type I allergic reactions, including anaphylaxis. This innovative formulation contains a prodrug of epinephrine that is designed to be portable while achieving rapid absorption through sublingual administration.

The oral epinephrine is about the size of a postage stamp and weighs less than an ounce. Its packaging is even thinner and smaller than the average credit card, making it easy to carry in a pocket. It can also withstand weather conditions like rain or sunlight. 

Anaphylm offers several advantages to patients and providers including:

With oral epinephrine on the horizon, the future of anaphylaxis management could be more convenient, safer and patient-friendly than ever before.

Challenges and Considerations for Anaphylm

While oral epinephrine offers exciting benefits, there are some current limitations to be aware of. On January 30, 2026, the FDA issues Anaphylm a Complete Response Letter, meaning the product was not approved in its current form. The agency raised concerns about usability, including trouble opening the pouch and correctly placing the film under the tongue. Importantly, these issues were related to the packaging and administration, rather than the drug’s safety or efficacy. 

The main issues involve practicality during emergency situations and the need for additional pharmacokinetic data. The company developing the product believes these concerns can be resolved quickly, with plans to resubmit as early as summer 2026. The FDA is requesting further information on packaging, labeling, and pharmacokinetics, and details on insurance coverage remain uncertain at this time. 

Despite these hurdles, oral epinephrine remains a promising innovation that could significantly improve the accessibility and ease of anaphylaxis treatment once these issues are addressed.

The Final Consensus of Anaphylm for Patients

Anaphylaxis remains one of the most urgent and high-stakes emergencies pharmacists may encounter, and rapid access to epinephrine continues to be the mainstay of treatment. While current auto-injectors and nasal formulations are effective, challenges such as device confusion, administration errors, and access barriers still exist. Emerging innovations like oral epinephrine have the potential to reshape the future of anaphylaxis management by improving portability, ease of use, and patient confidence. As the treatment landscape continues to evolve, pharmacists will remain at the forefront to educate patients, navigate coverage barriers, and ensure that when seconds matter the most, lifesaving therapy is ready and within reach. 

APPE Student, Hailey Montour

References

Allergy & Asthma Network. Anaphylaxis Statistics. Accessed February 26, 2026. https://allergyasthmanetwork.org/anaphylaxis/anaphylaxis-statistics/ 

Aquestive Therapeutics. Anaphylm®. Accessed February 26, 2026. https://aquestive.com/anaphylm/ 

Aquestive Therapeutics. Sublingual epinephrine (Anaphylm®) provides consistent pharmacokinetics in both adult and pediatric subjects. Accessed February 26, 2026. https://www.aquestivedata.com/pdfs/sublingual_epinephrine_anaphylm_provides_consistent_pharmacokinetics_in_both_adult_and_pediatric_subjects.pdf

Centers for Disease Control and Prevention (CDC). Recognizing and Responding to Anaphylaxis. Accessed February 26, 2026. https://www.cdc.gov/vaccines/covid-19/downloads/recognizing-responding-to-anaphylaxis-508.pdf 

Food Allergy Research & Education (FARE). Epinephrine Options and Training. Accessed February 26, 2026. https://www.foodallergy.org/resources/epinephrine-options-and-training 

Food Allergy Research & Education (FARE). What Epinephrine Option Is Best for You? Accessed February 26, 2026. https://aafa.org/wp-content/uploads/2026/02/what-epinephrine-option-is-best-for-you.pdf 

Kraus CN, Wargacki S, Golden D, Lieberman J, Greenhawt M, Camargo CA Jr. Integrated phase I pharmacokinetics and pharmacodynamics of epinephrine administered through sublingual film, autoinjector, or manual injection. Ann Allergy Asthma Immunol. 2025;134(5):580-586. doi:10.1016/j.anai.2025.01.006

Ziyar A, Kwon J, Li A, Naderi A, Jean T. Improving epinephrine autoinjector usability and carriage frequency among patients at risk of anaphylaxis: a quality improvement initiative. BMJ Open Qual. 2022;11(3):e001742. doi:10.1136/bmjoq-2021-001742

Introduction

For nearly two decades, GLP-1 receptor agonists have steadily reshaped metabolic care since the first agent reached the U.S. market in 2005. Initially developed for Type II diabetes, these medications quickly proved their ability to improve glycemic control and significantly lower A1C. Over time, their role expanded beyond glucose management, becoming widely recognized for promoting weight loss through appetite suppression and earlier satiety. Additional benefits, including cardiovascular risk reduction and kidney-protective effects, have further solidified their place in therapy. In 2025, polling from the Kaiser Family Foundation (KFF) reported that 1 in 8 U.S. adults were currently taking a GLP-1 medication for weight loss, diabetes, or another indication, highlighting just how mainstream these therapies have become.

Meanwhile, data from the Centers for Disease Control and Prevention (CDC) show that over 40% of U.S. adults are living with obesity, underscoring the growing severity of the obesity epidemic. The CDC map below illustrates obesity prevalence across the U.S. As obesity rates continue to rise, GLP-1 therapies have emerged as central players in addressing one of the nation’s most urgent public health challenges.

Despite their popularity and clinical benefits, GLP-1 therapies are not without barriers. High cost, gastrointestinal adverse effects, and the burden of weekly subcutaneous injections can limit initiation and long-term adherence. For some patients, needle aversion alone is enough to avoid treatment. That landscape shifted in December 2025, when the U.S. Food and Drug Administration (FDA) approved a once-daily oral tablet version of Wegovy (semaglutide) for chronic weight management, with availability beginning in January 2026. A report by health data firm Truveta found that within the first six weeks of the oral Wegovy launch, 21.1% of patients on the pill had transitioned from an injectable version of Wegovy, while 15.8% had switched from Zepbound. The arrival of an oral option has the potential to expand access. As questions inevitably increase, pharmacists will be on the front lines, making now the perfect opportunity to review what this new formulation means for practice and the evolving obesity treatment landscape. 

Background: GLP-1 Therapy Landscape

GLP-1 receptor agonists work by mimicking the body’s natural GLP-1 hormone, which plays several key roles in regulating metabolism:

• Stimulates glucose-dependent insulin secretion from the pancreas
• Suppresses glucagon release, helping to prevent excessive glucose production
• Slows gastric emptying, promoting a feeling of fullness

Together, these effects lead to lower blood glucose levels and weight loss by reducing appetite and increasing early satiety, making GLP-1 therapies powerful tools for both diabetes and obesity management.

The table below provides an overview of available GLP-1 therapies, including the newly approved oral Wegovy.

Besides diabetes and obesity management, GLP-1 drugs have shown many other potential benefits including:

• Lowering blood pressure
• Improving lipid disorders
• Improving fatty liver disease
• Reducing cardiovascular risk
• Decreases inflammation
• Reducing risk of kidney disease

It is common for patients starting GLP-1 therapy to experience side effects during the first few weeks, including nausea, vomiting, headache, dizziness, and diarrhea. These effects are usually temporary and tend to subside as the body adjusts, which is why GLP-1 medications are typically titrated from a low dose to a higher dose to help minimize discomfort. 

Although rare, serious adverse events can occur, including gallstones, pancreatitis, medullary thyroid cancer, acute kidney injury, and worsening of diabetes-related retinopathy. Monitoring and patient counseling are essential to help identify and manage these risks early.

Is Oral Wegovy the Same as Injectable Wegovy?

So, with all that context, let’s dive into the pill form of Wegovy and answer questions on how this may or may not differ from the standard injection.

Wegovy (semaglutide) tablets are 25 mg once daily oral tablets designed for chronic weight management and cardiovascular risk reduction. They are designed to be used alone and should not be combined with other GLP-1 injections. The oral tablets contain the same active ingredient as the injectable formulation, with an identical mechanism of action and comparable safety and efficacy profiles demonstrated in clinical trials.

Data from the OASIS 4 (oral semaglutide) and STEP 5 (injectable semaglutide) trials highlight similar outcomes across key endpoints. The table below provides a side-by-side comparison of selected results from these studies.

The primary difference between the injection and the pill lies in how the drug is absorbed. The oral Wegovy tablet uses a technology called SNAC (sodium N-(8-[2-hydroxybenzoyl]amino)caprylate) to overcome the low bioavailability typical of oral semaglutide. SNAC works by creating a temporary, localized pH-buffering effect that allows semaglutide to pass directly through the stomach lining into the bloodstream, protecting it from enzymatic degradation along the way. The image below illustrates the absorption mechanism and the protective role of SNAC. 

To achieve maximum benefit, Wegovy tablets should be taken on an empty stomach first thing in the morning, with no more than 4 oz of water, and at least 30 minutes before the first meal of the day. It is important to note that injectable Wegovy can be administered without regard to food, beverages, or time of day.

Another key difference between the two formulations is dosing flexibility. The injectable formulation is manufactured in multiple dose strengths to allow for stepwise titration:

• 0.25 mg once weekly for 4 weeks
• 0.5 mg once weekly for 4 weeks
• 1 mg once weekly for 4 weeks
• 1.7 mg once weekly for 4 weeks
• Maintenance dose: 2.4 mg once weekly

The oral tablet is only available in a single 25 mg strength offering a fixed-dose daily regimen. A higher milligram dose is required to achieve therapeutic systemic exposure. Although the oral tablet does not incorporate a stepwise titration schedule, clinical trial data demonstrated acceptable tolerability with the fixed dose-regimen.

What About Rybelysus?

You might be wondering: What about Rybelsus? After all, it’s also an oral formulation of semaglutide. While it is true that there are now two oral semaglutide products on the market, they differ significantly in indication and dosing.

Oral Wegovy is specifically approved for chronic weight management at a 25 mg daily dose, whereas Rybelsus is FDA approved for Type II diabetes with a maximum dose of 14 mg daily. The higher dose used in oral Wegovy is designed to achieve greater weight reduction, while Rybelsus dosing is optimized primarily for glycemic control. Although Rybelsus can still promote modest weight loss, oral Wegovy is formulated and studied specifically for obesity treatment at a higher therapeutic exposure. 

Despite these differences in indication and dosing, both products contain semaglutide and therefore share a similar mechanism of action and adverse effect profile.

Advantages and Challenges of Oral GLP-1 Therapy

So how does oral Wegovy stack up against the injectable version? The chart below highlights the key advantages and challenges of the oral formulation.

The Bottom Line on the Outlook of Oral GLP-1 Therapy

The introduction of oral Wegovy marks a significant advance in obesity management, offering patients a convenient, needle-free alternative to the weekly injectable while maintaining a comparable safety and efficacy profile. With over 40% of U.S. adults living with obesity, this new formulation provides an important tool to help address one of the nation’s most pressing public health challenges.

The role of pharmacists is pivotal to guide patients on proper administration, emphasizing the importance of taking the tablet on an empty stomach with limited water, managing gastrointestinal side effects, and supporting daily adherence are all key to achieving the best outcomes.

While oral Wegovy removes the injection burden and may improve patient acceptance, challenges such as variable absorption, strict dosing requirements, and cost considerations remain. By understanding these nuances and providing proactive counseling, pharmacists can help patients’ safety and effectively use oral Wegovy, ultimately contributing to broader efforts to combat obesity and improving long-term metabolic health in the U.S.

APPE Student, Hailey Montour

References

Aroda VR, Blonde L, Pratley RE. A new era for oral peptides: SNAC and the development of oral semaglutide for the treatment of type 2 diabetes. Rev Endocr Metab Disord. 2022;23(5):979-994. doi:10.1007/s11154-022-09735-8

BioSpace. Oral Wegovy brings in thousands of new GLP-1 patients. https://www.biospace.com/business/oral-wegovy-brings-in-thousands-of-new-glp-1-patients. Accessed February 25, 2026.

Centers for Disease Control and Prevention. Adult obesity prevalence maps. https://www.cdc.gov/obesity/data-and-statistics/adult-obesity-prevalence-maps.html. Accessed February 25, 2026.

Centers for Disease Control and Prevention. Summary health statistics: National Health Interview Survey, 2021–August 2023. https://www.cdc.gov/nchs/products/databriefs/db508.htm#:~:text=2021%E2%80%93August%202023.-,Summary,adults%20did%20not%20change%20significantly. Accessed February 25, 2026.

Cleveland Clinic. GLP-1 agonists. https://my.clevelandclinic.org/health/treatments/13901-glp-1-agonists. Accessed February 25, 2026.

Kaiser Family Foundation. 1 in 8 adults say they are currently taking a GLP-1 drug for weight loss, diabetes, or another condition, even as half say the drugs are difficult to afford. https://www.kff.org/public-opinion/poll-1-in-8-adults-say-they-are-currently-taking-a-glp-1-drug-for-weight-loss-diabetes-or-another-condition-even-as-half-say-the-drugs-are-difficult-to-afford/. Accessed February 25, 2026.

Latif W, Lambrinos KJ, Patel P, et al. Compare and contrast the glucagon-like peptide-1 receptor agonists (GLP1RAs) [Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572151/. Accessed February 25, 2026.

NovoMedlink. Wegovy: Obesity treatments. https://www.novomedlink.com/obesity/products/treatments/wegovy.html?_gl=1*18bf07x*_ga*MzY1MjUwMzQxLjE3NzIwMzE3NTc.*_ga_F40L5513K4*czE3NzIwMzE3NTYkbzEkZzAkdDE3NzIwMzE3NTYkajYwJGwwJGgw. Accessed February 25, 2026.

Introduction

Since the approval of the first statin in 1987, statin therapy has transformed the landscape of cardio›vascular medicine. Statins were originally developed to lower cholesterol levels and manage hypercholesterolemia; however, they soon proved beneficial for cardiovascular prevention, as elevated cholesterol is a major risk factor for cardiovascular disease. These medications quickly became a cornerstone in the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD), particularly among patients with diabetes, hypertension, and other cardiovascular risk factors. Statins not only reduce the incidence of heart attacks and strokes but also decrease overall mortality, making them one of the most widely prescribed drug classes in the United States. According to the Centers for Disease Control and Prevention (CDC), approximately 47 million U.S. adults were taking a statin in 2023, emphasizing their widespread use in clinical practice. 

Despite their established benefits in cardiovascular health, concerns have emerged that statins may contribute to neurocognitive decline, such as memory impairment and dementia. Understanding whether these concerns are supported by evidence is critical for pharmacists, who play a central role in medication counseling and patient education. This raises the question: what does the current scientific evidence reveal about statins and cognitive function?

These CDC maps illustrate the prevalence of high cholesterol (above) and heart disease (below) across U.S. counties from 2018 to 2020. The similar geographic patterns highlight the strong association between high cholesterol and increased heart disease risk.

What are Statins?

Statin medications are inhibitors of hydroxymethylglutaryl-CoA (HMG-CoA) reductase enzyme in the liver, which reduces the synthesis cholesterol. Inhibition of this rate-limiting step effectively lowers total cholesterol, low-density lipoprotein (LDL), and triglyceride levels, thereby reducing the risk of atherosclerotic plaque formation and cardiovascular events. FDA-approved statins include atorvastatin, rosuvastatin, simvastatin, pravastatin, lovastatin, and pitavastatin.

Statins are used to manage a variety of lipid disorders and prevent cardiovascular events. Indications for statin therapy include:

• Primary or mixed hyperlipidemia
• Hypertriglyceridemia
• Familial hypercholesterolemia
• Atherosclerosis
• Primary prevention of ASCVD
• Secondary prevention in patients with clinical ASCVD

In adults without established cardiovascular disease, statins are used to reduce overall cardiovascular risk. Common risk factors and enhancers of ASCVD include: 

• Diabetes mellitus
• Hypertension
• Obesity
• Smoking or tobacco use
• Chronic kidney disease
• Chronic inflammatory conditions
• Metabolic syndrome

In patients with clinical ASCVD, statins are indicated to prevent recurrent cardiovascular events. Conditions classified under clinical ASCVD include:

• Myocardial Infarction
• Stroke or transient ischemic attack
• Coronary artery disease
• Peripheral artery disease
• Post-revascularization

Statins are generally well tolerated. The most commonly reported adverse effects include:

• Musculoskeletal symptoms: myalgia, arthralgia, soreness, fatigue
• Gastrointestinal symptoms: diarrhea, constipation, nausea, flatulence

Rarely, statins may cause liver enzyme elevations or serious rhabdomyolysis, but these events are uncommon.

Understanding Dementia and Cognitive Decline

Dementia is a neurocognitive disorder characterized by progressive decline in memory, thinking, and reasoning, which can significantly impact daily functioning. Currently, Dementia affects an estimated 55 million people worldwide, with this number projected to nearly triple by 2050. As the disease progresses, patients may experience behavioral changes, personality shifts, and increased dependence on caregivers. Below is a table describing the different types of dementia.

Several modifiable risk factors have been identified, including lack of physical activity, uncontrolled diabetes, hypertension, hearing loss, and tobacco or alcohol use. According to the CDC, up to 45% of all dementia cases may be preventable or delayed through lifestyle modification and management of chronic conditions. With the global burden of dementia rising, preventative strategies are critical and understanding the impact of medications such as statins on cognitive health is an important aspect of care.

Historical Concerns About Statins and Cognition

Now that we delved into the many features of statins and dementia, where did the growing fear that statins might cause dementia originate from? A couple of factors contributed. 

First, in 2012, the FDA issued a safety communication regarding potential cognitive effects of statin therapy. The communication noted that memory loss and confusion had been reported, but emphasized that these cognitive side effects were minor and reversible upon discontinuation of therapy. 

Second, public concern is fueled by a common misconception about the brain’s dependence on cholesterol. Some worry that lowering blood cholesterol with statins could harm brain function, but that is not supported by physiology. Although it is true that the brain relies on cholesterol for proper function, the brain synthesizes its own cholesterol independently of blood cholesterol levels through the central nervous system. Early case reports and small observational studies also suggested a possible link between statin use and cognitive changes, which further amplified public concern. 

Given these factors, it is understandable why some patients and clinicians may perceive a connection between statin therapy and dementia. But what does the scientific evidence actually show? To answer this, we can turn to a recent systematic review and meta-analysis from 2025 to examine the most recent evidence on this topic.

What Does the Evidence Say?

A 2025 systematic review and meta-analysis analyzed data from 55 observational studies including over 7 million participants to investigate whether statin use is associated with dementia risk. The analysis found that statin therapy was associated with a statistically significant reduction in the risk of all-cause dementia, effectively refuting the misconception that statins negatively impact cognitive function. Among individual statins, rosuvastatin showed one of the strongest associations with reduced dementia risk. 

Several potential mechanisms have been proposed to explain the neuroprotective effects of statins:

Despite these findings, the 2012 safety communication regarding cognitive effects of statins remains relevant. Statins can occasionally cause temporary cognitive changes, such as memory lapses or “mental fuzziness”. These events are rare, generally mild, and reversible upon discontinuation of statin therapy. A proposed mechanism involves reduced coenzyme Q10 (ubiquinone) levels, as statins inhibit the pathway responsible for its synthesis. Since coenzyme Q10 is essential for mitochondrial energy production, temporary reductions may lead to mild cognitive symptoms in some individuals. Importantly, these effects do not indicate permanent dementia.

Implication for Pharmacists and Patients

Pharmacists play a key role in the community by providing medication counseling and education. This puts pharmacists in a unique position to address common misconceptions related to medications and to give peace of mind to patients who may worry about initiating statin drugs. When addressing patient concerns about statin therapy and cognition, key counseling points include:

• Emphasizing that serious or permanent cognitive impairment is not associated with statin use
• Explaining that temporary memory lapses are rare side effects of statins, but are not serious and reversible
• Highlighting that statins have cardiovascular and potential neuroprotective benefits 
• Encouraging adherence statin therapy to maximize long-term health outcomes

Patient education should also include lifestyle interventions to reduce both cardiovascular and dementia risk, such as regular exercise, blood pressure control, diabetes management, and avoidance of tobacco or alcohol.

Conclusion

Statins remain a cornerstone for cardiovascular health and are generally safe and well tolerated medications. While public concern has emerged regarding potential cognitive effects, evidence shows that statin use is not associated with an increased risk of dementia and may actually provide neuroprotective benefits. Several potential mechanisms have been proposed to explain these effects, though further research is needed to clarify the exact pathways by which statins influence brain health. Temporary cognitive changes are rare, mild, and reversible and do not outweigh the substantial cardiovascular and potential neurocognitive benefits of therapy. For pharmacists, understanding this evidence is critical for patient counseling, addressing misconceptions, and promoting adherence to ensure that patients receive the full spectrum of benefits statins offer. 

APPE student, Hailey Montour

References

Alzheimer’s Society (UK). Types of Dementia. Accessed February 24, 2026. https://www.alzheimers.org.uk/about-dementia/types-dementia

American Heart Association. 2018 AHA/ACC Guideline on the Management of Blood Cholesterol. Circulation. 2019;139(25):e1082–e1143. doi:10.1161/CIR.0000000000000678

Atrium Health. The facts about statins and dementia risk. Accessed February 24, 2026. https://www.atria.org/education/the-facts-about-statins-and-dementia-risk/

Bays HE, Taub PR, Epstein E, et al. Ten things to know about ten cardiovascular disease risk factors. Am J Prev Cardiol. 2021;5:100149. Published 2021 Jan 23. doi:10.1016/j.ajpc.2021.100149

Centers for Disease Control and Prevention. Alzheimer’s Disease and Preventing Cognitive Decline. Accessed February 24, 2026. https://www.cdc.gov/alzheimers-dementia/prevention/index.html

Centers for Disease Control and Prevention. Cholesterol Facts & Statistics. Updated 2023. Accessed February 24, 2026. https://www.cdc.gov/cholesterol/data-research/facts-stats/index.html

Centers for Disease Control and Prevention. What is dementia? Updated March 2024. Accessed February 24, 2026.

Available at: https://www.cdc.gov/alzheimers-dementia/about/index.html

Endo A. A historical perspective on the discovery of statins. Proc Jpn Acad Ser B Phys Biol Sci. 2010;86(5):484-493. doi:10.2183/pjab.86.484

Sizar O, Khare S, Patel P, et al. Statin Medications. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; Updated February 29, 2024. Accessed February 24, 2026. https://www.ncbi.nlm.nih.gov/books/NBK430940/

U.S. Food and Drug Administration. FDA Drug Safety Communication: Important Safety Label Changes to Cholesterol‑Lowering Statin Drugs. Accessed February 24, 2026. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-important-safety-label-changes-cholesterol-lowering-statin-drugs

van Vliet P. Cholesterol and late-life cognitive decline. J Alzheimers Dis. 2012;30 Suppl 2:S147-S162. doi:10.3233/JAD-2011-111028

Westphal Filho FL, Moss Lopes PR, Menegaz de Almeida A, et al. Statin use and dementia risk: A systematic review and updated meta-analysis. Alzheimers Dement (N Y). 2025;11(1):e70039. Published 2025 Jan 16. doi:10.1002/trc2.70039