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The FDA has expanded ADMA Biologics’ intravenous immunoglobulin (IVIG) therapy label to include pediatric patients aged 2 years and older with primary humoral immunodeficiency, allowing earlier treatment access to help prevent serious infections in children with this rare immune disorder

FDA Expands ADMA's IVIG Label to Include Pediatric Patients With Primary Immunodeficiency

Toothpaste tablets revolutionize oral care with eco-friendly, convenient options, while pharmacists guide consumers in making informed choices for dental health.

Toothpaste Tablets Are Gaining Popularity—Here’s Where Pharmacists Fit In

The BMJ study highlights that young children vaccinated against influenza in October experience the greatest protection, with lower infection rates than those vaccinated earlier.

Optimal Timing of Influenza Vaccination in Young Children: Practical Implications for Pharmacists

New research confirms oseltamivir (Tamiflu; Roche) is safe for children, reducing flu-related neuropsychiatric risks and encouraging timely antiviral treatment.

New Evidence Challenges Longstanding Label Warning for Tamiflu

Influenza vaccination significantly reduces cases and enhances community immunity, highlighting pharmacists' vital role in promoting public health.

Influenza Vaccination: Direct and Indirect Impact

Toothpaste tablets are becoming a fast-growing segment of the oral care market. These solid, premeasured alternatives to traditional toothpaste are often marketed as plastic-free, travel-friendly, and "clean." The chewable tablets dissolve in the mouth to form a brushable slurry. While consumer interest is mostly caused by sustainability and convenience, the increasing use of toothpaste tablets poses questions about formulation quality, anticaries efficacy, and appropriate patient selection. Being the most accessible health care professionals with a preventive care role already established, pharmacists are positioned to help patients make evidence-based decisions as this category evolves.

Understanding Toothpaste Tablets as a Dosage Form

From a pharmacy point of view, toothpaste tablets mark the start of a trend towards unit-dose oral care products. Unlike traditional pastes that use water-based emulsions and preservatives, toothpaste tablets are solids that are compressed to achieve a balance between hardness and rapid disintegration.

A 2025 materials science study on toothpaste tablet formulations found that the mechanical strength, friability, foaming ability, and pH of the tablets can vary greatly depending on the ingredients and compression parameters.

 These differences can have a significant impact on the user experience and, in general, oral health outcomes.

For pharmacists, this variability is a reminder of the necessity to instruct patients who may be unhappy with a tablet that "doesn't foam enough" or "crumbles in the container." These problems are not just cosmetic; they usually indicate formulation differences that can have an effect on adherence and correct use. Just like any other OTC product, pharmacists can assist patients in determining whether product performance issues are the result of incorrect use, selection, or a need to change formulations.

Fluoride, Hydroxyapatite, and Caries Prevention

One of the major clinical concerns regarding toothpaste tablets is whether they can provide adequate protection against dental caries. Fluoride toothpaste remains the best method of caries prevention and is strongly recommended by professional organizations for daily oral hygiene. However, many toothpaste tablets do not contain fluoride and use alternative remineralizing agents such as hydroxyapatite.

In 2025, a microbial study was conducted on a dentifrice tablet containing 5% nanohydroxyapatite. The study showed that the tablet was able to achieve the same performance as a standard sodium fluoride toothpaste (1100 ppm fluoride) in preventing demineralization in controlled laboratory conditions.

 The evidence suggests the potential use of some non-fluoride formulations; however, the results should be taken with caution. Laboratory results seldom have a direct correlation with clinical effectiveness, and various factors such as patient behavior, diet, saliva flow, and baseline caries risk can influence the outcomes.

A comprehensive systematic review and meta-analysis of biomimetic hydroxyapatite also found evidence supporting its role in enamel remineralization and caries prevention; however, the quality of the evidence varied between different study designs and types of products. Pharmacists should take this as a reminder to tailor their advice instead of merely trusting marketing claims.

Brand Positioning and Consumer Marketing of Toothpaste Tablets

As toothpaste tablets make their way into the mainstream, brands are progressively concentrating on educating consumers, aligning with their lifestyle, and making the product user-friendly. For instance, ENML promotes its toothpaste tablets as premeasured, waterless, and eco-friendly alternatives that not only simplify the brushing routine but also lessen the packaging waste. The brand’s educational resources highlight an easy pop, chew, brush method, guiding consumers in recognizing how tablets fit into their regular oral hygiene habits.

Another recognizable brand in the toothpaste tablet category is Bite Toothpaste Bits, which offers both fluoride and fluoride-free options in chewable formats.

 Bite’s product line includes mint and berry flavors, available in recyclable glass jars or refill pouches, and features ingredients such as nano-hydroxyapatite (a mineral that supports enamel remineralization), xylitol, calcium carbonate, and surfactants that help tablets create foam when brushed. The company emphasizes ease of use, portability, and reduced toothpaste tube waste, positioning Bits as part of a broader oral care routine that also extends to mouthwash bits, toothbrushes, and floss.

The literature is abundant with evidence that pharmacists should take part in oral health promotion. A community-based survey of pharmacists published in the 

 revealed that nearly all pharmacists recognized the role of pharmacists in oral health promotion. Most of them also expressed their willingness to be more involved if they were properly educated and collaboration was facilitated.

The study highlighted pharmacists' frequent contacts with patients who sought advice for oral pain, hygiene products, and preventive care, emphasizing their accessibility and the extent of their influence in the community environment.

As toothpaste tablets become more popular, pharmacists have a great chance to facilitate consumers making the right decision. By knowing the differences of formulations, interpreting the evidence of ingredients, and assessing the individual patient risk, pharmacists can guide patients to integrate toothpaste tablets into their oral hygiene routines based on evidence when it is appropriate. The increasing acknowledgment of the pharmacists' role in oral health promotion is a call to the importance of these conversations to ensure that innovation in oral care is accompanied by the right patient-centered guidance.

Agata Blicharz-Kania, Kot J, Andrejko D. Physical and Functional Properties of Toothpaste Tablets. 

. 2025;18(20):4804-4804. doi:https://doi.org/10.3390/ma18204804

ENML. How To Use. Published 2025. Accessed January 6, 2026. 

ADA. Toothpastes. Updated September 26, 2025. Accessed January 6, 2026. 

https://www.ada.org/resources/ada-library/oral-health-topics/toothpastes

Amaechi BT, Kanthaiah K, Farah R, et al. Evaluation of the Efficacy of a Dentifrice Tablet to Prevent Dental Caries: A Microbial Study. 

. 2025;13(5):201. Published 2025 Apr 30. doi:10.3390/dj13050201

Fluoride-Free Toothpaste - 4oz. Bite Toothpaste Bits. Updated 2026. Accessed January 6, 2026. 

https://bitetoothpastebits.com/?srsltid=AfmBOorbJHIeffm0sw_nxrBRVvhUY1vDbgaZuEGxPE7bNrZ9vLSJ8U59

Limeback H, Enax J, Meyer F. Biomimetic hydroxyapatite and caries prevention: a systematic review and meta-analysis. 

. 2021;55(3):148-159. Published 2021 Oct 1.

Mann RS, Marcenes W, Gillam DG. Is there a role for community pharmacists in promoting oral health? 

. 2015;218(5):E10-E10. doi:10.1038/sj.bdj.2015.172

Long COVID-19 continues to burden US adults, with an estimated 17 million individuals currently experiencing long COVID, and roughly 8% of individuals report having ever faced the condition. Meanwhile, vitamin D deficiency remains highly prevalent in the US, with an overall deficiency rate of approximately 41.6% when defined as serum 25-hydroxyvitamin D [25(OH)D] concentrations of 20 ng/mL or less, with the highest rates among Black non-Hispanic and Hispanic adults.

Given the theoretical immunologic rationale for vitamin D in modulating infection severity, investigators have long sought to determine whether supplementation could meaningfully alter COVID-19 outcomes.

The parallel 2-group, double-blinded, cluster-randomized, placebo-controlled Vitamin D for COVID-19 (VIVID) trial (NCT04536298), published in 

, represents one of the largest and most rigorous randomized controlled trials to date evaluating this question. The trial enrolled adults in the US and Mongolia from December 2020 through September 2022, including participants with newly diagnosed SARS-CoV-2 infection (n = 1747) that were randomly assigned with up to 1 cohabiting household contact (n = 277) to receive either oral vitamin D

 (cholecalciferol) supplementation, involving a loading dose of 9600 IU per day for 2 days followed by 3200 IU per day for 4 weeks, or placebo. The primary outcome was at least 1 health care visit, including hospitalization or death, within 4 weeks.

The trial population had a median age of 38 years and was 65.6% female, and nearly 45% of participants entering the study were already vitamin D deficient or insufficient (25(OH)D <20 ng/mL).

Despite the high burden of vitamin D deficiency at baseline, the 4-week cumulative incidence of health care utilization did not differ significantly between the vitamin D

 and placebo groups (28% vs 29%; OR, 0.97; 95% CI, 0.75-1.24). Similarly, no significant differences were found in disease severity scores or in new SARS-CoV-2 infections among household contacts.

In the vitamin D group, approximately 21% of individuals reported at least 1 persistent symptom compared with 25% in the placebo group—a difference of borderline statistical significance (OR, 0.78; 95% CI, 0.59-1.03).

While not meeting conventional thresholds for significance, this trend is notable given the mechanistic plausibility, as vitamin D modulates both innate and adaptive immunity by enhancing antimicrobial defense mechanisms and reducing excessive inflammatory responses. These same anti-inflammatory pathways are implicated in the persistent cytokine dysregulation hypothesized to drive long COVID symptoms, such as fatigue, brain fog, and dyspnea.

Pharmacists are uniquely positioned to counsel patients on vitamin D supplementation in the context of COVID-19 and long COVID. Given the high prevalence of vitamin D deficiency in the US population, pharmacists conducting medication therapy management should routinely assess vitamin D status and reinforce the importance of screening.

Since the VIVID trial used a high loading dose regimen that is not currently guideline-recommended for routine COVID-19 treatment, pharmacists should counsel patients that self-initiating high-dose vitamin D

 supplementation based on this single trial is premature. No safety signals were observed in the VIVID trial at the doses tested, but supraphysiologic dosing carries a risk of toxicity and should be medically supervised.

Additionally, as long COVID remains a condition with no approved pharmacologic treatments, pharmacists can play a pivotal role in helping patients navigate evidence-based supportive care strategies while setting realistic expectations about supplements whose efficacy data remain preliminary.

“There’s been tremendous interest in whether vitamin D supplements can be of benefit in COVID, and this is one of the largest and most rigorous randomized trials on the subject,” JoAnn Manson, MD, DrPH, senior author from the Mass General Brigham Department of Medicine, said in a news release. “While we didn’t find that high-dose vitamin D reduced COVID severity or hospitalizations, we observed a promising signal for long COVID that merits additional research.”

1. Long COVID household pulse survey. CDC. Updated March 21, 2024. Published March 16, 2026. https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm

2. Tracking long COVID. CDC. Updated March 9, 2026. Accessed March 16, 2026. https://www.cdc.gov/long-covid/php/surveillance/index.html

3. Forrest K, Stuhldreher W. Prevalence and correlates of vitamin D deficiency in US adults. 

. 2011;31(1):48-54. doi:10.1016/j.nutres.2010.12.001

4. Vitamin D for COVID-19 Trial (VIVID). ClinicalTrials.gov. Updated September 24, 2025. Accessed March 16, 2026. 

https://clinicaltrials.gov/study/NCT04536298

5. Ganmaa D, Cook K, Khudyakov P, et al. A randomized trial of vitamin D supplementation and COVID-19 clinical outcomes and long COVID: the VIVID Trial. 

 Published online March 12, 2026. doi:10.1016/j.tjnut.2026.101398

6. Caliman-Sturdza OA, Gheorghita RE, Soldanescu I. Vitamin D and COVID-19: clinical evidence and immunological insights. 

. 2025;15(5):733. doi:10.3390/life15050733

7. Trial finds vitamin D supplements don’t reduce covid severity but could reduce long COVID risk. News release. EurekAlert. March 12, 2026. Accessed March 16, 2026. 

https://www.eurekalert.org/news-releases/1119304

The VIVID trial finds high-dose vitamin D3 doesn’t cut COVID care visits but hints at fewer long COVID symptoms.

High-Dose Vitamin D3 Does Not Reduce Acute COVID-19 Severity But May Hold Promise for Long COVID

The connection between zinc deficiency and poor COVID-19 outcomes has been documented across multiple clinical studies. Patients with COVID-19 demonstrate significantly lower zinc levels than healthy controls, and zinc deficiency correlates with greater disease severity. More recently, zinc deficiency has been independently associated with approximately 63% higher predicted odds of worse COVID-19 outcomes—a finding with direct implications for patient risk stratification and supportive care decisions.

What has remained less clear, however, is precisely how systemic zinc status gets "translated" inside cells into the immune dysfunction that drives mortality. A new study published in 

 has taken a significant step toward answering that question.

A 2-Pronged Investigation: Meta-Analysis and Multi-Omics Profiling

Researchers at China Pharmaceutical University conducted a PRISMA-guided meta-analysis alongside an extensive multicompartment transcriptomic analysis to identify intracellular mediators of zinc-linked immune dysregulation in COVID-19.

In a meta-analysis of 7 studies totaling 1972 hospitalized patients with COVID-19, zinc supplementation was associated with a markedly lower risk of death, with an OR of 0.48 (95% CI, 0.36-0.64), low heterogeneity, and no evidence of publication bias. The result was robust across sensitivity analyses, but the researchers pushed further, using single-cell RNA sequencing (RNA-seq) and bulk RNA-seq data from blood, bronchoalveolar lavage fluid (BALF), sputum, and postmortem lung tissue to identify which molecular targets might explain this clinical benefit.

MT2A Emerges as a Severity-Linked Signal Across Tissue Compartments

Among the zinc-homeostasis genes examined, 

, which encodes metallothionein 2A, a cysteine-rich protein responsible for intracellular zinc buffering and redox regulation, emerged as the most reproducible marker of COVID-19 severity. Metallothioneins regulate zinc homeostasis, mitigate oxidative stress, and have emerged as important, yet underappreciated, components of the innate immune response.

In an analysis of over 1.4 million cells from 196 individuals, 

 showed the highest expression in monocytes and macrophages, decreased in mild and moderate disease, and increased significantly in severe and critical progression. The pattern held across multiple tissue compartments—including BALF and sputum—supporting 

 as a cross-compartment marker of metal/redox immune stress rather than an artifact of a single tissue type.

Temporal Dynamics: A Stage-Dependent Window for Intervention

One of the study's most pharmacologically relevant findings relates to timing. Longitudinal blood data indicated that 

 peaks at day 1 postinfection and then declines, supporting 

 as an early, stage-dependent marker of metal/redox immune stress. This temporal pattern, covarying with key innate immune genes including 

, suggests a narrow window during which biomarker-guided zinc interventions may carry the most benefit.

Implications for Pharmacy Practice and Future Research

These findings have several implications for clinicians and pharmacists managing hospitalized patients with severe respiratory illness. Although zinc supplementation is already widely used as adjunctive therapy, the heterogeneity of dosing regimens in clinical practice—varying in formulation, elemental dose, route, and duration—has made it difficult to define best practices. Zinc deficiency has been associated with higher hospitalization and mortality rates in patients with COVID-19, particularly those with cardiac and renal comorbidities, suggesting that managing zinc levels could improve long-term outcomes.

 as a candidate biomarker offers a potential path toward more precise patient stratification. Rather than applying a one-size-fits-all supplementation approach, pharmacists and clinicians may eventually be able to use 

 expression in circulating monocytes as an enrichment tool—identifying which patients are most likely to benefit from zinc intervention and at what stage of illness.

The study authors are careful to note that causal validation is still required. The transcriptomic associations are hypothesis-generating, and perturbation-based studies with controlled zinc conditions are needed before 

 can be used clinically as a therapeutic target. Nevertheless, the convergence of clinical trial data and multi-omics evidence positions 

 as one of the most promising host-directed nodes identified in postpandemic COVID-19 research to date.

1. Li Z, Hua S, Song S, et al. Multi-omics integration identifies 

 as a biomarker and a candidate host target linking zinc dysregulation to COVID-19 mortality. 

. 2026;2(1):e006. doi:10.48130/targetome-0026-0006

2. Jothimani D, Kailasam E, Danielraj S, et al. COVID-19: Poor outcomes in patients with zinc deficiency. 

. 2020;100:343-349. doi:10.1016/j.ijid.2020.09.014

3. Mouchati C, Durieux JC, Zisis SN, et al. Zinc deficiency and sTNF-RII are associated with worse COVID-19 outcomes. 

. 2024;154(5):1588-1595. doi:10.1016/j.tjnut.2023.11.026

4. Zinc, immune stress, and COVID-19: MT2A emerges as a cross-compartment marker linked to severity. News release. Maximum Academic Press. April 4, 2026. Accessed April 6, 2026. https://www.eurekalert.org/news-releases/1122818

5. Hung L, Liu M, Yu T, et al. Zinc deficiency and post-acute outcomes in patients with COVID-19: a six-month retrospective cohort analysis of 3,726 patients. 

. 2024;16(10):e71609. doi:10.7756/cureus.71609

Researchers shed new light on how zinc deficiency contributes to severe disease and death, pointing to a specific intracellular protein as a key mediator.

Study Identifies MT2A as a Novel Biomarker Linking Zinc Status to COVID-19 Mortality

The FDA has approved a supplemental biologics license application for immune globulin intravenous (IVIG, human-slra; ASCENIV; ADMA Biologics), expanding its indication to include pediatric patients 2 years and older with primary humoral immunodeficiency (PI). The therapy was previously approved for use in patients 12 years and older.

“This expanded label for Asceniv allows ADMA to actively address the treatment needs of younger PI and immunocompromised patients earlier in their treatment journey,” Adam Grossman, president and CEO of ADMA, said in a news release. “In the periods ahead, we look forward to continuing to expand the utilization of Asceniv by offering our differentiated and patented immune globulin as an FDA-approved treatment option for immunocompromised pediatric patients in need.”

IVIG is a plasma-derived product indicated for the treatment of primary immunodeficiency diseases.

It is manufactured using a proprietary plasma pooling process that incorporates respiratory syncytial virus (RSV)–enriched donor plasma, designed to provide elevated titers of antibodies against respiratory pathogens.

Pediatric Label Expansion and Regulatory Context

The approval fulfills a postmarketing requirement to evaluate IVIG in pediatric populations. The submission included data from a pediatric assessment program conducted following the product’s initial approval in 2019.

With this update, the prescribing information has been revised to allow use in children as young as 2 years, aligning IVIG with other therapies that have expanded into pediatric populations.

 Earlier access to therapy is particularly important for pediatric patients with PI, who face increased risks of recurrent infections, hospitalization, and long-term complications.

Company representatives noted that expanding treatment into younger populations may help clinicians intervene earlier in disease progression. In the announcement, ADMA stated that the approval “enables physicians to treat pediatric patients sooner, potentially improving clinical outcomes and reducing the burden of disease.”

PI disorders are characterized by impaired antibody production, leaving patients vulnerable to recurrent bacterial and viral infections. IVIG therapy remains a cornerstone of treatment, providing passive immunity through pooled IgG antibodies derived from human plasma.

The expanded indication for IVIG offers an additional treatment option for pediatric patients requiring immunoglobulin replacement, particularly those with persistent or severe infections. Earlier initiation of therapy may improve infection control and overall quality of life, although long-term real-world outcomes will continue to be evaluated.

Notably, the product’s RSV-enriched plasma composition may provide broader pathogen coverage compared with conventional IVIG therapies.

 This characteristic may be particularly relevant in pediatric populations, where respiratory infections remain a leading cause of morbidity.

The approval also strengthens ADMA Biologics’ immunoglobulin portfolio and builds on prior pediatric-focused regulatory efforts. Expanding access to younger patients may increase utilization in specialty immunology and pediatric care settings.

From a regulatory standpoint, the decision reflects the FDA’s continued emphasis on ensuring that biologic therapies are evaluated across age groups, particularly for chronic conditions such as primary immunodeficiency, which often present early in life.

The FDA’s expansion of IVIG to include pediatric patients 2 years and older represents an important advancement in the management of primary immunodeficiency. By enabling earlier intervention, this approval may help reduce infection burden and improve outcomes in a vulnerable patient population while reinforcing the role of IVIG therapy in comprehensive immunologic care.

1. ADMA Biologics announces FDA approval to expand the label for Asceniv to include pediatric immunocompromised patients two years of age and older. News release. Adma Biologics. May 4, 2026. Accessed May 4, 2026. 

https://ir.admabiologics.com/news-releases/news-release-details/adma-biologics-announces-fda-approval-expand-label-ascenivtm

2. Asceniv. FDA. Updated May 4, 2026. Accessed May 4, 2026. 

https://www.fda.gov/vaccines-blood-biologics/approved-blood-products/asceniv

3. Asceniv (immune globulin intravenous, human-slra). ADMA Biologics Inc. Accessed May 4, 2026. 

4. FDA approves novel intravenous immune globulin. 

https://www.pharmacytimes.com/view/fda-approves-novel-intravenous-immune-globulin

Thirty years ago, a simple but powerful idea took shape: ask the pharmacists. Not the manufacturers. Not the marketers. The pharmacists—the health care professionals standing at the counter every day, fielding questions, guiding decisions, and earning the trust of patients, 1 interaction at a time. 

®, and this year, we mark its 30th edition. What began as a modest survey has grown into one of the most trusted barometers of frontline pharmaceutical expertise in the country. Each year, practicing pharmacists across the nation share their firsthand knowledge of which OTC products they recommend most. The result is a resource built not on advertising budgets or brand recognition, but on real-world clinical experience and patient outcomes.

In 3 decades, much has changed. The OTC landscape has expanded dramatically, with dozens of prescription-strength therapies now available without a prescription. Consumer health literacy has risen. Digital tools have transformed how patients research their symptoms before ever reaching the pharmacy counter. And the role of the pharmacist has evolved alongside all of it—from dispenser to counselor, from back-of-store professional to frontline health care provider.

What hasn’t changed is the pharmacist’s unique position of trust. Study after study confirms that Americans regard their pharmacist as among the most accessible and reliable sources of health care guidance. The 

 exists to honor and amplify that expertise.

This milestone edition reflects the input of hundreds of pharmacists who took time from their demanding schedules to share their recommendations. Their collective voice is what gives this guide its authority and enduring value—to patients, to the broader health care community, and to the industry professionals who rely on it each year.

As we celebrate the 30th anniversary, we do so with deep gratitude to every pharmacist who has contributed over the years. You are the reason this guide matters. You are the reason it has lasted.

Here’s to the next 30 years, and to the patients who are better served because of your dedication.

What began as a modest survey has grown into one of the most trusted barometers of frontline pharmaceutical expertise in the country.

OTC Guide: Thirty Years Strong

The rapid rise of glucagon-like peptide-1 (GLP-1) receptor agonists has transformed the treatment landscape for patients with obesity and type 2 diabetes. GLP-1 is an incretin hormone secreted by intestinal L-cells in response to nutrient intake.

 It promotes glucose-dependent insulin secretion, suppresses glucagon release, slows gastric emptying, and contributes to appetite regulation through central nervous system pathways.

GLP-1 receptor agonists are designed to directly activate this pathway in a durable and clinically measurable way.

Medications such as semaglutide (Wegovy, Ozempic; Novo Nordisk) and tirzepatide (Zepbound; Eli Lilly) have demonstrated clinically significant weight reduction and cardiometabolic benefits in large clinical trials.

 Newer agents are also expanding the field, including orforglipron (Foundayo; Eli Lilly), an oral small-molecule GLP-1 receptor agonist, highlighting continued innovation in this therapeutic class.

As public awareness of GLP-1 therapy has increased, so has consumer interest in OTC products marketed as GLP-1 boosters. These supplements are often promoted in pharmacies, online, and through social media as natural alternatives that can increase satiety, improve metabolism, or support weight loss. Compared with GLP-1 receptor agonists, these supplements generally do not directly activate GLP-1 receptors to the same extent. For community pharmacists, this creates an important counseling opportunity for patients who ask about products similar to GLP-1 receptor agonists.

Common ingredients found in OTC products marketed as GLP-1 boosters include berberine, chromium picolinate, resveratrol, dietary fiber, green tea extract, and probiotics. Some may have modest metabolic effects, but none should be considered equivalent to GLP-1 receptor agonists. This distinction is especially important because the FDA has warned that many weight loss products marketed as supplements may contain hidden drug ingredients, may be falsely advertised as natural products, and can pose serious health risks.

 The National Institutes of Health’s Office of Dietary Supplements also emphasizes that weight-loss supplements vary widely in ingredients, mechanisms, evidence, and safety profiles.

Berberine is one of the most promoted ingredients in “natural Ozempic” messaging.

 Evidence suggests that berberine may improve lipid parameters, with 1 systematic review and meta-analysis finding reductions in total cholesterol, low-density lipoprotein cholesterol, and triglycerides.

However, the authors noted high clinical heterogeneity and generally low methodological quality among included trials, meaning the findings should be interpreted cautiously.

 From a safety perspective, berberine was generally associated with mild adverse effects such as constipation, flatulence, nausea, headache, and transaminase elevation, with no serious adverse events reported in the reviewed trials.

 Pharmacists should still screen for gastrointestinal intolerance, pregnancy status, liver disease, and potential drug interactions.

Chromium picolinate is another common ingredient promoted for glucose metabolism and insulin sensitivity. A systematic review and meta-analysis in patients with diabetes found that chromium supplementation improved glycemic control and did not significantly increase adverse events compared with placebo.

 Reported adverse events included watery stool, dizziness, headache, nausea, constipation, and flatulence.

 However, this evidence is more relevant to glycemic outcomes in diabetes than to weight loss. Pharmacists should be cautious when patients use chromium alongside insulin or other glucose-lowering therapies because of the risk of additive glucose-lowering effects.

Resveratrol is a polyphenol marketed for its effects on metabolic health, antioxidant activity, and weight management.

 However, human evidence for weight loss remains inconsistent. A review of resveratrol obesity trials found substantial heterogeneity in study design, including differences in dose, duration, delivery method, participant characteristics, and outcomes measured.

 Additionally, a literature review reported that resveratrol may have dose-related adverse effects, possible cytochrome P450 interactions, and potential interaction with drugs such as warfarin, which could increase bleeding risk.

 High doses have also been associated with gastrointestinal symptoms such as diarrhea and nausea.

Dietary fiber may be the most clinically reasonable ingredient to discuss as an adjunctive, nonprescription option, although not as a GLP-1 substitute. Fibers such as glucomannan, psyllium, and inulin may promote satiety, delay gastric emptying, and support modest weight reduction when combined with energy restriction.

 In a randomized controlled study of adults with overweight or obesity and traits of metabolic syndrome, fiber supplementation with energy restriction improved body weight, body mass index, fat mass, visceral fat, lipid profile, and inflammatory markers.

 Safety counseling should focus on bloating, flatulence, diarrhea, constipation, adequate water intake, and separation from other medications to reduce the risk of impaired absorption.

Green tea extract is often marketed for thermogenesis and “fat burning.” A Cochrane review found that green tea preparations produced a small, statistically nonsignificant weight loss in adults with overweight or obesity and that the amount of weight loss was unlikely to be clinically meaningful.

Safety concerns include gastrointestinal symptoms, caffeine-related effects such as insomnia or palpitations, and hepatotoxicity, particularly with concentrated extracts.

 The same review noted that reported adverse events were generally mild to moderate, although adverse event reporting was inconsistent across studies.

Probiotics are increasingly included in weight-management supplements due to growing interest in the gut microbiome. A 2024 systematic review found that probiotics showed a trend toward preventing weight gain and reducing body weight in individuals with excess weight or obesity, with combinations of 

 Pharmacists should avoid generalizing the effects of a single probiotic strain or combination to all probiotic products. Although probiotics are generally well tolerated, caution is warranted in immunocompromised patients or those with significant underlying illness.

When counseling patients, pharmacists should clearly state that these products may have limited supportive metabolic data and do not replicate the pharmacologic action or clinical outcomes of GLP-1 receptor agonist therapies.

Community pharmacists are well-positioned to respond to patient questions in a practical, nonjudgmental way. The first step is to identify the patient’s goal: weight loss, appetite control, glycemic improvement, or avoidance of prescription therapy due to cost, lack of access, or fear of injections. Pharmacists should then review current medications, pregnancy status, history of liver or kidney disease, diabetes history, anticoagulant use, immunocompromising conditions, and prior adverse reactions to medications.

Pharmacists should also assess patients’ expectations for these products and clarify that OTC supplements do not produce effects comparable to those of semaglutide or tirzepatide. Counseling should include discussion of potential adverse effects, drug-supplement interactions, variability in supplement quality, and situations in which referral to a primary care clinician or specialist may be appropriate. This approach allows pharmacists to move beyond “Does it work?” and toward “Is it appropriate and safe for this patient?”

Clinical recommendations should emphasize evidence-based care. Patients with obesity, diabetes, cardiovascular risk, or obesity-related complications may benefit from referral to a primary care clinician, dietitian, or specialist. For patients interested in OTC options, fiber may be a reasonable adjunct when used appropriately, but it should be paired with nutrition, physical activity, and realistic expectations. Other supplements should be approached cautiously, especially when evidence is inconsistent or safety concerns exist.

OTC GLP-1 boosters reflect both the excitement surrounding modern obesity pharmacotherapy and the vulnerability of patients to marketing claims. Although some ingredients may have varying degrees of metabolic evidence, none should be considered a substitute for FDA-approved GLP-1 receptor agonists. As demand for weight-loss therapies grows, pharmacists play a critical role in distinguishing evidence-based treatments from marketing-driven alternatives.

Rosen CJ, Ingelfinger JR. GLP-1 receptor agonists. 

OTC GLP-1 boosters are marketed for weight loss, but pharmacists should help patients distinguish evidence-based care from supplement claims.

Danielle Valletti, Assistant Editor

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