Ketamine Website Take-Downs; 2.5 Million Steroid Eye Drops Recalled; Stomach Bug Outbreak Update; Xeljanz and Rinvoq New Warnings; Understanding Kids' Rashes; More
FDA Warns Websites Selling Illegal Ketamine
The FDA is cracking down on unlawful online sales of ketamine products. Ketamine has been used illegally for years as a “club” drug (with names like “Special K”) by those who seek dissociation effects or a feeling of detachment from the body and reality. In recent years, it has been studied as a treatment for substance use disorders, depression, and other mental disorders.
Last week, FDA sent warning letters to 14 companies running websites including Extra Medication, Legitketaminesuppliers, Medshopinc, ketaminestore.org, Buy Keta Online, and 10 more. The companies were ordered to stop selling the unapproved and misbranded drugs for sale to U.S. consumers. The websites were marketing the products as treatments for acute and chronic pain or for depression.
FDA-approved versions of ketamine include Ketalar (brand name) and Ketamine HCL, a Schedule III controlled substance approved as a general anesthetic and administered by I.V. or injection. While ketamine is not FDA-approved for any psychiatric disorder, it is sometimes used off-label for depression. Also, a ketamine derivative called esketamine (Spravato brand name) is administered as a nasal spray and is approved to treat depression.
For more letters, check the Warning Letters List. Letters dated July 7 are for websites selling illegal ketamine products.
Related: In March and April of this year, the FDA sent 16 warning letters to websites and pharmacies selling unapproved, experimental obesity drug “triple agonist” retatrutide. To find those 16 letters, type “retatrutide” in the FDA Warning Letters search box.
"Illegal-prescriptions-abound-for-unapproved-glp-1-retatrutide"
Recall of Levothyroxine Sodium Tablets by Accord
Accord Healthcare is recalling 6,543 90-count bottles of .3 mg levothyroxine (Synthroid brand name) because the tablets are subpotent. Levothyroxine treats hypothyroidism. The tablets were made by Intas Pharmaceuticals in Selaqui, India.
FDA Enforcement Report
Recall of More Than 2.5 Million Steroid Eye Drops by Lupin
Lupin Pharma is recalling 2,530,182 bottles (5, 10 and 15 ml size) of 1% prednisolone acetate ophthalmic suspension because of potential “foreign substance” (not identified) in the bottles. These steroid eye drops are used to treat eye noninfectious allergic and inflammatory disorders of the lid and eye (conjunctiva, cornea, and sclera). This recall involves multiple lots, which were made in Pithampur, India by Lupin Limited. Check the enforcement report for lot numbers and expiration dates.
FDA Enforcement Report
Recall of PRED MILD (prednisolone acetate ophthalmic suspension) eye drops by Allergan
Allergen, Inc. (an AbbVie company) has a much smaller recall of its brand of the same eye drug, PRED MILD (prednisolone acetate ophthalmic suspension). The recall involves 2,736 bottles (0.12%, 10 mL) because of failed shelf life stability testing. The products were made in France. Check the FDA Enforcement Report for lot numbers and expiration dates.
Expanded Approval for Breast Cancer Treatment Ibrance
Pfizer’s Ibrance breast cancer drug received expanded approval as a maintenance option for patients with HR-positive, HER2-positive locally advanced or metastatic breast cancer. Previously, it was only approved for the more common HR-positive, HER2-negative cancer types.
FDA Press Release: FDA-approves-palbociclib-trastuzumab-or-without-pertuzumab-and-endocrine-therapy-maintenance
Fierce Pharma: Pfizer scores-its-first-expansion in-7-years-breast-cancer-blockbuster-ibrance
New Warnings for RA drugs Rinvoq, Xeljanz, and Eczema topical treatment Anzupgo
Rheumatoid arthritis (RA) drugs Rinvoq (upadacitinib) and Xeljanz (tofacitinib citrate) have new warnings about the risk of developing severe hypoglycemia (low blood sugar) in patients with diabetes. During treatment of diabetes patients with a Janus kinase (JAK) inhibitor such as Rinvoq or Xeljanz, providers should carefully monitor blood glucose levels. Patients should notify their healthcare provider if they develop signs or symptoms of hypoglycemia, which can include shaking, sweating, nervousness, dizziness, irritability, or confusion. JAK inhibitors help relieve symptoms of autoimmune conditions by decreasing the activity of the immune system.
Safey-Related Label Change for Rinvoq tablets
Have experience (good or bad) with this medication? Rate RINVOQ at Ask a Patient. Check out others’ side effects or experiences with using Rinvoq for the autoimmune conditions Chron’s, Psoriatic Arthritis, RA, and eczema.
Safety-Related Label Change for Xeljanz tablets
Have experience (good or bad) with this medication? Rate Xeljanz at Ask a Patient. Check out others’ side effects or experiences with using Xeljanz taken for RA, Ulcerative Colitis (UC), Chron’s, and Psoriatic Arthritis.
Anzupgo (Delgocitinib) Label Update
Amzupgo (delgocitinib) is a topical cream approved in 2025 for chronic hand eczema. It is not known whether using Anzupgo has the same risks as taking oral JAK inhibitors like Xeljanz or Rinvoq. However, the drug label was updated with the notice that oral JAK inhibitors have been associated with hypoglycemia in patients with diabetes.
Safety-Related Label Change for Anzupgo.
Have experience (good or bad) with Anzupgo cream? Rate Anzupgo at Ask a Patient. This is a new drug so be the first to rate it.
Strattera (Atomoxetine Hydrochloride) Warnings Update
Lilly updated the drug label for its non-stimulant ADHD (Attention-Deficit Hyperactivity Disorder) drug Strattera (Atomoxetine hydrochloride) to clarify boxed warnings, age indications and dosages, and make formatting changes to the label. The effect is that it clarifies and seems to strengthen warnings about the risk of suicidal thoughts and behaviors in pediatric patients age 6 and older. We have a lot to post about the update, so this link will be active within a few days and sent out as a note!
Ask a Patient News: Strattera: New Label, More Clarity (to be posted soon)
Summer 2026 Intestinal Bug Outbreak (Cyclosporiasis)
Cyclosporiasis is an intestinal protozoal infection that normally occurs in the summer in the U.S., but in the past two weeks multiple states are reporting a surge in cases compared with the same period in 2025, according to state health departments and the CDC. The infection is a kind of food poisoning caused by the microscopic parasite Cyclospora. It sometimes lasts for weeks without treatment and is usually transmitted through contaminated produce like snow peas, lettuce, berries, or fresh herbs like cilantro. Unfortunately, no specific produce or supplier has yet been identified as the likely culprit that could link the surge of nationwide cases or even be responsible for a single state’s outbreak.
Michigan reports having the most cases in the U.S., with 1,762 reported cases as of July 10, 44 of which resulted in hospitalizations. New York has recorded a total of 394 cases this year since May 1, most of which were in New York City. Ohio Department of Health reported 177 cases (171 of those in June alone) in 43 counties so far in 2026. North Carolina reports nearly 150 cases Between May 1 and July 7, and Illinois had 141 reported cases as of July 7, many of which are reported to have been acquired outside the U.S.
Read more about the outbreak affecting 31 states so far. Most states have not yet published an official case count. (USA Today): “Cases of ‘explosive’ diarrhea illness top 1K. See states with the most.”
CDC Information on Cyclosporiasis: CDC Surveillance on Cyclosporiasis (updated July 10) The CDC is tracking U.S.- acquired cases; some states have records of cases that were acquired as a result of travel out of the country. Symptoms (diarrhea and nausea) typically develop two to 14 days after exposure.
Treatments for Cyclosporiasis
Fluid replenishment (hydration), electrolytes, and over-the-counter antidiarrheal medications may be all that is needed for many who come down with this awful intestinal bug. Although most people with healthy immune systems recover without drug treatment, for some, the recovery period can be much longer without it. The prescription medication usually prescribed for Cyclosporiasis is a sulfa antibiotic containing sulfamethoxazole and trimethoprim (brand name Bactrim or Septra). These drugs should be avoided by patients who are pregnant or nursing because of potential adverse effects on the fetus or nursing infant.
The CDC does not recommend alternative drugs for people that have sulfa drug allergies, as none are highly effective. However, Cleveland Clinic says that the fluoroquinolone antibiotic Ciprofloxacin (comes with the risk of very severe side effects) or nitazoxanide (approved to treat parasitic infections caused by Cryptosporidium parvum or Giardia) might be prescribed instead. Read more about CDC’s treatment recommendations, including a list of drugs that have been found to be ineffective:
Clinical Care and Treatments for Cyclosporiasis
Artificial Intelligence Concerns
Call center nurses at Kaiser Permanente are concerned and stressed about new workplace surveillance tools which they say prioritize speed and cost savings over quality and safety. For example, Kaiser uses software that tries to predict on a daily basis whether nurses are being unproductive, staying too long on calls with patients, or failing to answer calls quickly. Artificial intelligence systems have also been used to rate their empathy and tone of voice.
The Markup: Kaiser Permanente nurses say technology is making their jobs — and patient care — worse
Medication Tips: How to Know If Your Child’s Rash Needs Treatment
Kids often get rashes, sometimes as an obvious allergic reaction, but sometimes they appear for seemingly for no reason. If your child is sick with a fever and gets a rash, how do you know if it’s serious enough for a doctor’s visit or a medication? Often, it is just a sign that your child’s immune system is hard at work fighting a virus. Pediatrician Alisdair Munro, writer of The Munro Report, explains that most of these rashes are completely benign and require no intervention; but how are parents supposed to know the difference? Check out “Making Rash Decisions” with advice and photos:
Treatment Tips:
Are you taking care of your liver? Coffee and soft drinks have different impacts. Curcumin may blunt the effects of fatty liver disease. The People’s Pharmacy’s Joe Graedon explains what the liver does and how to take care of it:
The People’s Pharmacy: Do you love your liver enough?
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