Q&A: Emerging Compounded Therapies Demand Pharmacist’s Clinical Judgment | NCPA 2026

As interest in methylene blue, low-dose naltrexone, and ketamine grows among patients and prescribers, pharmacists play a key role in weighing limited evidence and safety data to guide individualized compounded therapy.

“By the time a patient gets to a compounding pharmacy, they've already tried all the conventional therapies,” Sara Hover, RPh, FAARM, senior director of clinical services at PCCA, told Drug Topics®. “Obviously, they're looking for other solutions. All 3 of those, methylene blue, low-dose naltrexone, ketamine, are all just emerging because there's a lot of interest, number one, from prescribers, but also from patients as well.”

At the National Community Pharmacists Association (NCPA) Annual Convention and Expo 2026, Hover presented a session titled “How to Turn Emerging Compounding Trends into Practice Opportunities,” and we caught up with her afterwards to provide greater nuance on the 3 specific products making waves in the compounding space.

READ MORE: Wearable Tech as a Revenue, Clinical Service Opportunity for Pharmacists | NCPA 2026

Drug Topics: Why are the therapies you discussed in your session—including methylene blue, naltrexone, and ketamine—getting so much attention in the compounding space right now?

Sara Hover: By the time a patient gets to a compounding pharmacy, they've already tried all the conventional therapies. Obviously, they're looking for other solutions. All 3 of those, methylene blue, low-dose naltrexone, ketamine, are all just emerging because there's a lot of interest, number one, from prescribers, but also from patients as well. All 3 of these are required to have a prescription, so it’s prescriber-directed. But as a pharmacist, it's our role to understand the evidence and safety data for each patient and help guide both prescribers and patients.

Drug Topics: How should pharmacists weigh or value emerging evidence when considering compounded therapies given that new and novel agents are rapidly increasing in popularity and use?

Sara Hover: With new therapies and evidence being a little limited, you have to look at everything. You have to look at mechanisms of how the drug works, the safety data, which is really the most important, and then, what makes sense for that individual patient. Obviously, safety is first. Without the large randomized controlled trials, our professional clinical judgment is really key; again, making sure it's the right patient, the right dose, the right therapy for those patients.

I know when I have students come on rotation at PCCA, I'm always emphasizing to them that sometimes we have to just really look at the mechanism, look at the safety data, and then decide for that individual patient what is best. This case-by-case review is really what personalized medicine is about, [which] is individualized therapy.

Drug Topics: How are the overall shifts in compounding affecting how pharmacies personalize medications for their patients?

Sara Hover: Obviously, there's new regulatory standards, which, as pharmacists, we're all for that. Pharmacists have to just be intentional about where they put their efforts, making sure that they're compliant with the new regulations, and then just trying to be as efficient with their operations as possible. At PCCA, this is something that we help pharmacists with. We help them with the knowledge, the processes, the training, just so that they can be efficient and be able to deliver those therapies. The regulatory part of it is tough. But pharmacists, we like rules and want to follow the rules, but it's just a matter of making sure that we can still take care of our patients.

Drug Topics: Whether it’s the products you explored in our discussion today or during your presentation, which ones do you believe pharmacists will need to keep the closest eye on as compounding and overall health care models continue to evolve?

Sara Hover: It's really hard to choose. When I designed the talk, I was like, ‘What are the 3 hottest things?’ And I really think all 3 of those actives really address big disease states that are just continuing to grow. Due to many factors from the environment, food choices, autoimmune diseases are on the rise, and low-dose naltrexone has been shown in literature to benefit many autoimmune disorders. Methylene blue, to me, is so fascinating just because it is a drug from the 1800s, and we're just continuing to learn new ways that we can help our patients with it. But really, the biggest area that's been shown in the data is really about the mitochondria. Supporting the mitochondria helps with their energy, helps with their focus, and so a lot of patients could really benefit from that. Ketamine is also very intriguing with its potential role in depression and pain. We're seeing that on the rise as well.

For all 3 of these, evidence is still developing. We still need to put more legs underneath the tables, but I think things are starting to grow. Patients are requesting personalized medicine. Then, pharmacists really need to not only stay current but really we need to stay on the cutting edge so that we can help those patients, as many as possible.

READ MORE: NCPA Annual Convention & Expo Resource Center