The White House approved the move on Friday after pressure from senior HHS leaders, though Makary remained in post and acting replacement options included Kyle Diamantas, Grace Graham and Lowell Zeta.
His position deteriorated after clashes over fruit-flavoured vape approvals, abortion-pill policy, vaccine regulation and drug reviews, despite authorising the vape sales on Tuesday after Trump intervened.
The FDA is already under strain, with several centres led by acting officials after high-profile departures, and any permanent successor would need Senate confirmation.
Will the next FDA commissioner be forced to choose between presidential policy and scientific integrity?
After mass layoffs and leadership turmoil, how can the FDA regain the trust of patients and innovators?
Is the FDA's current crisis a preview of a new normal for all federal agencies?