Nationwide assessment of community pharmacists’ practices and atorvastatin–drug interactions in Egypt

TL;DR

This study assesses how well Egyptian community pharmacists manage atorvastatin drug interactions and identifies areas for improvement in safety practices.

Contribution

The study provides a nationwide evaluation of pharmacists' practices and reported drug interactions with atorvastatin in Egypt.

Findings

Pharmacists frequently counsel patients and use web-based resources but less often use structured DDI screening tools.

Female pharmacists and those with diplomas showed better adherence to safety practices than their counterparts.

Common DDIs included cyclosporine, clarithromycin, and azithromycin, with regional variations in frequency.

Abstract

Atorvastatin (ATV) is widely prescribed in Egypt, where cardiovascular disease remains the leading cause of mortality; however, it is prone to clinically significant drug–drug interactions (DDIs). This national cross-sectional study evaluated community pharmacists’ (CPs’) knowledge, practice behaviors, and reported rates of ATV-related DDIs across Egypt. A total of 973 licensed pharmacists completed a validated survey. The mean cumulative practice score was 7.2 ± 1.91, indicating high adherence to recommended safety practices. Frequently reported roles included targeting polypharmacy patients (80.1%), initiating single-drug therapy when appropriate (82.2%), counseling patients about adverse effects (85.1%), and using web-based drug-information resources (88.2%), whereas structured DDI screening tool use was less common (46.1%). Compared with male pharmacists, female pharmacists presented significantly higher cumulative practice scores (7.52 ± 1.59 vs. 7.08 ± 1.99; p = 0.016), and diploma holders scored higher than Ph.D. holders did (7.47 ± 1.81 vs. 6.82 ± 1.87; adjusted p = 0.02). High-frequency encounters were reported for major DDIs with cyclosporine (49.3%) and clarithromycin (45.8%) and for moderate DDIs with digoxin (42.2%), phenytoin (41.0%), and azithromycin (40.5%). Regional variation showed higher interaction frequencies in Upper Egypt and the Delta. Strengthening pharmacist stewardship programs and expanding standardized DDI screening approaches may improve ATV safety.

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