Nationwide assessment of community pharmacists' practices and atorvastatin-drug interactions in Egypt

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.