Pharmacy最新文献

{"title":"Pharmacists' Management of Urinary Tract Infection Symptoms in Community Pharmacy: Counseling Practices and Attitudes Toward Antibiotic Therapy.","authors":"Aleksandar Jovanović, Radmila Veličković Radovanović, Ivana Tadić, Milica Drobac, Bojana Vidović, Dragana Pavlović, Marina Odalović, Dušanka Krajnović","doi":"10.3390/pharmacy14040100","DOIUrl":"10.3390/pharmacy14040100","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Pharmacists play a key role in managing urinary tract infection (UTI) symptoms by providing medications, self-care advice, and over-the-counter treatments, while referring patients to a doctor when necessary. This study aimed to examine the practices of community pharmacists in managing UTI symptoms and to gain insight into their attitudes toward antibiotic use for this condition. <b>Methods</b>: A cross-sectional study was conducted among community pharmacists in Serbia using a previously validated online questionnaire, assessed for content and face validity and pilot-tested among pharmacists. <b>Results</b>: A total of 430 community pharmacists participated in the study. Patients more often consulted pharmacists before visiting a doctor than after (median 5 vs. 3 per week; <i>p</i> < 0.001). For uncomplicated UTIs, pharmacists primarily recommended increased fluid intake (92.8%), herbal teas (94.7%), and food supplements (85.6%), whereas for complicated UTIs, most referred patients to a doctor (95.4%). Attitudes, perceived competence, and support for over-the-counter antibiotic availability were significantly associated with gender, years of experience, and specialization. Pharmacists who agreed that antibiotics are the most effective treatment for uncomplicated urinary tract infections were more likely to refer patients to a doctor (<i>p</i> < 0.01). <b>Conclusions</b>: Pharmacists are frequently consulted for UTI management and emphasize non-antibiotic approaches for uncomplicated cases. Their attitudes influence counseling practices, highlighting the need for standardized UTI counseling services, antimicrobial stewardship education, and structured communication training to support appropriate antibiotic use.</p>","PeriodicalId":30544,"journal":{"name":"Pharmacy","volume":"14 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacy Students' Perception of E-Learning During the COVID-19 Pandemic Across the League of Arab States: A Regional Scoping Review.","authors":"Haroon Malak, Madeeha Mirza, Stephen F Gambescia, Basil H Aboul-Enein","doi":"10.3390/pharmacy14040099","DOIUrl":"10.3390/pharmacy14040099","url":null,"abstract":"<p><p>The COVID-19 pandemic compelled higher education to resort to e-learning, posing new challenges to the teaching/learning of pharmacy students worldwide. While digital learning provided flexibility, diverse technological infrastructure and institutional availability of resources greatly influenced the student experience. This scoping review aims to assess the perceptions relating to the pivot to e-learning among pharmacy students in the League of Arab States due to the COVID-19 pandemic and how the shift affected student engagement, learning outcomes, and institutional preparedness. Following PRISMA-ScR guidelines, a comprehensive search across ten databases was conducted to identify relevant studies published between January 2020 and December 2025. Forty studies satisfied the inclusion criteria. Pharmacy students in this region responded to the transition to e-learning in diverse ways. While most appreciated the convenience of online modalities, several challenges were consistently enumerated. These were limited technological infrastructure, reduced interpersonal interaction, and disruption of hands-on practical training. Blended learning approaches were largely favored, particularly for their ability to marry online theoretical instruction with face-to-face experiential learning. Reliability and validity issues of internet-based tests were felt by both faculty and students. Stress and mental health problems among students surfaced. Student complaints in general depicted pharmacy education's need for pedagogic reform, better infrastructure, and student mental health services during e-learning. Areas identified from this review are instructional technology infrastructure improvement, adopting a blended learning strategy, and the need to consider the mental health of students learning at a distance.</p>","PeriodicalId":30544,"journal":{"name":"Pharmacy","volume":"14 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13414875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skills Developed by Student Pharmacists Completing a Research Project in the Doctor of Pharmacy Program.","authors":"David R Axon, Becka Eckert, Alyx Meilinger, Maren Steffen, Haylee Bingham, Justin Pacheco, Houston Swann, Kayleen Tubbs","doi":"10.3390/pharmacy14040097","DOIUrl":"10.3390/pharmacy14040097","url":null,"abstract":"<p><strong>Objective: </strong>To explore fourth-year student pharmacists' perspectives of the skills they develop by completing a research project in the pharmacy curriculum at one United States College of Pharmacy.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with a sample of fourth-year student pharmacists until thematic saturation was achieved. Interviews were recorded and transcribed verbatim. Thematic analysis was conducted to identify main themes. All records were reviewed by two researchers, and consensus was sought at each step of the analysis.</p><p><strong>Results: </strong>Eleven interviews were conducted. Three themes related to skills developed by students while completing a research project were apparent from the final reconciled code list: Theme 1-critical analysis skills; Theme 2-residency preparedness skills; and Theme 3-interpersonal skills. Critical analysis skills helped students review the literature and appropriately translate the findings into clinical settings. Residency preparedness skills described how students perceived completing a research project would prepare them for a residency program. Interpersonal skills were inter-related and consisted of collaboration, communication, conflict resolution, leadership, and project management skills.</p><p><strong>Conclusions: </strong>These study findings should be considered by curriculum committees as changes to the pharmacy program are considered. Future research is suggested to explore other perspectives of the research process.</p>","PeriodicalId":30544,"journal":{"name":"Pharmacy","volume":"14 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coordinated Primary-Care Access in Rural and Suburban Alberta, with a Contextual Comparison to Rural Wyoming: A Systematic Review and Narrative Synthesis of Community Pharmacist-Family Physician Care Models.","authors":"Tomasz Karczewski, Jennifer M L Stephens, Dawid Karczewski, Sahar Feizizadeh, Dhwani Dixit, Mihaela Olsen","doi":"10.3390/pharmacy14040098","DOIUrl":"10.3390/pharmacy14040098","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Primary-care access in Alberta, Canada, is shaped by geography, attachment, timeliness, continuity, and local service capacity. Rural communities may face travel burden, workforce fragility, and intermittent services, whereas suburban communities may have nearby facilities but still experience delayed access, low attachment, and fragmented episodic care. Rural Wyoming has some similar geographic and workforce constraints, although the jurisdictions differ in financing, regulation, and pharmacist scope. This systematic review and narrative synthesis examined evidence on coordinated community pharmacist-family physician care in rural and suburban Alberta and considered, separately, the contextual relevance of the findings to rural Wyoming and comparable frontier settings. <b>Methods:</b> We searched PubMed/MEDLINE, Embase, Scopus, CINAHL, and the Cochrane Library using controlled vocabulary and free-text terms to identify English-language peer-reviewed studies and practice-relevant evidence published from 1 January 2010 to 19 April 2026. Two authors screened titles/abstracts and full texts and resolved decisions by consensus. Methodological appraisal used design-appropriate Critical Appraisal Skills Programme criteria, and outcome-level certainty was considered using GRADE domains. <b>Results:</b> Thirty-four eligible peer-reviewed or practice-evaluation records were included in the narrative synthesis, and seven official contextual or methodological sources supported jurisdictional interpretation. Evidence was strongest for hypertension, cardiovascular risk reduction, medication management, and chronic disease monitoring. No included study directly compared the same intervention in Alberta and Wyoming; evidence for emergency-department effects and equivalent effectiveness across settings was limited. <b>Conclusions:</b> Coordinated pharmacist-family physician care may extend access to selected medication-related and chronic disease services when supported by documentation, referral, follow-up, and red-flag protocols. Application to Wyoming should be treated as a context-dependent proposition requiring local adaptation and prospective evaluation, not as demonstrated transferability or a substitute for physician-led longitudinal primary care.</p>","PeriodicalId":30544,"journal":{"name":"Pharmacy","volume":"14 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13416386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiential Learning Through Editorial Practice: The <i>Panamacani</i> Initiative in Pharmacy Education.","authors":"Gustavo A Hernández-Fuentes, Iván Delgado-Enciso, Alejandra E Hernández-Rangel, Jesús E Castrejón-Antonio, Héctor R Galván-Salazar, Janet Diaz-Martinez, Nibardo Cobian-Gutiérrez, José Guzmán-Esquivel, Alicia Olvera-Montejano, Carmen Meza-Robles, Alberto M Ramírez-Montes, Fabian Rojas-Larios, Gabriel Ceja-Espíritu, Daniel A Montes-Galindo","doi":"10.3390/pharmacy14040095","DOIUrl":"10.3390/pharmacy14040095","url":null,"abstract":"<p><p>Science communication is increasingly recognized as a key component of higher education; however, its integration into disciplinary training remains limited, particularly in pharmaceutical sciences. This study analyzes the <i>Panamacani</i> initiative as an institutional science communication initiative embedded within pharmacy education, based on editorial practice within the Pharmaceutical Chemist Biologist program at the Universidad de Colima, Mexico. A descriptive institutional case study was conducted using data from the first five issues (2023-2025), comprising 58 published contributions. Institutional participation, authorship profiles, and audience engagement were evaluated through descriptive statistics and editorial records. Results showed that 70.7% of contributions originated from the host institution, while 29.3% involved external institutions, indicating progressive expansion. Undergraduate students accounted for 44.8% of authorship, with a gradual increase in participation from postgraduate students and researchers. External contributions reached up to 50% in one issue, suggesting increased visibility beyond the host institution. Article visibility totaled approximately 1500 views, with applied health topics receiving the highest level of audience attention. These findings suggest that editorial-based initiatives may provide opportunities for student participation in science communication, peer review, and knowledge dissemination. However, the present study did not directly evaluate educational outcomes or competency development. This model may represent a scalable framework for integrating science communication activities into pharmacy education while fostering public engagement with science.</p>","PeriodicalId":30544,"journal":{"name":"Pharmacy","volume":"14 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Processes and Artificial Intelligence in Generating Candidates for Oncology Drug Repurposing: Three-Year Scoping Review of Data.","authors":"Antonio Ivanov, Ines Hababa-Ivanova, Savina Elitova, Svetoslav Stoev, Violeta Getova-Kolarova","doi":"10.3390/pharmacy14040096","DOIUrl":"10.3390/pharmacy14040096","url":null,"abstract":"<p><p>Oncology conditions are increasingly defined by their molecular profiles, and drug repurposing exploits this new evidence to identify new therapeutic uses of authorized/investigational medicinal products outside their original indication(s). This scoping review mapped original research published between January 2022 and December 2024 to determine the impact of automated processes and artificial intelligence in generating oncology candidates for drug repositioning, and 42 individual projects met the eligibility criteria and were analyzed. The included studies demonstrate extensive use of computational approaches for candidate prioritization, large-scale data integration, and hypothesis generation in oncology drug repurposing, creating opportunities for positive impact on efficiency. The included projects most commonly were target-oriented and disease-oriented and used multiple databases and computational validation procedures, while experimental and clinical validation were less frequently reported. The available open-access literature suggests substantial activity in China and India, which can support the notion that digitalization represents an important instrument in healthcare systems of low- and middle-income countries but should be interpreted cautiously. While the search was limited to PubMed and open-access English-language publications, we identified a relatively small number of drug-oriented projects, the importance of providing publicly accessible source code to reduce development costs, and the predominant role of academic institutions.</p>","PeriodicalId":30544,"journal":{"name":"Pharmacy","volume":"14 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"The Most High-Risk People Are Given the Most High-Risk Drugs in the Most High-Risk Way\": Experiences of Treating Problematic Over-the-Counter and Prescription-Only Medication Use in Substance Misuse Services.","authors":"Rosalind Gittins, Roya Vaziri, Ian Maidment","doi":"10.3390/pharmacy14040094","DOIUrl":"10.3390/pharmacy14040094","url":null,"abstract":"<p><p>Misuse of over-the-counter (OTC) and prescription-only medicines (POMs) is increasingly recognised as a public health and medicine-safety concern. Although specialist substance misuse services (SMS) increasingly support people affected by OTC/POM misuse, little is known about how SMS staff perceive the characteristics, challenges, and treatment needs of this population. This study explored the experiences of SMS staff to address this evidence gap and inform pharmacy practice and service development. Confidential semi-structured interviews were conducted with staff across five community adult English SMS. Audio recordings were transcribed verbatim and analysed thematically using NVivo^®. Twenty interviews with varied professionals achieved data saturation. Three overarching themes emerged: (1) characteristics of OTC/POM misuse; (2) staff-perceived patterns among people who misuse OTC/POM; and (3) negative experiences and concerns. Dependence on orally administered opioids (particularly codeine-containing products), benzodiazepines and gabapentinoids predominated. Polypharmacy including illicit substance use was also reported. Withdrawal symptoms frequently perpetuated misuse, and abrupt supply cessation created additional risks. Routine enquiry about OTC/POM misuse and provision of tailored harm-reduction interventions are essential. The findings suggest that pharmacists may have an important role in early identification of problematic OTC/POM use, harm-reduction interventions, medicine review and facilitating referral into appropriate treatment pathways. Further research should examine whether dedicated OTC/POM pathways are required and explore differences in demographic and treatment needs across medicine types.</p>","PeriodicalId":30544,"journal":{"name":"Pharmacy","volume":"14 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13416170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Community Pharmacists' Knowledge of Voluntary Assisted Dying and Authorised Disposal in Australia.","authors":"Michelle Gyr, Heather Brown, Victoria Crisp, Milan du Plooy, Noora Al Hasooni, Natalia Popowicz, Liza Seubert, Tanya Burgess","doi":"10.3390/pharmacy14040093","DOIUrl":"10.3390/pharmacy14040093","url":null,"abstract":"<p><strong>Background: </strong>Voluntary Assisted Dying (VAD) legislation in Western Australia (WA) introduced new responsibilities for community pharmacists, including the safe disposal of unused VAD substances. Pharmacists may receive VAD-related enquiries; however, their preparedness, including their knowledge of VAD, remains largely unexplored.</p><p><strong>Aim: </strong>To explore Western Australian community pharmacists' knowledge of VAD and their role as Authorised Disposers under the Voluntary Assisted Dying Act 2019 (WA).</p><p><strong>Methods: </strong>Community pharmacists in WA were invited to participate in an anonymous, online survey consisting of multiple choice and open-ended questions.</p><p><strong>Results: </strong>Of 143 respondents, 76% were aware that VAD is an end-of-life option; despite this, 64% were uncertain about its relevance to their role. Almost one-third had received VAD-related enquiries. Of these, 40% could not provide information, with half attributing this to insufficient knowledge. Among those yet to receive a VAD-related enquiry (<i>n</i> = 115), 75% felt 'not confident' to respond, with 76% attributing this to lack of knowledge. A total of 63% of participants were unaware that they may be requested to perform authorised disposal. Uncertainty surrounding the process and the legal and ethical aspects were frequently mentioned.</p><p><strong>Conclusion: </strong>WA Community pharmacists demonstrate awareness of VAD legislation but have gaps in knowledge, particularly regarding authorised disposal. Further training and resources are essential.</p>","PeriodicalId":30544,"journal":{"name":"Pharmacy","volume":"14 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolution of Pharmacist Administered Vaccinations in Australia: A Narrative Review of Legislation and Regulatory Documents.","authors":"Shambel Nigussie Amare, Kwang Choon Yee, Myra Leung, Mark Naunton, Abbey Wilson, Annika Rooney, Omar Gannash, Mary Bushell","doi":"10.3390/pharmacy14040092","DOIUrl":"10.3390/pharmacy14040092","url":null,"abstract":"<p><p><b>Background</b>: Since 2014, all Australian jurisdictions have progressively amended legislation to authorise pharmacists to administer vaccines, evolving from restricted pilots to an essential public health pillar. <b>Objective</b>: This review analyses the longitudinal evolution of pharmacist-administered vaccinations (PAVs), documenting changes in authorised vaccines, age eligibility, and regulatory frameworks across all Australian jurisdictions. <b>Methods</b>: A retrospective review of Australian jurisdictional legislation, regulations, and policy documents was undertaken. Searches included official legislative registers, Government Gazettes, Health Department protocols, and professional guidance published by Pharmaceutical Society of Australia (PSA) and The Pharmacy Guild of Australia between 2014 to 2026. Documents were independently reviewed by five authors, followed by secondary verification and consensus-based adjudication to resolve discrepancies and confirm findings. <b>Results</b>: PAVs scope was expanded from a single influenza pilot in 2014 to include over 21 vaccine-preventable diseases by 2026. The COVID-19 pandemic catalysed rapid reform, leading to the standardisation of age eligibility (largely ≥5 years). A landmark milestone occurred in 2025 when South Australia enabled pharmacists to administer any vaccine within their professional scope. <b>Conclusion</b>: Legislative reforms have significantly enhanced vaccine accessibility. However, jurisdictional fragmentation persists. National harmonisation, using a competency-based model similar to South Australia, is recommended to streamline delivery and optimise public health outcomes.</p>","PeriodicalId":30544,"journal":{"name":"Pharmacy","volume":"14 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13415602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-Glucose Co-Transporter 2 Inhibitors and Hyperkalemia-Related Discontinuation of Renin-Angiotensin-Aldosterone System Inhibitors During Mineralocorticoid Receptor Antagonist Therapy: A Real-World Cohort Study.","authors":"Abdullah Hashim Almalki, Nourah Abdulaziz Alorainan, Muhjah Abdulhakim Bukhari, Fahad Ali Dokhaikh, Salma Mohamed Abbas Quqandi, Reyan Hatem Merdad, Laila Fahad Sadagah","doi":"10.3390/pharmacy14040091","DOIUrl":"10.3390/pharmacy14040091","url":null,"abstract":"<p><p><b>Background:</b> Hyperkalemia (HK) is a common complication of renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and the risk is often increased by concomitant use of a mineralocorticoid receptor antagonist (MRA). The effect of SGLT2i co-prescription on this risk in routine clinical practice remains incompletely understood. <b>Methods:</b> This is a secondary analysis of a published retrospective cohort of 905 adult RAASi users attending outpatient clinics at King Abdulaziz Medical City, Jeddah, Saudi Arabia (IRB: NRJ22J/279/11), followed for a median of 28 months. Patients were classified as RAASi alone (n = 723) or RAASi plus MRA (n = 182). Beta-blockers and digoxin were excluded from the exposure definition. Effect modification by SGLT2i was assessed using logistic regression with a multiplicative interaction term. <b>Results:</b> MRA addition was associated with significantly higher rates of any HK (48.4% vs. 28.9%; RR 1.67, 95% CI 1.38-2.02, <i>p</i> < 0.001) and moderate-to-severe HK (13.7% vs. 6.9%; RR 1.99, 95% CI 1.26-3.12, <i>p</i> = 0.003). Overall, RAASi discontinuation rates were similar between groups. SGLT2i co-prescription significantly modified the association between MRA use and HK-driven RAASi discontinuation (interaction <i>p</i> = 0.004): among patients without SGLT2i, MRA addition was associated with a more than 5-fold increase in HK-driven discontinuation (21.1% vs. 4.1%; RR 5.11, <i>p</i> = 0.001), whereas no significant excess risk was observed among SGLT2i users (1.8% vs. 4.2%; RR 0.44, 95% CI 0.12-1.57, <i>p</i> = 0.190), although this subgroup estimate was imprecise. CKD (aOR 2.16, 95% CI 1.56-2.99) and age ≥ 75 years (aOR 1.64, 95% CI 1.04-2.58) were the strongest independent predictors of HK. <b>Conclusions:</b> MRA addition to RAASi substantially increases HK burden, and SGLT2i co-prescription appears to protect against HK-driven RAASi discontinuation in combined RAASi-MRA-treated patients. In patients with established indications for SGLT2i, co-prescription may confer the additional benefit of preserving RAASi continuity in the setting of MRA combination therapy.</p>","PeriodicalId":30544,"journal":{"name":"Pharmacy","volume":"14 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13414869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}