Introduction: Medication Therapy Management (MTM) is identified as a group of services provided to the patient in order to optimize the medication use in order to mitigate adverse drug reactions (ADRs), drug–drug interaction (DDI), and polypharmacy. Elderly populations above 60 years old are at high risk for Medication-related Problems (MRPs) due to several factors. Therefore, MTM programs showed good contributions globally regarding enhancing medication use in the elderly population. Thus, evident information regarding its implementation in Saudi Arabia is lacking in the literature. Objective: Our objective is to assess community pharmacists’ knowledge, attitude, and barriers to providing MTM services to the older adult population in Saudi Arabia. Methodology: A cross-sectional study has been conducted among community pharmacists across the Kingdom. It was survey-based research that was designed and conducted through (QuestionPro). The survey was distributed for the community pharmacists from Feb–May 2023 via (QuestionPro). Descriptive analysis was performed using SAS OnDemand to analyze the categorical variables and test it with the outcome of interest. Results: Out of the 528 participants who have viewed our questionnaire, 319 participants have completed the survey in 5 min average time. Most of our participants were male, holding a bachelor’s degree, and had an average working load of more than 40 h a week, respectively (84.95%, 92.48%, and 76.18%). In addition, the participants were from different regions of the Kingdom, which enhanced the generalizability of our findings. Moreover, 65.52% have reported a higher level of knowledge, while 34.48% have reported a moderate to low level of knowledge regarding MTM service. Most of those with a higher level of knowledge maintain a positive attitude regarding MTM service, its implementation, and dealing with older adult patients in the community pharmacy. In addition, lacking the time, training, and presence of a private consultation room were the top barriers to provide MTM services in the community pharmacy in Saudi Arabia. Conclusion: Educational sessions regarding MTM services among the older adult population are highly recommended for community pharmacists before its implementation.

This study examined the level of adherence to self-care behaviors among individuals with type 2 diabetes in Saudi Arabia and its connection with depression and demographic factors. A cross-sectional survey was conducted among diabetes patients using the Patient Health Questionnaire (PHQ-9) to measure depression and the Summary of Diabetes Self-Care Activities (SDSCA) to evaluate diabetes self-care activities. Among the 252 participants who completed the survey, 43.2% were older than 55 and 59% were men. The ordinal regression model showed an association between the PHQ-9 and SDSCA scores with an OR of 0.83 (95% CI: 0.71 to 0.96, p = 0.013). The PHQ-9 score was significantly associated with blood sugar monitoring (OR: 0.90 [95% CI: 0.82 to 0.99, p = 0.003]), exercise (OR: 0.88 [95% CI: 0.79 to 0.98, p = 0.002]), and diet (OR: 0.94 [95% CI: 0.85 to 1.03, p = 0.045]). Of all the diabetes-related factors, only a history of hospitalization and receiving diabetes education were found to be associated with improved self-care behaviors. In conclusion, a negative association was found between PHQ-9 scores and the SDSCA mean score and most daily diabetic self-care behavior components.

Tacrolimus is a narrow-therapeutic-index immunosuppressant whose clinical performance is XR^®Envarsus XR^®), an extended-release tacrolimus formulation, was developed to enhance dissolution, improve bioavailability, and reduce pharmacokinetic variability. This systematic review evaluated the clinical and translational impact of LCPT compared with immediate-release tacrolimus (IR-Tac) across solid-organ transplantation. A systematic search of PubMed/MEDLINE and Google Scholar was conducted from database inception through October 2025. Owing to heterogeneity in study populations, designs, and outcome reporting, a quantitative meta-analysis was not performed, and findings were synthesized qualitatively. Of 351 identified records, 326 underwent screening, and six studies met inclusion criteria. The primary outcome was biopsy-proven acute rejection (BPAR); secondary outcomes included graft survival, mortality, renal function, metabolic complications, adverse events, and tacrolimus trough concentrations. Across studies, LCPT demonstrated clinical efficacy comparable to IR-Tac. In de novo kidney transplantation, BPAR rates were similar (13.1% vs 13.5%), with comparable graft survival and mortality. In heart transplantation, LCPT maintained noninferior outcomes (BPAR 15% vs 10%). In conversion settings, rejection rates remained comparable. LCPT consistently achieved therapeutic trough concentrations with approximately 20– 30% lower total daily doses, reflecting enhanced bioavailability attributable to MeltDose technology. These findings support LCPT as a formulation-driven optimization of tacrolimus delivery. While pharmacokinetic advantages are evident, their translation into superior long-term clinical outcomes remains to be fully established.

BACKGROUND Herbal medicine is commonly used in Saudi Arabia, and is widely viewed as natural and safe. However, its use among transplant recipients poses risks due to interactions with immunosuppressive therapies. This study explores herbal medicine use, knowledge, and attitudes among Saudi transplant recipients. MATERIAL AND METHODS A cross-sectional study of 203 transplant recipients from multiple clinics in Saudi Arabia was conducted using a structured questionnaire to assess demographics, herbal supplement use, awareness of risks, and attitudes. Statistical analyses compared users and non-users of herbal supplements. RESULTS Post-transplant herbal supplement use decreased significantly (44.3% to 19.2%, p=0.0001). Many relied on unreliable sources like friends or the internet, and 54.24% of reported supplements posed interaction risks with immunosuppressive drugs. Participants aware of these risks were significantly less likely to use herbal supplements (15% vs 88%, p=0.0007). Alarmingly, 81.1% received no pre-transplant education, and 70.4% received no post-transplant care, despite 81% desiring guidance from healthcare providers. CONCLUSIONS Herbal supplement use among transplant recipients in Saudi Arabia is prevalent and risky due to potential drug interactions. Most patients lack education about these risks, underscoring the need for improved healthcare education.

Introduction: Neuropsychiatric toxicity is a recognized complication of calcineurin inhibitor (CNI) therapy; however, large-scale comparative assessments across tacrolimus immediate-release (IR), once-daily LCP-tacrolimus (LCPT), and cyclosporine remain limited. Methods: We performed a decade-long pharmacovigilance study using the FDA Adverse Event Reporting System (FAERS) database from 2015 to 2025 to characterize the spectrum, seriousness, temporal trends, and drug-specific reporting signals of neuropsychiatric adverse events (AEs) in transplant recipients in whom tacrolimus IR, LCPT, or cyclosporine was listed as a suspect agent. Events were categorized as neurological, psychiatric, or combined neuropsychiatric. Disproportionality was assessed using reporting odds ratios (RORs) and proportional reporting ratios (PRRs). Results: A total of 5,437 neuropsychiatric AE reports were identified, involving tacrolimus IR (71.9%), cyclosporine (23.7%), and LCPT (4.5%). Most reports were neurological (74.1%), followed by psychiatric (17.1%) and combined neuropsychiatric events (8.8%). Serious outcomes were frequently reported (92.5%), including hospitalization (52.1%) and reported death (16.2%). Combined neuropsychiatric events had the highest hospitalization rate (62.1%); however, such outcomes should be interpreted in the context of complex clinical illness and treatment exposure rather than as directly attributable to CNI-related neuropsychiatric toxicity alone. Tremor demonstrated elevated reporting disproportionality for tacrolimus IR (ROR 1.97; PRR 1.78) and LCPT (ROR 2.42; PRR 1.97). In contrast, cyclosporine showed no tremor signal but demonstrated elevated disproportionality for encephalopathy (ROR 1.73; PRR 1.45), insomnia (ROR 1.87; PRR 1.76), and anxiety (ROR 1.50; PRR 1.48). Reporting increased from 2015 to 2019 and remained elevated through 2025. Conclusion: These findings suggest distinct drug-specific neuropsychiatric reporting patterns among CNIs in FAERS. However, given the inherent limitations of spontaneous reporting systems and differences in real-world utilization across CNIs, these findings should be interpreted as hypothesis-generating pharmacovigilance signals rather than evidence of causation, incidence, or comparative risk. They highlight the potential clinical relevance of neuropsychiatric tolerability when individualizing CNI selection, monitoring, and formulation strategies, and support further integration of pharmacovigilance data with pharmacokinetic and registry-level evidence to improve individualized risk assessment.