Chirality is among the factors impacting drug activity in terms of therapeutic or adverse effects. Pure enantiomeric drugs, presumed to offer greater benefits in accordance with this concept, have been recommended for new drug development. We aimed to analyse the chirality status of the commonly consumed drugs in Turkey and assess their cost implications. We evaluated top-selling 200 active substances using nationwide sales data from IQVIA Turkey, identifying chirality status of 173. These were categorized into “chiral mixtures”, “achiral”, and “pure enantiomers”, and their distribution and mean cost per unit (CPU) values by chirality status were examined. To examine the impact of chiral switching on expenses, CPUs of chiral-switched mixtures and resulting pure enantiomers, were compared. Among 173 compounds, 35.8% were achiral, 22.0% were chiral mixtures and 42.2% were pure enantiomers. Total cost was $2.09b, with pure enantiomers accounting for 46.4% and chiral mixtures 22.0%. Mean CPUs for pure enantiomers ($2.8±3.5), achiral drugs ($2.3±2.5), and chiral mixtures ($1.7±0.9) were similar (p>0.05). For drugs that underwent chiral switching, mean CPU of chiral mixtures ($1.4±0.4) was similar to that of pure enantiomers ($1.7±1.2), (p>0.05). Half of the chiral pairs that underwent switching had higher CPU for chiral mixture, while the other half had higher CPU for pure enantiomer. We demonstrated that pure enantiomers occupy a significant portion of top-selling drugs in Turkey. The observed cost similarity between commonly used pure enantiomers and chiral mixtures suggests that pure enantiomers may continue to gain preference in the market.

Background and Objectives: The effects of nicotine on wound healing and flap survival remain controversial. While smoking is associated with increased flap complications, emerging evidence suggests that nicotine may exert dose- and duration-dependent effects. This study aimed to investigate how short-term, low-dose nicotine affects flap survival and to evaluate its potential role in oxidative stress and ferroptosis. Materials and Methods: Twelve adult male BALB/c mice were randomly assigned to either a control group or a nicotine-treated group, with six mice in each group. Nicotine, at a dose of 2 mg/kg, was given subcutaneously for fourteen days before flap surgery. This treatment continued for seven days after the surgery. A dorsal random-pattern skin flap model was established in all animals. The flap necrosis area was assessed on postoperative day 7 using planimetric analysis. Serum and tissue glutathione peroxidase 4 (GPX4) levels and serum malondialdehyde (MDA) levels were measured. Histopathological evaluation included epithelialization, microvascular density, neovascularization, fibroblast density, and inflammatory cell infiltration. Results: Nicotine treatment significantly reduced flap necrosis compared with the control group. Histopathological analysis demonstrated significantly increased epithelialization and microvascular density in the nicotine-treated group, whereas no significant differences were observed in neovascularization, fibroblast density, or inflammatory cell infiltration. Biochemical analyses revealed no significant differences in serum or tissue GPX4 levels or serum MDA levels between the groups. Conclusions: Short-term nicotine administration enhanced flap survival, correlating with increased epithelialization and microvascular density, while not significantly affecting markers of oxidative stress or ferroptosis. These results imply that the positive impact of nicotine on flap viability might be largely attributable to vascular processes rather than pathways involving oxidative stress.