TX_1~ABS:AT/ADD:TX_2~ABS:AT 19 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2024, 8 (2): 19-25 ReseaRch aRticle Knowledge and Awareness toward Food Drug Interaction among Pharmacists in Erbil City Behnaz Shahrokhisahneh, Noor O. Ahmed, Rangin Najmadin, Ala H. Abdulwahab, Sima S. Hamasalh Department of Nutrition and Dietetics, College of Health Technology, Cihan University-Erbil, Kurdistan Region, Iraq ABSTRACT In the evolving landscape of healthcare, understanding the potential interactions between pharmaceutical drugs and food is imperative yet often overlooked. This study aimed to assess pharmacists’ knowledge of food-drug interactions (FDI) in Erbil city, focusing on comprehension, risk factors, counseling practices, and familiarity with drug databases. Conducted through a survey-based approach, the research involved 100 pharmacists from varying educational backgrounds, sampled purposively from Doctors Street in Erbil. Data collection occurred over 2 months through a self-administered questionnaire comprising 34 questions covering basic FDI awareness and advanced topics. Results indicate a correlation between higher education levels and a deeper understanding of FDI, particularly in recognizing specific drug-nutrient interactions. Nonetheless, knowledge gaps persist, underscoring the complexity of FDI comprehension. Intriguingly, pharmacists with institute certificates exhibited nuanced understanding in certain scenarios, challenging assumptions about the linear relationship between education and awareness. The study emphasizes the necessity for targeted interventions in pharmaceutical education to address these nuances effectively. These findings contribute to the growing body of knowledge on FDI awareness among pharmacists, highlighting the importance of continuous education to ensure optimal patient care, treatment efficacy, and safety. Keywords: Erbil, Food-drug interactions, Knowledge assessment, Patient care, Pharmaceutical education INTRODUCTION In today’s fast-paced world, the use of pharmaceutical drugs has become increasingly common. As individuals seek medical assistance for various ailments, it is crucial to consider the potential interactions between medications and food, which can significantly impact treatment outcomes and patient safety.[1] The complex interactions between the substances we consume and the drugs we take can significantly impact the therapeutic outcomes and potentially lead to adverse reactions or reduced efficacy of treatments.[2-7] Food and drug interactions (FDI) arise due to either pharmacokinetic or pharmacodynamics mechanisms. Pharmacokinetic mechanisms refer to how the body processes a drug, while pharmacodynamics mechanisms pertain to the effects of drugs on the body.[8] Various types of food have been demonstrated to impact drug metabolism and absorption.[9] Numerous factors contribute to FDI, including the chemical composition of foods, the mechanisms of drug absorption and metabolism, and individual variations in metabolism and genetic predispositions.[4-13] Some foods can interfere with drug absorption by binding to or altering the pH of the gastrointestinal tract, thus affecting the drug’s bioavailability. In addition, certain foods may interact with drugs at the metabolic level, either by inhibiting or inducing enzymes responsible for drug breakdown, leading to changes in drug concentration and effects. Understanding these interactions is crucial for healthcare professionals and patients to optimize medication regimens and ensure patient safety.[14-17] The intricate relationship between food and drugs, known as FDI, has gained recognition as a critical area of study in healthcare.[18] Pharmacists, as frontline healthcare professionals, play a pivotal role in ensuring patients’ well- being by possessing in-depth knowledge and awareness of FDI.[19] It is essential for pharmacists to possess a comprehensive understanding of FDI and its implications. Despite the growing importance of this subject, limited research has focused on Corresponding Author: Behnaz Shahrokhisahneh, Department of Nutrition and Dietetics, College of Health Technology, Cihan University-Erbil, Kurdistan Region, Iraq. E-mail: behnaz.shahrokhi@cihanuniversity.edu.iq Received: March 29, 2024 Accepted: June 23, 2024 Published: July 20, 2024 DOI: 10.24086/cuesj.v8n2y2024.pp19-25 Copyright © 2024 Behnaz Shahrokhisahneh, Noor O. Ahmed, Rangin Najmadin, Ala H. Abdulwahab, Suma S. Hamasalh. This is an open-access article distributed under the Creative Commons Attribution License. Cihan University-Erbil Scientific Journal (CUESJ) Shahrokhisahneh, et al.: Food Drug Interaction among Pharmacists 20 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2024, 8 (2): 19-25 assessing the knowledge and awareness levels of pharmacists regarding FDI in Erbil city. This article aimed to bridge this knowledge gap by exploring the current understanding and awareness of pharmacists in Erbil city regarding FDI, which can provide valuable insights into the extent to which pharmacists in this region are equipped to identify and manage potential FDI risks. Enhancing the knowledge and awareness of pharmacists toward FDI is crucial for promoting patient safety and optimizing therapeutic outcomes. By shedding light on the current scenario in Erbil city, this study aims to contribute to the existing body of knowledge in FDI research and provide actionable insights for healthcare policymakers, regulatory bodies, and pharmaceutical education institutions. Ultimately, it is our hope that this research will foster the development of targeted interventions and initiatives that empower pharmacists to deliver effective pharmaceutical care, ensuring the well-being of the population they serve. MATERIALS AND METHODS Study Design This study employed a survey-based research methodology to assess the knowledge and awareness of FDI among pharmacists in Erbil city. The main aim was to investigate the degree of knowledge and awareness among pharmacists of both genders and varying academic backgrounds and to associate their knowledge and awareness with their education levels. Study Population The study population included male and female pharmacists with different education levels, ranging from certificate holders from institutes to those with bachelor’s degrees and higher education (postgraduate and Ph.D.). The pharmacists were selected from pharmacies located on Doctors Street in Erbil city. Sampling Design and Techniques Purposive sampling was implemented for this study. A total of 100 pharmacists were selected, comprising 47 males and 53 females. Participants were distributed according to their education levels. Only those who accepted to participate voluntarily and provided their consent were included in the study. Survey Structure The survey covered various aspects of FDI, including: • Understanding of common drug-nutrient interactions • Identification of risk factors • Counseling practices • Familiarity with relevant drug databases and resources. Data Collection and Analysis Data were collected through the administered survey, which was designed to gauge the overall level of knowledge and awareness among pharmacists. The collected data were then analyzed to identify potential areas for improvement in knowledge and awareness regarding FDI. Method of Data Collection The required information obtained using a suitable questionnaire. Study pattern: In this study, the required data collected from the pharmacists using a self-administered Questionnaire.[20] The data were collected within 2 months (December to February 2022) from the pharmacies in Doctors Street of Erbil City. Questionnaire was included 34 questions which could be divided into two different domains: (1) Basic and general awareness about FDI and (2) advanced questions about the interaction of different foods with certain drugs. Scoring guideline: The overall level of knowledge and awareness about FDI is calculated by summing up all the correct answers. Each correct answer scored 1 and each incorrect answer scored 0. The sum of total scores considered as overall FDI knowledge value. The possible range of scores was 0–34 scores. However, the minimum score in our results was 11, and the maximum score was 33. To make comparison between the three groups in terms of the level of knowledge regarding FDI, a range defined: (1) 11–18: Low knowledge, (2) 19–25: Medium knowledge, (3) 26–34: High knowledge. Statistical Analysis After data cleaning, data were entered to Microsoft Excel and then SPSS (V.16) was implemented for further statistical analysis. The Chi-square test and ANOVA test were used for making comparison between the percentage of participants, and the mean of scores, respectively. A p≤0.05 was considered as statistically significant. RESULTS AND DISCUSSION Drug interactions (DI) are the main cause for many issues in pharmacotherapy. Changes which occur in these interactions can lead to altered drug effectiveness, increased or decreased drug potency, changes in the way a drug is metabolized or absorbed, or the occurrence of unexpected side effects in effects of a drug or simultaneous administration of another drug may cause DI.[21] FDI, herb DI, laboratory DI, etc. are concepts emerged from the DI.[22] The more complicated nature of food with different components increases the risk of food-drug interaction. Even FDI might reveal more difficulties than a drug-drug interaction.[23] Food-induced changes in drug bioavailability determine the patient’s safety is the first and foremost critical issue in health care system.[24,25] Lack of knowledge, or report about FDI, and ignorance may cause irrecoverable health complications.[26] Table 1 presents the general information of the participants. Required demographic information of the participants including the age, gender, and education level of the participants has been presented in Table 1. The study population comprised 45% male, and 51% female pharmacists from different pharmacies from Erbil city. A higher percentage Shahrokhisahneh, et al.: Food Drug Interaction among Pharmacists 21 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2024, 8 (2): 19-25 of the participants both male and females, belonged to the age range of 20–30 years old (Males-87.2%; Females-92.5%). The higher percentage of the male participants (44.7%) had a bachelor degree, while a higher percentage of females (41.5%) had only an institute certification in pharmacy. The overall knowledge of the pharmacists with different academic background (institute certificate holders, Bachelor, Higher education) toward FDI is presented in Table 2. The total correct responses to the questionnaire were used as a determinant of overall knowledge of participants regarding food-drug interaction. Table 2, displays the knowledge and comparison of FDI among pharmacists with different level of education in Erbil city. The percentage of total correct answers to each question among participants is representative of the level of knowledge of the participants in each education group. The differences between the levels of knowledge regarding each question were significant only in Q4, Q9c, Q10f, and Q17. It is obvious from Table 2 that the higher percentage of pharmacist with higher level of education was aware of the possibility of interaction between MAO Inhibitors with cheese, processed meats, legumes, wine & beer, fava beans, and fermented products. It is surprising that in certain questions (Q9e, Q9f, Q9g, Q10j, Q12, Q14, and Q15) the percentage of total scores of pharmacists with higher level of education were lower than even their institute certificate holder counterparts. Conversely, in other questions, the percentage of total correct answers showed an ascending trend in favor of higher-educated pharmacists. However, the differences between the percentages of total scores were not statistically significant. The comparison between the mean of total scores among the pharmacists with different education level has been presented in Table 3. It is evident from the table that the mean of total scores was higher for pharmacist with a higher level of education (Higher education-20.56±6.206; Bachelor-20.48±4.139) compared to their institute certificate holder counterparts (17.97±3.765); this shows that knowledge and awareness of pharmacists with higher education level regarding FDI was higher in comparison with pharmacist with a certificate from institutes. It is interesting that the differences in the mean of total scores were highly significant (Pv=0.024). The level of awareness and knowledge of the participants with different age groups is presented in Table 4. In general, degree of awareness and knowledge is associated with age. Here, in the present study, we investigated the association between degrees of knowledge of participants toward FDI with different age ranges. The mean of total scores compared between participants with age group 20–30, and 31–40. It was surprising that the majority of the participants were belonged to the age group 20–30 years old, and only 10 participants belonged to the age group of 31–40. Table 1: General information of the participants n (%) Variables Gender Total Male Female n-47 n-53 100 Education Institute 18 (38.3) 22 (41.5) 40 (40.0) Bachelor 21 (44.7) 21 (39.6) 42 (42.0) Postgraduate 6 (12.8) 8 (15.1) 14 (14.0) Ph.D. 2 (4.3) 2 (3.8) 4 (4.0) Age 20–30 41 (87.2) 49 (92.5) 90 (90.0) 31–40 6 (12.8) 4 (7.5) 10 (10.0) Table 2: Comparison of the knowledge of food-drug interactions of pharmacists with different academic level in % Q No. Level of education among pharmacists Chi-square Institute Bachelor Higher education n n=40 n=42 n=18 X2 Pv Q1 80.0 76.2 83.3 0.428 0.807 Q2 77.5 95.2 83.3 5.484 0.064 Q3 80.0 92.9 88.9 3.064 0.216 Q4 62.5 72.2 92.9 10.944 0.004 Q5 37.5 35.7 44.4 0.415 0.813 Q6 55.0 61.9 72.2 1.573 0.456 Q7 72.5 90.5 88.9 5.232 0.073 Q8 40.0 19.0 27.8 4.384 0.112 Q9a 65.0 71.4 66.7 0.4.07 0.816 Q9b 60.0 69.0 66.7 0.764 0.682 Q9c 60.0 83.3 94.4 10.210 0.006 Q9d 70.0 66.7 66.7 0.123 0.941 Q9e 57.5 61.9 44.4 1.574 0.455 Q9f 50.0 52.4 44.4 0.317 0.853 Q9g 60.0 59.5 55.6 0.110 0.947 Q10a 87.5 97.6 100.0 5.121 0.077 Q10b 32.6 40.5 44.4 0.940 0.625 Q10c 45.0 54.0 66.7 2.430 0.297 Q10d 40.0 47.6 66.7 3.541 0.170 Q10e 0.0 2.4 11.1 5.362 0.068 Q10f 22.5 52.4 38.9 7.772 0.021 Q10g 20.0 35.7 44.4 4.220 0.121 Q10h 60.0 64.3 72.2 0.807 0.668 Q10i 62.5 52.4 66.7 1.401 0.496 Q10j 70.0 66.7 66.7 0.123 0.941 Q11 32.5 50.0 44.4 2.630 0.269 Q12 47.5 66.7 44.4 4.029 0.133 Q13 37.5 35.7 61.1 3.697 0.157 Q14 70.0 71.4 50.0 2.888 0.236 Q15 57.5 64.3 55.6 0.574 0.751 Q16 82.5 83.3 83.3 0.012 0.994 Q17 50.0 81.0 72.2 9.148 0.010 Q18 52.5 52.4 66.7 1.207 0.547 Shahrokhisahneh, et al.: Food Drug Interaction among Pharmacists 22 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2024, 8 (2): 19-25 Although the mean of total knowledge scores was slightly higher (20.10±3.281) among elder participants (age group 31–40), however, the differences between the mean of scores statistically were not significant. That could be due to having un-homogenized groups in terms of a number of participants in each group. It could be even more favorable to do the comparison between the level of knowledge and awareness of male and female participants with different age groups, however, due to the lack of a homogenized population groups (uneven number of participant) in each group it is impossible. The degree of awareness and attitude toward FDI has been presented in Table 5. It is obvious from Table 5 that the higher percentage of pharmacists with different level of education were aware about food-drug interaction but the differences between the three groups in both males and females were not statistically significant. The majority of the participants both males and females stated the importance of knowledge about FDI, hence, it was obvious from Table 3 that a higher percentage of pharmacists with bachelor and higher degree emphasized in the importance of knowledge regarding FDI. However, the differences between a number of positive responds to the importance of knowledge regarding FDI in both males and females with different degree certificates were not statistically significant. The level of awareness of the participants with different academic background (Institute, bachelor, and higher education) regarding the importance of FDI for elderly people is presented in Table 6. Higher percentage of pharmacist with master or Ph.D degree (Higher education level) was aware of the importance of food and drug interaction among the senior citizens due to increasing the likelihood of occurrence of food and drug interaction. In the contrary, the higher percentage of individuals with only institute certificate in pharmacy had a higher level of awareness toward the necessity of FDI for older individuals followed by pharmacist with higher level of education and bachelors. However, the results do not support any relationship between the degree of awareness regarding the importance of FDI for the elderly and the level of education of the participants. The degree of knowledge and understanding of the participants with different academic background about the concept of food-drug interaction has been presented in Table 7. It is apparent from Table 7 that, a higher percentage of the pharmacists with a bachelor degree and higher (Males: bachelor-52.4%, Higher education-75.0%; Females: Bachelor-71.4%, Higher education-70.0%) had a better understanding about food and drug interaction compared to their institute certificate holder counterparts. However, the comparisons were not statistically significant. The level of awareness of the participants regarding the factors affecting FDI has been presented in Table 8. Age of the individuals, drug dosage, and health status are the main factors affecting FDI. It is interesting that a higher number of pharmacists with higher degree (bachelor and above) both males and females were more knowledgeable about factors affecting food and drug interaction compared to their counterparts. Level of knowledge of the participants toward Food-drug interaction among male and female pharmacist with different education levels is presented in Table 9. The knowledge here represents the total correct answers regarding the food and drug interaction. It is obvious from Table 9 that a higher number of pharmacists both males and females (Male-55.6%; Females-63.6%) with a lower education level (institute) had lower knowledge about food and drug interaction. Among the participants, pharmacists with the bachelor degree, both males (61.9%) and females (57.1%) had a medium level of knowledge regarding FDI. The level of knowledge of the participants regarding the importance of avoidance of consumption of drugs with certain food items has been presented in Table 10. It is evident from Table 10 that among males, a higher percentage of pharmacists with a bachelor degree and above (bachelor-66.7%, Higher education-75%) compared to their institute certificate holder counterparts were more aware about the importance of not consuming theophylline/NSAID with tea, chocolate, and coffee. However, females with bachelor’s degree were more knowledgeable about the interaction occurs between theophylline and chocolate, tea, and coffee in the body, still the degree of difference in their responses is not statistically significant. Likewise, a higher percentage of female participants with a higher degree in pharmacy (bachelor and above) (Bachelor-66.7%; Higher education-80.0%) revealed to be more aware about the significance of avoidance of ingestion of dairy products with tetracycline and fluroquinolones. However, this pattern was not observed among male counterparts. It was interesting that the majority of participants both male and females with higher degree in pharmacy (bachelor and above) were highly familiar with the importance of prevention of the intake of MAO inhibitors and cheese, possessed meats, legumes, wine and beer, fava beans compared to their institute certificate holder counterparts. Similarly, the higher percentage Table 3: Comparison of the overall knowledge of the participants: Based on Mean±SD total scores Q No. Level of education among Pharmacists ANOVA Institute Bachelor Higher education n n=40 n=42 n=18 F Sig. Mean±SD 17.97±3.765 20.48±4.139 20.56±6.205 3.888 0.024 Table 4: Knowledge and awareness of the participants with different age ranges: presented as (Mean±SD) Variable Age range (years) ANOVA 20–30 31–40 F Sig. n n=90 n=10 Mean±SD 19.42±4.695 20.10±3.281 0.197 0.658 Shahrokhisahneh, et al.: Food Drug Interaction among Pharmacists 23 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2024, 8 (2): 19-25 of pharmacists with a higher level of education (bachelor and above) had a better level of understanding about the significance of stopping the consumption of acidic foods with antibiotics. Interns showed poor performance in overall FDI, which could be due to a lack of knowledge, awareness, and clinical exposure. Table 5: Awareness and attitude toward food-drug interactions Variables Male Female Institute Bachelor Higher education Institute Bachelor Higher education n n=18 n=21 n=8 n=22 n=21 n=10 Awareness about FDI (being familiar with FDI) Yes 15 (83.3) 15 (83.3) 7 (87.5) 17 (77.3) 17 (81.0) 8 (80.0) Chi-square χ2=1.263, Pv=0.532 χ2=0.093, Pv=0.955 Importance of knowledge about FDI Yes 13 (72.2) 18 (85.7) 7 (87.5) 19 (86.4) 21 (100.0) 9 (90.0) Chi-square =1.415, Pv=0.493 =2.970, Pv=0.227 Importance of report about FDI Yes 12 (66.7) 20 (95.2) 5 (62.5) 13 (59.1) 19 (90.5) 8 (80.0) Chi-square 6.239, Pv=0.044 =5.854, Pv=0.054 Table 6: Knowledge regarding the importance of food-drug interactions for elderly Variable Male Female >60 years Institute Bachelor Higher Education Institute Bachelor Higher education Yes 4 (22.2) 7 (33.3) 4 (50.0) 11 (50.0) 8 (38.1) 4 (40.0) Chi-square χ2=2.002, Pv=0.368 χ2=0.678, Pv=0.713 χ2=1.394, Pv=0.238 Table 7: Knowledge and understanding the concept of food-drug interactions Gender Male Female Variable Institute Bachelor Higher education Institute Bachelor Higher education Concept of FDI Chi-square 9 (50.0) 11 (52.4) 6 (75.0) 13 (59.1) 15 (71.4) 7 (70.0) χ2=1.533, Pv=0.465 χ2=0.815, Pv=0.665 Table 8: Knowledge regarding factors affecting food-drug interactions Variable Male Female Institute Bachelor Higher education Institute Bachelor Higher education Awareness regarding factors affecting FDI Chi-Square 16 (72.7) 20 (95.2) 9 (90.0) 13 (72.2) 18 (85.7) 7 (87.5) χ2=1.415, Pv=0.493 χ2=4.498, Pv=0.106 Table 9: Level of knowledge toward food-drug interactions (FDI) among male and female pharmacist with different level of education Gender Male Female Variables Institute Bachelor Higher education Institute Bachelor Higher education n=18 n=21 n=8 n=22 n=21 n=10 Low knowledge 11–18 10 (55.6) 8 (38.1) 3 (37.5) 14 (63.6) 5 (23.8) 4 (40.0) Medium knowledge 19–25 8 (44.4) 13 (61.9) 3 (37.5) 8 (36.4) 12 (57.1) 5 (50.0) High knowledge≥26 0 (0.0) 0 (0.0) 2 (25.0) 0 (0.0) 4 (19.0) 1 (10.0) Chi-square χ2=11.449, Pv=0.022 χ2=9.100, Pv=0.059 Shahrokhisahneh, et al.: Food Drug Interaction among Pharmacists 24 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2024, 8 (2): 19-25 Our results were not in line with the results of Benni et al. (2012) in terms of awareness regarding cheese reaction[20] which occurs in depressive disorder patients on monoamine oxidase inhibitors as the majority of our population study were aware about this type of interaction. However, it could be due to the population in their study was not comprised of pharmacists but medical doctors and surgeons. It is obvious from Table 10 that the majority of female pharmacists with a higher level of education were well- informed about the importance of avoiding the intake of caffeine consumption with quinidine, diazepam, pseudoephedrine and theophylline due increasing the risk of drug toxicity with symptoms such as nervousness, tremor, and insomnia. However, surprisingly pharmacists with only institute certificate were more educated about the risk of consumption of quinidine, diazepam, pseudoephedrine and theophylline along with caffeine. It is interesting from the result that among the males, a higher percentage of the institute certificate holders were more aware about the increasing the risk of bleeding by increasing the potential of these drugs in terms of stimulating and anticoagulation in multiple ways in the body. Conversely, female pharmacist with higher degree had better knowledge regarding the interaction between garlic and ginger with coumarin. The level of knowledge regarding the interaction of different drugs with certain foods has been presented in Table 11. The level of knowledge of the participants regarding the possibility of interaction of certain foods with specific drugs has been presented as Mean±SD of scores. It is obvious from Table 8 that the mean of scores for knowledge regarding the possibility of food and drug interaction did not show significant differences among male and female participants with different education level. CONCLUSION Our results indicate that pharmacists with higher academic backgrounds generally possess a better understanding of FDI. This study highlights the necessity to increase knowledge and awareness among pharmacists, as inadequate information about FDIs can lead to improper patient counseling and adverse side effects. Table 10: Importance of prevention of consumption of drug with foods Gender Male Female Variables Institute Bachelor Higher education Institute Bachelor Higher education n n=18 n=21 n=8 n=22 n=21 n=10 Consumption of theophylline/NSAIDs with tea, chocolate, and coffee Yes 11 (61.1) 14 (66.7) 6 (75.0) 15 (68.2) 16 (76.2) 6 (60.0) Chi-Square =0.890, Pv=0.641 =0.484, Pv=0.785 Milk and dairy products iron-rich food and supplements with tetracycline and fluro-quinolones Yes 14 (77.8) 15 (71.4) 4 (50.0) 10 (45.5) 14 (66.7) 8 (80.0) Chi-square =4.005, Pv=0.135 =2.070, Pv=0.355 MAO inhibitors and cheese, possessed meats, legumes, wine & beer, fava beans Yes 10 (55.6) 16 (76.2) 8 (100.0) 14 (63.6) 19 (90.5) 9 (90.0) Chi-square =5.749, Pv=0.056 =5.573, Pv=0.062 Caffeine consumption with quinidine, diazepam, pseudoephedrine & theophylline Yes 14 (77.8) 12 (57.1) 5 (62.5) 14 (63.6) 16 (76.2) 7 (70.0) Chi-square =1.889, Pv=0.389 =0.804, Pv=0.669 Garlic/ginger with coumarins Yes 14 (77.8) 12 (57.1) 3 (37.5) 9 (40.9) 14 (66.7) 5 (50.0) Chi-square =4.136, Pv=0.126 =2.900, Pv=0.235 Acidic foods and beverages, and antibiotics Yes 7 (38.9) 11 (52.4) 5 (62.5) 13 (59.1) 11 (52.4) 3 (30.0) Chi-square =1.416, Pv=0.493 =2.357, Pv=0.308 Table 11: Degree of knowledge about the likelihood of interaction of different food with certain drugs (Mean±SD) Gender Male Female Variables Institute Bachelor Higher education Institute Bachelor Higher education Mean of scores (Range of scores 0–7) Mean±SD 4.44±1.338 4.48±1.340 4.39±1.614 4.05±1.290 4.81±1.537 4.30±1.418 ANOVA F=0.067, Pv=0.796NS Shahrokhisahneh, et al.: Food Drug Interaction among Pharmacists 25 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2024, 8 (2): 19-25 The findings reveal a positive association between higher education levels and a deeper comprehension of FDIs, particularly in recognizing specific drug-nutrient interactions. 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