Knowledge, Attitudes, and Practices of Community Pharmacists toward Herbal–Drug Interaction: A Cross-Sectional Study in Libya

Abstract

The use of herbal medicines has increased globally, leading to a higher risk of herbal–drug interactions, particularly when patients take herbal products alongside conventional medicines. Community pharmacists play a crucial role in ensuring the safe use of herbal products; however, limited data are available concerning the pharmacists' knowledge of herbal –drug interactions in Libya. This study aimed to assess the knowledge, practices, and attitudes of community pharmacists regarding herbal medicines and herbal–drug interactions, focusing on Ashwagandha, Ginkgo biloba, curcumin, and echinacea in Libyan cities (Tripoli, Benghazi, and Al-Khums) and a small number from Canada and Germany. A cross-sectional descriptive study was conducted between May and October 2025 among 191 community pharmacists working in Libya, Canada, and Germany. Data were collected using a structured, self-administered questionnaire. Data were analyzed using SPSS version 27. Most pharmacists were from Libya (87.4%), with limited participation from Canada and Germany. Overall knowledge of herbal medicines and general awareness of herbal–drug interactions were rated as good. However, actual knowledge of targeted herbal medicines–drug interactions was low, particularly for echinacea. Higher educational level, longer professional experience, and city of practice were significantly associated with better knowledge of herbal medicines–drug interactions. Attitudes toward herbal medicines were mostly positive. Community pharmacists demonstrated acceptable general knowledge and positive attitudes toward herbal medicines; however, their actual knowledge of related herbal medicines–drug interactions was notably insufficient and low. These findings highlight the need for targeted educational programs and the development of national guidelines.