Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 05 10 1430 1430 Sarah Mousavi Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran. Monir Karimi School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran. Shadi Farsaei Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran. 2025 09 30 2025 10 29 Background: Drug-related problems (DRPs) are highly prevalent among critically ill patients in intensive care units (ICUs) and may negatively influence clinical outcomes. Pharmacist-led interventions play a pivotal role in detecting and resolving DRPs; however, their implementation and acceptance vary across healthcare systems. Methods: This cross-sectional, descriptive-analytical study was conducted in the ICUs of Al-Zahra Hospital, Isfahan, Iran, during the second half of 2024. Adult patients admitted for more than 24 hours were evaluated for DRPs using Cipolle’s classification system. Data were obtained from medical charts, direct observation, and patient assessments. The severity of DRPs was graded using the NCC-MERP index, and pharmacist interventions as well as their acceptance by physicians were documented. Results: A total of 100 patients were enrolled (60% male; mean age, 55.1 ± 18.1 years). A total of 324 DRPs were identified from 1,682 reviewed medication orders (mean of 3.24 DRPs per patient, with a median of 16.8 medication items received per patient). The most frequent categories were dosage too low (n = 68), ineffective drug therapy (n = 64), unnecessary drug therapy (n = 39), and dosage too high (n = 45). The most frequently implicated drugs were pantoprazole, acetaminophen (Apotel), vitamins and supplements, and broad-spectrum antibiotics including meropenem, vancomycin, and ceftazidime. Although 83% of drug-related problems (DRPs) caused no immediate harm, 18% led to actual patient harm. Clinical pharmacists offered several recommendations; however, only 18% of these were accepted by physicians. Conclusion: Drug-related problems are very common among ICU patients, with dosing errors and unnecessary treatments being the most frequent types. The involvement of clinical pharmacists is essential for early detection and prevention, but the low rate of acceptance of their recommendations highlights the need for stronger interdisciplinary collaboration. Evidence from both international studies and Iranian research points to similar challenges, supporting the integration of clinical pharmacists into ICU teams as a key strategy to improve patient safety and treatment outcomes. https://aacc.tums.ac.ir/index.php/aacc/article/view/1430