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Objectives Quality Use of Medicines (QUM) is fundamental to optimal patient care and outcomes. This study evaluated pharmacists’ knowledge and attitudes regarding QUM practices in Saudi Arabia (SA).Method A validated questionnaire was distributed to hospital-based pharmacists across SA, assessing four themes: Knowledge and Attitudes towards QUM, Medication Review, Patient Education and Adherence, and Medication Dosage and Monitoring. Responses were rated on a 5-point scale. Demographic data were collected, and statistical analysis was performed using SPSS version 29.Results 318 surveys out of 360 have been completed. Overall, pharmacists demonstrated high levels of knowledge and positive attitudes toward QUM (mean scores >4 for all domains). The highest mean score was in Knowledge and Attitudes towards QUM (4.63), while Medication Review scored lowest (4.24). Female pharmacists consistently scored higher across all categories (p<0.05). Younger pharmacists (21–30 years) tended to score higher, particularly in Patient Education and Adherence (p<0.05).Conclusions Pharmacists in Saudi hospitals show a strong understanding of QUM principles. However, discrepancies between knowledge and practice in areas such as medication reviews suggest a need for targeted interventions. Gender and age-related differences in QUM knowledge highlight opportunities for tailored educational programs to enhance QUM practices among hospital-based pharmacists in SA.