Kusnandar Anggadiredja

Context: Herbal galactagogues are commonly used to promote lactation. Despite their increasing use, concerns remain regarding their safety because evidence from preclinical and clinical studies is limited and heterogeneous. Therefore, an updated systematic review is needed to synthesize the current evidence and inform clinical practice and future research. Aims: To provide a systematic and integrated assessment of the available preclinical and clinical evidence regarding the safety of herbal galactagogues. Methods: This systematic review was conducted in accordance with the PRISMA 2020 Statement. Eligible studies were identified through systematic searches of PubMed, ScienceDirect, Springer Nature Link, and SAGE, including all records indexed from database inception to July 31, 2026. Study selection and data extraction were performed independently by two reviewers. Thirteen studies met the prespecified selection criteria after full-text review. Quality appraisal was undertaken using instruments appropriate to the study design, with the SYRCLE Risk of Bias tool and the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Results: The review ultimately included 13 eligible studies. Preclinical studies generally reported no treatment-related toxicity, while clinical studies reported no serious treatment-related adverse events, although safety reporting varied across study designs. Heterogeneous interventions and inconsistent safety reporting limited the interpretation of the findings. Conclusions: Current evidence did not identify major short-term treatment-related safety concerns. However, heterogeneous methods, inconsistent safety reporting, and limited long-term data warrant further clinical studies using standardized herbal preparations and integrated maternal–infant safety monitoring.

Context: Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in Indonesia. Treatment outcomes are often compromised by adverse drug reactions (ADRs), particularly those related to prolonged linezolid use. Aims: To compare the incidence and temporal patterns of hematological and neurological ADRs between linezolid- and non-linezolid–based regimens in patients with DR-TB. Methods: A retrospective cohort study was conducted involving 295 DR-TB patients, including 278 receiving linezolid-based regimens and 17 receiving non-linezolid regimens. ADRs were identified from medical records, including patient-reported symptoms, clinical assessments, and laboratory data. Results: ADRs were more frequent in the linezolid group than in the non-linezolid group (268/278 vs 13/17). Anemia was the most common ADR among linezolid-treated patients (92.1%) and was significantly associated with linezolid use (aOR 8.15; 95%CI 2.28–23.50; p<0.001). Peripheral neuropathy occurred in 63.7% of patients and was also significantly associated with linezolid exposure (aOR 4.21; 95%CI 1.44–12.28; p = 0.005). Optic neuritis was less frequent (18.7%) and was not significantly associated with linezolid use. Anemia typically occurred within the first 1–5 months of treatment, whereas peripheral neuropathy and optic neuritis were associated with longer treatment duration. Distinct temporal patterns of ADRs onset were observed (Gray’s test, p<0.001). Conclusions: Linezolid-containing regimens were associated with a high burden of clinically significant ADRs in DR-TB treatment. Early-onset anemia and duration-dependent neurotoxicity highlight the importance of routine laboratory monitoring and structured neurological and ophthalmological surveillance during prolonged therapy.

Introduction:: Carbon-based nanomaterials, specifically carbon dots (CDs), are increasingly being explored for applications in the health sector. The goal of synthesizing CDs is to enhance the therapeutic effectiveness and reduce the toxicity of raw materials. Kepok banana (Musa paradisiaca L.) peel contains higher levels of flavonoids and phenols compared to other types of bananas. Flavonoids play a key role in inhibiting the formation of proinflammatory cytokines, making them effective as anti-inflammatory agents. This study aimed to explore the biomedical applications of banana peel-derived CDs as anti-inflammatory agents. method: This research study utilized both pyrolysis (P-CDs) and hydrothermal (H-CDs) techniques to convert banana peels into CDs. The resulting CDs were tested for anti-inflammatory effectiveness using the carrageenan-induced inflammation model in Wistar rats, with doses of 25 mg/kg body weight (BW), 50 mg/kg BW, and 100 mg/kg BW, and compared to the standard drug, ibuprofen, at a dose of 36 mg/kg BW. result: Banana peel-derived CDs effectively exhibited anti-inflammatory activity in both preventive and curative modes, as measured by the volume of edema formed and the percentage of inhibition of inflammation in the paws of the rats. This activity was further supported by a decrease in IL- 6 and TNF-α levels in rat serum. Discussion:: P-CDs (25 mg/kg BW) showed enhanced preventive anti-inflammatory effects versus H-CDs and ibuprofen, attributed to their optimized surface chemistry and nanoscale properties. Future studies should implement chromatographic purification to address residual precursors detected by FTIR, ensuring clinical-grade reproducibility. Conclusion:: Banana peel-derived CDs have the potential to serve as an active ingredient for antiinflammatory therapy; however, further studies on their pharmacokinetics are needed in relation to their safety and effectiveness as medicinal materials.

Background/Objectives: The use of linezolid in drug-resistant tuberculosis has shown good effectiveness but has a high risk of adverse drug reactions (ADRs). Linezolid-related ADRs have been widely reported and may affect their therapeutic effect. This systematic review aimed to describe linezolid-related ADRs in drug-resistant tuberculosis. Methods: This literature review was conducted on PubMed, Scopus, ProQuest, and Sage without year limitation, up to June 2023. Study quality was assessed using the JBI checklist to evaluate method quality and risk of bias in the included articles. Inclusion criteria included studies assessing linezolid-correlated ADRs in drug-resistant tuberculosis patients with individual regimens, having access to the full text, and using the English or Indonesian language. Potential reporting bias was minimized by comprehensive database search and duplicate screening. Results: Initially, we identified 650 potential studies. Upon further assessment for relevance and eligibility, seven articles were selected for analysis. From seven articles, it was shown that all articles were reporting about linezolid-correlated ADRs. The three main ADRs are hematologic toxicity, peripheral neuropathy, and optic neuritis. In addition, gastrointestinal disorder and hyperlactatemia are reported as ADRs too. Varied doses of linezolid were used in the seven articles; they range from 300 mg to 1200 mg, with 600 mg/twice daily and 1200 mg/day being dominant. Conclusions: Linezolid-associated ADRs are dose- and duration-dependent. Hematological toxicity most commonly occurs at the beginning of treatment, while peripheral neuropathy and optic neuritis appear after long-term use. Therefore, intensive monitoring and therapeutic drug monitoring are essential to ensure the safety of linezolid therapy.

Context: Biochemical assessment is crucial for evaluating pancreatic damage and subsequent recovery. Investigation of pancreatic elemental composition and comparison of levels between normal and diabetic states could serve as a valuable focus. Aims: To compare pancreatic elemental levels between healthy mice and those with streptozotocin-induced diabetes. Methods: X-ray fluorescence spectroscopy was employed to quantify pancreatic elemental levels in normal mice and mice induced with intraperitoneal streptozotocin at 45 mg/kg, four weeks post-induction. Histopathological examination of the pancreas was also performed to confirm diabetic changes. Results: Significant alterations were observed in the levels of antimony, calcium, and phosphorus, with subtle variations detected in scandium, chloride, magnesium, aluminum, sulfur, silicon, potassium, and sodium. Conclusions: These elemental deviations can serve as indicators of pancreatic integrity and function, aiding in the evaluation of pancreatic condition in diabetes. This understanding may be applied to the development of novel therapeutic strategies for combating diabetes.

Lipoxygenase (LOX) is an enzyme essential for the formation of leukotriene, an endogenous substance involved in inflammatory pathological conditions, including asthma and rheumatoid arthritis. Plants that belong to the Zingiberaceae family have been empirically used as drugs in Indonesia. This study aimed to screen the LOX-inhibiting activity of 18 plants from the Zingiberaceae family. The highest activity has been identified for their compound to continue with bioinformatics studies. Bioinformatics analysis to reveal and confirm the gene target of the active compound was acquired from the STITCH, STRING, and Swiss Target Prediction databases. The research result showed that the ethanol extract of Curcuma zedoaria at 100 ppm had the highest inhibiting activity compared to other extracts with a value of 54.8% and the IC50 value is 86.03 ppm. The further test also showed that the essential oil of C. zedoaria (EOCZ) in the selected plants was better than the extracts and their fractions. The bioinformatics study showed that the potential target of EOCZ is MAPK3, MPO, HMOX1, ACE, PARP1, PPARG, ALOX 5 (5-LOX), PTGS1, PTGES, ESR, and NOS2. The further test also showed that the essential oil content of C. zedoaria was better than the extracts and their fractions. The bioinformatics study showed that one of the potential targets of EOCZ is 5-LOX. 5-LOX is essential in inflammatory reactions and might be the potential as an adjunct therapy for this disease for this particular respiratory disorder.

Breast cancer is the most prevalent cancer in women. Anthracyclines are commonly used as the first line of treatment, often combined with other agents, including trastuzumab. Despite their efficacy, both drugs pose a risk of cardiotoxicity, which may impair patients’ quality of life (QoL) and hinder treatment persistence. Anthracycline-induced cardiotoxicity is dose-dependent and generally irreversible, whereas trastuzumab is associated with potentially reversible cardiac dysfunction. This review discusses the risk factors and biological mechanisms underlying chemotherapy-induced cardiotoxicity in breast cancer and explores effective strategies for prevention and treatment. It has been demonstrated that several cardioprotective strategies, such as treatments with angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), beta-blockers, and dexrazoxane, can help lessen cardiotoxic effects. A better understanding of cardioprotective strategies may help optimize cancer treatment without compromising cardiovascular function.

The management of acute lymphoblastic leukemia (ALL), the most common pediatric malignancy, critically relies on thiopurine therapy, such as 6-mercaptopurine (6-MP), during the maintenance phase. However, significant inter-individual response variety and high risk of myelosuppression often disrupt therapy efficacy. Pharmacogenetics offer crucial strategies to personalized therapy. While thiopurine methyltransferase (TPMT) was initially the primary focus, the discovery of nudix hydrolase 15 (NUDT15) appears as a more comprehensive determinant of thiopurine intolerance. This review aims to consolidate and critically evaluate the advancement achieved in unraveling the biological mechanism and clinical significance of NUDT15 pharmacogenetics in thiopurine therapy. Foundational studies showed the vital role of NUDT15 in the detoxification of active thiopurines, with common genetic variants (for instance, p. Arg139Cys) significantly disrupting its activity, leading to the accumulation of toxic metabolites. Observational studies consistently associated NUDT15 variants with severe myelosuppression, notably in Asian populations. Recent randomized controlled trials (RCTs) confirmed that NUDT15 genotype-guided dosing effectively reduces thiopurine-induced toxicity without interfering with the therapeutic outcome. Despite these advancements, challenges remain present, including the incomplete characterization of rare variants, limited data in the diverse Asian populations, and the need for standardized integration with metabolite monitoring. In conclusion, NUDT15 pharmacogenetics is essential for improving patient safety and thiopurine dosage optimization in the treatment of ALL. For thiopurine tailored medicine to be widely and fairly implemented, future research should focus on increasing genetic data across different populations, improving the dose adjustment algorithm, and harmonizing therapeutic guidelines.

Indah Tri Lestari, Kusnandar Anggadiredja, Afrillia Nuryanti Garmana, Ratna Annisa Utami. J Pharmacopuncture 2025;28:11-23. https://doi.org/10.3831/KPI.2025.28.1.11