JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA

Exploring Side Effects of Warfarin in Outpatients at Tertiary Hospital in Indonesia

Fatimatuz Zahra Oviary Satryo — 2025-08-31

Background: Patients with atrial fibrillation, venous thromboembolism, valvular disease, cardioembolic stroke, and acute myocardial infarction are prescribed the oral anticoagulant warfarin to treat thrombi. To guarantee its efficacy and safety, anticoagulants must be closely monitored. Furthermore, warfarin has a narrow therapeutic index, which increases the risk of side effects, particularly in the early stages of treatment. Objective: This study aimed to analyze the incidence of warfarin side effects in outpatients at Dr. Soetomo General Hospital. Methods: A retrospective cross-sectional design was adopted for outpatients at the Cardiology Department of Dr. Soetomo General Hospital from March to May 2023. Data were collected on the incidence of side effects in outpatients who received warfarin for a minimum of one month through an interview process. Other data, including age, sex, duration of warfarin therapy, comorbidities, and INR at the last scan, were extracted from medical records. The Chi-Square test was used to examine the data. Results: The results showed that 88 patients (42.7%) had side effects of bleeding (126 events). These included gum bleeding (22.3%), hematoma (20.4%), melena (7.7%), menometrorrhagia (2.4%), epistaxis (1.9%), hematuria (1.5%), hematemesis (1.0%), hemoptysis (1.0%), spontaneous venous bleeding (1.0%), hematochezia (0.5%), hemostasis during blood sampling (0.5%), tongue bleeding (0.5%), and subconjunctival bleeding (0.5%). Conclusion: The incidence of side effects during warfarin treatment was high, accounting for approximately 42.7% of cases. Furthermore, one patient experienced more than one side effect.

Optimization and Stability Assessment of Clindamycin HCl Transethosome: Exploring the Effects of Ethanol and Tween 80 Concentrations

Annisa Amriani — 2025-08-31

Background: Clindamycin HCl is drug commonly used as an anti-acne in conventional topical formulations. However, effectiveness of clindamycin HCl in conventional topical formulations is limited due to poor skin penetration, whereas Propionibacterium acnes colonies in the deeper sebaceous follicle area. To overcome this limitation, transethosome emerged as an innovative drug delivery system capable of enhancing drug permeation through the skin. Objective: This study aimed to optimise clindamycin HCl transethosome formula using a 2²-factorial design. Methods: The optimisation was carried out with two factors and two levels, ethanol (20% and 40%) and Tween 80 (15% and 25%), on the responses of particle size, polydispersity index, and entrapment efficiency. Transethosomes were prepared using the thin-layer hydration method. Furthermore, the optimum transethosomes were tested for stability using the ICH Q1A(R2) method. Results: The optimum formula contains 20% ethanol and 15% Tween 80. The optimum transethosome shows a particle size of 240.933 ± 1.488 nm, a polydispersity index (PDI) of 0.177 ± 0.013, and an entrapment efficiency (EE) of 89.401 ± 0.118%. The release model follows zero-order kinetics with an activation energy of 2.978758 cal/mol. The shelf life at 25°C ± 2°C / RH 60% ± 5% is 22.536 days, and at 5°C ± 3°C is 24.572 days. Conclusion: The optimum transethosomal formula of clindamycin HCl exhibited good initial physical characteristics, with particle size below 250 nm, polydispersity index (PDI) of less than 0.3, and high entrapment efficiency (EE). However, the low shelf life indicated a need for further optimisation to achieve long-term stability.

Efficacy of Ticagrelor Monotherapy in Patients at High Bleeding Risk Undergoing Percutaneous Coronary Intervention: a Systematic Review

Erlita Nur Arifana — 2025-08-31

Background: Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) prevents ischemic events. However, prolonged therapy increases the risk of bleeding. In this context, an antithrombotic strategy is applied to post-PCI patients by discontinuing aspirin and maintaining P2Y12 receptor monotherapy. Currently, patients with ACS treated with the single antiplatelet agent ticagrelor prefer to apply DAPT for 1 to a few months to open blocked arteries. Objectives: This systematic review aimed to evaluate the clinical efficacy of transitioning high-bleeding-risk patients to ticagrelor monotherapy following a three-month course of DAPT. Methods: A systematic literature review based on the PRISMA statement was conducted to review articles on DAPT, PCI, ticagrelor monotherapy, and high bleeding risk (HBR). The article search was conducted using Internet search databases, including PubMed and ScienceDirect, published between January 2014 and December 2024. Results: Six studies met the inclusion criteria and were included in the analysis. Clinical outcomes were assessed over a follow-up period of up to one year, including endpoints such as all-cause mortality, myocardial infarction, stent thrombosis, stroke, and target vessel revascularization. The secondary endpoints included major adverse cardiovascular and cerebrovascular events (MACCE), significant bleeding defined by Bleeding Academic Research Consortium (BARC) types 2, 3, or 5, and net adverse clinical events (NACE). Conclusion: the use of ticagrelor monotherapy after 3 months of dual antiplatelet therapy is expected to assist healthcare professionals in considering the risk-benefit of single therapy for patients after percutaneous coronary intervention.

Medication Adherence, Quality of Life, and Rehospitalization in Post-Acute Coronary Syndrome Patients

Yustiana — 2025-08-31

Background: Post-ACS patients often face an increased likelihood of mortality, rehospitalization, and diminished quality of life as a consequence of poor medication adherence. Objective: This study aimed to evaluate the level of adherence to medication in post-ACS patients and its relationship with quality of life and rehospitalization rates. Methods: A cross-sectional, observational, single-center, prospective study conducted at Universitas Airlangga Teaching Hospital, Surabaya. Compliance with medication was evaluated using the Adherence Refill Medication Scale-7 (ARMS-7) questionnaire, while quality of life was measured using the Short Form-36 (SF-36) Quality of Life questionnaire. Rehospitalization rates were obtained through direct interviews and medical record observations within 45 days of hospital discharge. Results: In total, 39 patients participated in this study, with overall adherence rates of 35.89% for all prescribed medications, 53.85% for antiplatelets, 38.46% for statins, 55.56% for beta-blockers, and 58.06% for ACEIs/ARBs. Among the quality-of-life dimensions, social functioning had the highest score (93.01 ± 15.89), whereas physical role functioning had the lowest score (40.39 ± 35.18). Within 45 days of hospital discharge, 26% of the patients experienced rehospitalization. Statistical analysis indicated a positive correlation between adherence to all prescribed medications and physical role functioning in relation to QoL (p = 0.038). In addition, overall medication adherence was negatively correlated with the risk of rehospitalization (p = 0.019). Conclusion: Total medication adherence was associated with improved physical function and rehospitalization events. Providing education can lead to better therapeutic outcomes, improved quality of life, and reduced rehospitalization in patients.

Implementing Electronic Forms for Prescription Screening during Pregnancy in Outpatient Obstetric Clinic

Lisa Aditama — 2025-08-31

Background: Prescription screening is an assessment of the suitability of a prescription performed by a pharmacist to minimize medication errors. Numerous drugs can cross the placenta; therefore, caution is required when using medications during pregnancy. Objective: This study aimed to determine the problems of prescribing based on administrative, pharmaceutical, and clinical requirements using electronic forms and to analyze drug safety during pregnancy using electronic prescription archives from the outpatient obstetric clinic. Methods: This research employed an observational study utilized quantitative methods and retrospective data collection. The analysis focused on descriptive statistics to summarize and interpret the data according to the Pharmaceutical Care Standard in hospitals. Results: Administrative problems included the absence of a digital signature from the prescriber, patient weight, and allergy history in 100 electronic prescriptions (100%). Pharmaceutical requirement problems included the absence of dosage strength (8.00%) and unclear usage rules (9.00%). Clinical considerations included indications for drug selection (8%), potential drug interactions (3.00%), dose appropriateness (3.00%), duplication (2.00%), and contraindications (6.00%). Based on drug safety in pregnant women, 40 types of drugs were identified as category A drugs (7.50%), category B (32.50%), category C (50.00%), off-label (2.50%), and unknown (7.50%). Conclusion: Electronic prescription screening, which uses digital forms to review prescriptions, is a tool developed to improve patient safety by efficiently identifying potential drug therapy problems. The system accommodates structured screening based on specific criteria, such as pregnancy category and potential drug interactions, which helps prevent errors and ensures appropriate medication use.

Effect of Glycerin on Stability and Antioxidant Activity of Ethyl Acetate Fraction of Secang Wood Face Mist

Nur Halisa Rahmawati — 2025-08-31

Background: Secang wood (Caesalpinia sappan L.) is a plant that contains brazilin, a natural antioxidant. A potential problem in the brazilin formulation process is that brazilin becomes unstable due to environmental influences. Face mist is one of the formulations that contains glycerin to maintain the stability. Glycerin can stabilize brazilin by forming hydrogen bonds between glycerin and brazilin. Objective: The main objective of this research was to evaluate the effect of glycerin on the physical stability and antioxidant activity in ethyl acetate fraction of secang wood face mist. Methods: Face mist formulation was prepared using different glycerin concentrations, such as F1 (10%), F2 (15%), and F3 (20%). Face mist was formulated using ethyl acetate fraction of secang wood, glycerin, phenoxyethanol, and aquadest. Physical evaluation stages included organoleptic, homogeneity, pH, specific gravity, viscosity, spray spreadability, skin moisture, cycling tests, and hedonic tests. 2,2-Diphenyl-1-picrylhydrazyl (DPPH) method was used to examine antioxidant activity. Results: The physical evaluation showed that face mist produced good results and complied with the requirements of face mist. The antioxidant activity test showed that face mist with the IC₅₀ value for F1 was 22.114±0.046 µg/mL, F2 was 21.828±0.033 µg/mL, and F3 was 21.378±0.025 µg/mL. Conclusion: Based on these observations, the best formula was F3 because the antioxidant activity was classified as very strong, and the physical evaluations were considered more stable than others. In addition, F3 had the highest average score on the hedonic test.

Preliminary In Vitro Antiplatelet Potential of Ipomoea pes-caprae from North Lombok with Adenosine Diphosphate-Induced Platelet Aggregation

Ilsa Hunaifi — 2025-08-31

Background: Cardiovascular diseases, particularly ischemic stroke, remain a global health burden, necessitating potential candidate for further antiplatelet with fewer side effects. Objectives: This study aimed to evaluate the antiplatelet potential of ethanolic extracts from the leaves and stems of Ipomoea pes-caprae (Katang-katang) from North Lombok, Indonesia, through ADP-induced platelet aggregation. Phytochemical screening, total tannin quantification, and in vitro antiplatelet assays were conducted. Methods: The leaves and stems were macerated with 96% ethanol, followed by qualitative phytochemical tests, Folin-Ciocalteu-based tannin analysis, and platelet aggregation inhibition assays using human platelet-rich plasma. Results: The extracts contained alkaloids, flavonoids, and tannins, with higher tannin levels in leaves (4.02 ± 0.02 mgEAT/g) than stems (3.67 ± 0.17 mgEAT/g). Concentration-dependent antiplatelet activity was observed, with leaf extracts showing inhibition (85.9% at 2000 μg/mL) compared to stems (79.5%) and aspirin (77.3%). IC₅₀ values were 727.78 μg/mL (leaves) and 349.95 μg/mL (stems). Statistical analysis confirmed significant differences across concentrations (p < 0.05). Conclusion: These findings demonstrate that Ipomoea pes-caprae exhibits potent antiplatelet activity, attributed to its tannin and phytochemical content, with leaves being more effective. Although these findings suggest preliminary antiplatelet potential, further analysis is required to validate the method using aspirin IC₅₀, and subsequent in vivo and pharmacological investigations are necessary before therapeutic application can be claimed.

Formulations and Antibacterial Activity of Shallot (Allium cepa L.) Peel Extract Patch against Streptococcus pyogenes

Siwi Nur Azizah — 2025-08-31

Background: Bacterial pharyngitis is an inflammatory condition in the back of the throat caused by Streptococcus pyogenes. Patients are often prescribed antibiotics and antiinflammatories to alleviate pain and discomfort while reducing bacterial growth in the throat. However improper and prolonged use of antibacterial and antiinflammatory agents increases the risk of bacterial resistance and side effects. An often discarded Shallot (Allium cepa L.) peel rich in flavonoids with great antibacterial and anti-inflammatory properties is potentially used as an alternative treatment for bacterial pharyngitis. Objective: This study aimed to develop shallot peel extract as an antibacterial against Streptococcus pyogenes. Methods: Patch was formulated with variations in extract concentration of 5% (F1), 10% (F2), and 15% (F3) to observe their influence on weight uniformity, thickness, folding endurance, surface pH, moisture content, and antibacterial activity using disc diffusion. Results: All formulations produce slightly heavy and thicker but uniform patches (CV<5%), surface pH suitable for application in the skin (4.6-4.9), flexible and durable patches with high folding endurance (> 300 folds), good moisture content (<10%) and moderate to strong antibacterial activity (inhibition zone diameter ranging from 9 to 13.67 mm). Variations in extract concentration in the formula significantly influenced the thickness, weight, folding endurance, and also the antibacterial activity of the patches. Higher concentrations of extract produce thicker and heavier patches but stronger antibacterial activity against pharyngitis pathogens. Conclusion: Therefore, antibacterial patches containing up to 15% shallot peel extract are potentially used as an alternative treatment for pharyngitis.

A Systematic Review: Cost-Effectiveness of SGLT2 Inhibitors versus DPP-4 Inhibitors as Add-on to Metformin

Izzatu Al Hanifiyah — 2025-08-31

Background: The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) are two second-line therapy alternatives for T2DM patients inadequately controlled with metformin. Objective: This study aimed to systematically review the cost-effectiveness of combining metformin+SGLT2i vs metformin+DPP-4i for T2DM treatment. Methods: A systematic search was conducted in PubMed, Scopus, and ScienceDirect for articles published between 2015-2025, using predefined keywords and following the PRISMA and PICOS frameworks (P: T2DM patients uncontrolled on metformin monotherapy; I: Metformin+SGLT2i therapy; C: Metformin+DPP-4i therapy; O: Cost, clinical outcomes (HbA1c% reduction), Incremental Cost-Effectiveness Ratio (ICER) values, Quality Adjusted Life Years (QALY); S: Study with cost-effectiveness analysis design). Additional studies were identified through reference screening. Eligible articles were independently reviewed and assessed for reporting quality using the CHEERS-2022 standards. Results: Five studies met the inclusion criteria. Considerable heterogeneity was observed with mean patient ages ranging from 55-61 years old and baseline HbA1c levels from 7.9%-9.4%. The studies were conducted in the US, UK, Mexico, and Greece, all funded by the pharmaceutical industry, and used economic models. Despite these differences, all studies consistently demonstrated that combining metformin+SGLT2i was more cost-effective than metformin+DPP-4i. SGLT2i improved the quality of life by 0.032–0.04 QALYs, reduced hypoglycemia, and provided additional benefits for patients with cardiovascular risk, although it was associated with higher initial costs. Conclusion: This review showed that the combination of metformin+SGLT2i was more cost-efficient and effective in managing T2DM than the combination of metformin+DPP-4i.

In-Vitro and In-Silico Study: The Anti-Inflammatory Activity of Ethanol Extract from Cogon Grass Roots (Imperata cylindrica L.

Siti Warnasih — 2025-08-31

Background: Inflammation is a protective reaction triggered by harmful substances, microbes, or physical trauma. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat inflammation, though they have certain drawbacks, such as the potential for chronic kidney failure and unfavorable gastrointestinal side effects. Therefore, alternative treatments are needed. Cogon grass (Imperata cylindrica L.) roots contain secondary metabolites that may offer potential for inflammation treatment. Objective: This study aims to investigate the potential of secondary metabolites from cogon grass roots as anti-inflammatory agents, both in vitro using protein denaturation inhibition techniques and in silico against the COX-1 and COX-2 enzyme receptors. Methods: Molecular docking of COX-1 (PDB ID 6Y3C) and COX-2 (PDB ID 1PXX) using AutoDock Tool 1.5.6 was used to test the anti-inflammatory activity. In parallel, the in vitro technique involved spectrophotometric denaturation inhibition of the BSA (bovine serum albumin) protein. Results: The in silico results showed that the cyclovalone ligand exhibited the highest interaction and stability, with Gibbs free energies of -9.3 kcal/mol against COX-1 and -9.8 kcal/mol against COX-2, compared to the control ligand diclofenac, which had Gibbs free energies of -6.5 kcal/mol against COX-1 and -8.5 kcal/mol against COX-2. The 30% ethanol extract of cogon grass roots demonstrated anti-inflammatory activity in the in vitro analysis, with an IC50 value of 71.79 µg/mL. Conclusions: These preliminary findings suggest that the ethanol extract of cogon grass roots contains cyclovalone compounds with potential as anti-inflammatory agents.

Acute Oral Toxicity and Histophatological Study of Ethanol Extract and Fractions of Etlingera elatior Flowers in Mice

Inayatush Sholihah — 2025-08-31

Background: Etlingera elatior (Jack) R.M. Sm or Kecombrang Flower had been used traditionally to enhance the taste of food. Some studies reported its pharmacological activities such as antioxidant, anti-inflammatory, antimicrobial, and anticancer. However, its safety has not yet been reported explicitly. Objective: To investigate the acute oral toxicity, macropathological and histopathological changes of 96% ethanol extract, n-hexane, ethyl acetate and methanol-water fractions of Etlingera elatior flowers in Balb/C mice. Methods: The 96% ethanol extract, n-hexane, ethyl acetate and methanol-water (3:7) fractions were given to mice with 4 dose levels (75, 150, 300, and 600 mg/Kg body weight). Single oral administration of them was done on the first day of the test and the mice were then observed in 14 consecutive days. The control group received Na-CMC 0,3%. Changes in behavior, mortality rate, body weight, macropathology and histopathology of kidneys and liver were assessed. Results: No signs of toxicity or mortality were observed when mice were exposed to the 96% ethanol extract, n-hexane, ethyl acetate and methanol-water fractions. The were no significant changes in the body weight. Macropathological examination of the liver and kidneys showed normal results with a brownish red color, smooth surface and rubbery consistency. Histopathological examination revealed mild, moderate, and severe damage to the liver and kidneys of mice, however the level of damage was not followed by an increase in dose. The oral lethal dose was higher than 600 mg/Kg. Conclusion: Etlingera elatior (Jack) R.M. Sm did not produce toxic effects in mice after acute treatment.

Public Perception and Practices Towards Ethanol Content and Halal Assurances of Herbal Syrup Products

Savira Wahyu Larasati — 2025-08-31

Background: Herbal syrup is known to be an alternative medicine due to its safe material. However, the presence of ethanol content in herbal syrup as the extraction residue can be crucial in determining the halalness of the product. Objectives: The study aims to evaluate public perceptions and practices regarding the ethanol content and halal assurances of herbal syrup products in Yogyakarta City, Indonesia. Methods: A cross-sectional study using convenience sampling was conducted with 300 respondents for perception and 250 respondents for practices among the general public in 14 sub-districts across Yogyakarta City. A validated and self-administered questionnaire was developed and distributed both online and paper-based. Results: This study found that 51% of the respondents had positive perceptions and 62.80% of the respondents had positive practices regarding the ethanol content and halal assurances of herbal syrup products. Age (p<0.001) was found to have an association with perception, while religion (p=0.0013) was found to be associated with practices. The correlation between perception and practices was also found to be moderate (p<0.001; r=0.340). Conclusion: The majority of general public perceptions and practices in Yogyakarta City were found to be positive regarding the ethanol content and halal assurances of herbal syrup products and identified a correlation between perception and practices as well as sociodemographic characteristics with perception and practices. These findings can be used by various stakeholders, including the government and manufacturers, to improve the halal certification of herbal syrup products and raise public awareness about the ethanol content of herbal syrup products.