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UTILIZATION OF INDONESIA’ NATURAL RESOURCES AS RAW MATERIALS IN PHARMACEUTICAL INDUSTRIES FOR THE TREATMENT OF DEGENERATIVE DISEASES MEISARANI, AGI; Sinuraya, Rano K.
Farmaka Vol 16, No 2 (2018): Farmaka (Agustus)
Publisher : Fakultas Farmasi, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (262.213 KB) | DOI: 10.24198/jf.v16i2.17902

Abstract

In Indonesia, health problems such as treatment of degenerative diseases are still not be handled properly. The common degenerative diseases in Indonesia are diabetes mellitus and hypertension. Generating qualified medicines with lower cost for degenerative disease are still be a major problem because Indonesia has not been independent in pharmaceutical raw materials. Raw materials are important part in the production process of pharmaceutical preparations. Indonesia obtained raw materials by importing from various countries. By looking at the various potentials of natural resources that can be used as a source of raw material in pharmaceutical industries, both active pharmaceutical ingredients (API) and excipients, Indonesia will be able to independently produce the pharmaceutical raw materials. To achieve independency of pharmaceutical raw materials, the appropriate processing methods to produce quality raw materials is needed. Based on this issue, a review of various studies was performed including the processing of API and pharmaceutical excipients raw materials of plant and animal body parts. ?Kayu Manis? (Cinnamomum burmanii) and ?Brotowali? (Tinospora cripa L.) which can be utilized as raw material pharmaceutical ingredient for the treatment of diabetes mellitus and ?Mengkudu" (Morinda citrifolia L.)  which can be used for the treatment of hypertension disease. Meanwhile, some natural resources that can be used as excipients are gelatin from the skin and fish bones (as a binder in the preparation of tablets), carrageenan from seaweed (emulsifier and suspending agent) and the Mimosa ?Putri Malu? (Mimosa pudica L.) mucilago seed (as an alternative to polymer as buchoadhesive agent, disintegrator and binder)
REVIEW: PENGGUNAAN OBAT OFF-LABEL PADA ANAK-ANAK PURWADI, FEBBY VALENTINE; Sinuraya, Rano K.
Farmaka Vol 16, No 1 (2018): Farmaka (Juni)
Publisher : Fakultas Farmasi, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (165.412 KB) | DOI: 10.24198/jf.v16i1.16843

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Hingga saat ini pengujian klinis pada populasi pediatrik masih terbilang sedikit dibandingkan dengan pengujian klinis pada populasi dewasa. Hal ini berdampak pada ketersediaan informasi mengenai efikasi dan keamanan obat untuk populasi pediatrik. Alhasil, dokter dengan terpaksa harus mengambil keputusan untuk memberikan obat secara off-label. Penggunaan obat off-label dapat meningkatkan insiden terjadinya Medication error dan Adverse drug reaction (ADR), sehingga penggunaannya memunculkan kekhawatiran sebagaimana risiko tersebut dapat terjadi. Review ini bertujuan untuk memberikan gambaran mengenai pengguanaan obat off-label dan keamanan penggunaan obat off-label pada populasi pediatrik.
PELAYANAN FARMASI KLINIS MENINGKATKAN KONTROL GULA DARAH PASIEN DIABETES MELITUS Sinuraya, Rano K.; Oktrina, Amalia; Handayani, Nurul K.; Destiani, Dika P.; Puspitasari, Irma M.
Indonesian Journal of Clinical Pharmacy Vol 8, No 4 (2019)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2019.8.4.271

Abstract

Tingginya prevalensi diabetes melitus (DM) di Indonesia menjadi perhatian khusus oleh pemerintah karena selain pengobatannya seumur hidup, tingkat kepatuhan pasien cenderung rendah sehingga kadar gula darah pasien sering tidak terkontrol. Apoteker memiliki peranan yang sangat penting dalam mengotrol outcome klinis ini. Peranan apoteker dimulai dari skrining resep, compounding, dispensing, pelayanan informasi obat, konseling hingga monitoring terapi dapat meningkatkan kualitas hidup pasien. Penelitian ini bertujuan untuk menganalisis perbedaan outcome klinis antara pasien DM yang menerima pelayanan farmasi klinis dari apoteker dan yang tidak menerima pelayanan farmasi klinis dari apoteker. Penelitian ini merupakan studi observasional dengan desain case control yang dilakukan di delapan fasilitas kesehatan tingkat pertama di Kota Bandung pada bulan Desember 2017?Maret 2018. Pengambilan sampel dilakukan dengan purposive sampling, sebanyak 262 data diperoleh dari rekam medis pasien berupa demografi dan kadar glukosa darah puasa selama tiga bulan berturut-turut. Hasil penelitian menunjukkan bahwa kontrol glukosa darah puasa memiliki hubungan yang signifikan terhadap jenis kelamin (p 0,019), lama menderita DM (p 0,018), dan riwayat keluarga (p 0,047). Pasien yang memperoleh pelayanan farmasi klinis dari apoteker memiliki kontrol glukosa darah yang baik dengan rata-rata nilai glukosa darah puasa per bulan berada di bawah 126 mg/dL (p 0,000); OR 11,6 (CI 95% 6,282?21,420). Pelayanan farmasi klinis yang dilakukan oleh apoteker meningkatkan kontrol glukosa darah puasa pasien DM sebanyak 11 kali dibandingkan dengan pasien yang tidak memperoleh pelayanan farmasi klinik dari apoteker.Kata kunci: Diabetes melitus, farmasi klinik, fasilitas kesehatan tingkat pertama (FKTP), gula darah puasa Clinical Pharmacy Services Improve Blood Sugar Control of Diabetes Mellitus PatientsAbstractHigh prevalence of diabetes mellitus (DM) in Indonesia is a government particular concern because it will be a lifetime treatment then, the level of patients? compliance tends to be low and causes patients? blood sugar levels often uncontrolled. Pharmacists have a very important role in controlling this clinical outcome. The role of pharmacists such as prescription screening, compounding, dispensing, drug information, counseling and monitoring therapy can improve patients? quality of life. This study aimed to investigate the differences in clinical outcomes between DM patients who received clinical pharmacy services from pharmacists and who did not receive clinical pharmacy services from pharmacists. This research was an observational study with case control design which conducted at eight Primary Healthcare Centers (PHCs) in Bandung City during December 2017?March 2018. Sampling was conducted using purposive sampling, as many as 262 data obtained from patient medical records such as demographics and fasting blood glucose levels for 3 consecutive months. The results showed that fasting blood glucose control had a significant relationship with gender (p 0.019), duration of DM (p 0.018), and family history (p 0.047). Patients who received clinical pharmacy services from pharmacists had good blood glucose control with an average monthly fasting blood glucose value below 126 mg /dL (p 0,000); OR 11.6 (95% CI 6,282-21,420). Clinical pharmacy services provided by pharmacists can improve patients? fasting blood glucose control up to 11 times compared with who do not receive clinical pharmacy services.Keywords: Clinical pharmacy, diabetes mellitus, fasting blood glucose, primary healthcare center (PHC)
RISIKO PENINGKATAN EFEK SAMPING TERHADAP INTERAKSI OBAT WARFARIN DAN ANTIBIOTIK FARHATY, NAELI; Sinuraya, Rano K.
Farmaka Vol 16, No 2 (2018): Farmaka (Agustus)
Publisher : Fakultas Farmasi, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (256.874 KB) | DOI: 10.24198/jf.v16i2.17681

Abstract

Interaksi obat adalah salah satu permasalahan utama bagi pasien yang menerima terapi polifarmasi. Adanya interaksi antar obat menyebabkan terjadinya peningkatan risiko terjadinya efek samping dan rawat inap di rumah sakit. Salah satu interaksi obat yang sering terjadi yaitu obat warfarin  dan antibiotik. Interaksi kedua obat tersebut dapat menyebabkan terjadinya peningkatan risiko pendarahan. Antibiotik kuinolon, sulfonamid, dan makrolida dianggap memiliki risiko tinggi terhadap peningkatan toksisitas warfarin, sedangkan amoksisilin dan sefaleksin diyakini memiliki risiko yang lebih kecil. Umumnya, mekanisme interaksi antara kedua obat tersebut dapat melalui penghambatan enzim hati CYP2C9 dan menghambat sintesis vitamin K dari flora normal usus. Agar efektifitas dari kedua obat tetap sesuai maka diperlukan penyesuaian dosis dan pemantauan INR (International Normalized Ratio).
Analisis Minimalisasi Biaya Antibiotik Pasien Sepsis Salah Satu Rumah Sakit Kota Bandung Purwanti, Okky S.; Sinuraya, Rano K.; Pradipta, Ivan S.; Abdulah, Rizky
Indonesian Journal of Clinical Pharmacy Vol 2, No 1 (2013)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (691.334 KB)

Abstract

Terapi antibiotik empirik merupakan salah satu komponen penunjang keberhasilan terapi sepsis, khususnya sepsis sumber infeksi pernapasan. Ketidaktepatan pemilihan terapi antibiotik empirik akan menimbulkan dampak buruk berupa munculnya resistensi bakteri terhadap antibiotik, perawatan pasien menjadi lebih lama, kematian, biaya pengobatan menjadi lebih mahal dan bagi rumah sakit akan menurunkan kualitas pelayanan rumah sakit bersangkutan. Tujuan penelitian ini adalah untuk mengetahui kelompok kombinasi antibiotik empirik yang paling efisien secara biaya yang digunakan pada pasien sepsis sumber infeksi pernapasan yang dirawat di salah satu rumah sakit di Kota Bandung periode tahun 2010?2012. Penelitian ini merupakan studi observasional analisis dengan pengumpulan data secara retrospektif. Data diambil dari rekam medis pasien rawat inap sepsis sumber infeksi pernapasan dan mendapat terapi antibiotik empirik seftazidim-levofloksasin atau sefotaksim-eritromisin. Komponen biaya yang dikumpulkan meliputi biaya antibiotik empirik, biaya tindakan, biaya penunjang, biaya rawat inap, dan biaya administrasi. Hasil penelitian menunjukkan bahwa total biaya perawatan kombinasi antibiotik seftazidim-levofloksasin sebesar Rp 12.751.082,49 dan kombinasi sefotaksim-eritromisin sebesar Rp 21.641.678,02. Berdasarkan hasil penelitian dapat disimpulkan bahwa kombinasi antibiotik seftazidim-levofloksasin lebih efisien dibanding kombinasi sefotaksim-eritromisin.Kata kunci: Antibiotik empirik, infeksi pernapasan, minimalisasi biaya, farmakoekonomi, sepsis Cost Minimization Analysis of Antibiotic Used by Sepsis Patients at a Hospital in Bandung Empirical therapy is one of the important supporting therapies for successful sepsis management including, sepsis with respiratory infection. Inappropiate empirical antibiotic therapy leads to resistance of antibiotics which results increases length of stay, mortality and subsequently higher the cost of healthcare and decreases the quality of hospital?s service. This study?s objective was to determine which the antibiotic combination group used for the treatment of sepsis with respiratory infection is the most efficient in cost minimization at a hospital in Bandung. Observational analitycal study is conducted by retrospective data. Data were collected from medical record of inpatients sepsis with respiratory infection who received empirical antibiotic therapy of ceftazidime-levofloxacin or cefotaxime-erythromycin. Direct medical cost were calculated from empirical antibiotic costs, costs of medical treatment, medical expenses, hospitalization costs, and administrative costs. The results showed that total cost of the combination of ceftazidime-levofloxacin is 12,751,082,49 IDR and cefotaxime-erythromycin is 21,641,678,02 IDR. It can be conclude that the combination of ceftazidime-levofloxacin is more efficientthan cefotaxime-erythromycin.Key words: Empirical antibiotics, respiratory infection, cost minimization, pharmacoeconomy, sepsis
Analisis Peresepan Obat Anak Usia 2–5 Tahun di Kota Bandung Tahun 2012 Pratiwi, Ami A.; Sinuraya, Rano K.
Indonesian Journal of Clinical Pharmacy Vol 3, No 1 (2014)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (554.821 KB) | DOI: 10.15416/ijcp.2014.3.1.18

Abstract

Penggunaan obat yang tidak rasional dapat menyebabkan kesalahan dalam pengobatan atau timbulnya efek samping yang tidak diinginkan. Kebijakan Obat Nasional (KONAS) telah mengembangkan kebijakan obat umum yang mengikat semua pelaku farmasi di Indonesia agar penggunaan obat dapat dilakukan secara rasional. Untuk mengembangkan strategi yang efektif dalam mengatasi penggunaan obat tidak rasional, maka perlu diketahui sejauh mana tingkat masalahnya, salah satunya melalui Indikator Peresepan yang telah ditetapkan oleh World Health Organization (WHO). Penelitian ini bertujuan untuk mengetahui pola peresepan obat pada anak usia 2 hingga 5 tahun di 14 Apotek Kota Bandung periode 2012 melalui indikator peresepan. Data yang digunakan sebanyak 2.195 lembar resep dari 14 Apotek Kota Bandung diambil secara retrospektif dan diolah berdasarkan indikator peresepan WHO. Hasil penelitian menunjukkan bahwa jumlah obat rata-rata dalam setiap lembar resep 3,54 item; persentase pasien yang menerima obat injeksi 0%; persentase pasien yang menerima antibiotik 75%;persentase obat yang diresepkan dengan nama generik 8,13% dan persentase obat yang diresepkan sesuai dengan Daftar Obat Esensial Nasional (DOEN) adalah 32,9%. Dengan demikian dapat disimpulkan pola peresepan obat anak usia 2?5 tahun di Kota Bandung pada tahun 2012 adalah jumlah item obat rata-rata yang diresepkan masih tinggi jika dibandingkan dengan standar WHO dan KONAS; peresepan injeksi di apotek tidak ada; persentase pasien yang menerima antibiotik jauh lebih tinggi dengan data WHO untuk penggunaan antibiotik di negara berkembang; peresepan obat generik lebih rendah daripada data WHO; dan peresepan obat yang sesuai dengan DOEN masih lebih rendah daripada data KONAS.Kata kunci: Indikator peresepan, pediatrik, penggunaan obat rasionalPrescribing Analysis for 2?5 Years Old Children in Bandung During Year 2012Despite the fact that irrational use of drugs will give medication errors effect or cause the unwanted side effects. The National Drug Policy (KONAS) has developed drug policies that involve all stake-holders in Indonesia in order to minimize the irrational drug use. This study aims to analyze drug prescribing for 2?5 years old children in 14 pharmacies in Bandung during 2012. Approximately 2,195 prescription sheets from 14 pharmacies in Bandung were collected and analyzed by using prescribing indicators from the World Health Organization (WHO). We found an average number of 3.54 drugs in a prescriptionsheet. We also found that 75% and 0% of all patients received antibiotics and injection, respectively. In particular, approximately 8% and 33% of all prescribed drugs were included in generic drug list and National List of Essential Medicines (DOEN), respectively. Based on data from the WHO and KONAS, it can be interpreted that the average number of drugs in a prescription-sheet is still high and the use of antibiotics is significantly higher compared to the use of antibiotics in other developing countries. Also,we summarized that the use of drugs according to generic drug list and DOEN are still low.Key words: Pediatric, prescribing indicators, rational use of medicine
Analisis Efektivitas Biaya Penggunaan Antibiotik Pasien Sepsis di Rumah Sakit di Bandung Rahayu, Cherry; Purwanti, Okky S.; Sinuraya, Rano K.; Destiani, Dika P.
Indonesian Journal of Clinical Pharmacy Vol 2, No 2 (2013)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (597.835 KB)

Abstract

Tujuan penelitian ini adalah untuk mengetahui kelompok kombinasi antibiotik empirik yang paling efektif secara biaya (cost effectiveness) yang digunakan pada sepsis sumber infeksi pernapasan yang dirawat di salah satu rumah sakit di kota Bandung periode tahun 2010?2012. Penelitian merupakan studi analisis observasional dengan pengumpulan data secara retrospektif. Data diambil dari rekam medis pasien rawat inap sepsis sumber infeksi pernapasan dan mendapat terapi antibiotik empirik sefotaksimmetronidazol dan sefotaksim-eritromisin. Komponen biaya yang dikumpulkan meliputi biaya antibiotik empirik, biaya tindakan, biaya penunjang, biaya rawat inap, dan biaya administrasi. Hasil Incremental Cost Effectiveness Ratio (ICER) menunjukkan rasio nilai biaya langsung terhadap pasien yang selamat sebesar Rp 3.301.090,00 untuk kombinasi sefotaksim- metronidazol yang dibandingkan dengan antibiotik empirik lain, sedangkan perbandingan kombinasi sefotaksim-eritromisin dengan antibiotik lain terhadap biaya dan pasien yang selamat sebesar Rp 2.227.366,89. Dapat disimpulkan bahwa kombinasi antibiotik sefotaksim-eritromisin lebih efektif secara biaya dibanding kombinasi sefotaksim-metronidazol.Kata kunci: Antibiotik empirik, cost effectiveness, farmakoekonomi, sepsis Cost Effectiveness Analysis of Antibiotic Used among Sepsis Patients in Hospital in BandungThe aim of this study was to determine the antibiotic combination group that were the most effective in cost (cost effectiveness) used as sepsis with respiratory infections treatment at one of hospital in Bandung. Observational study was conducted by retrospective data. Data were collected from medical record from inpatients sepsis with respiratory infection and received empirical therapy cefotaximemetronidazole or cefotaxime-erythromycin. Direct medical cost is collected from empirical antibiotic costs, costs of medical treatment, medical expenses, hospitalization costs, and administrative costs. The results of Incremental Cost Effectiveness Ratio (ICER) showed that ratio of direct medical cost and survived patients is 3.301.090,00 IDR for cefotaxime-metronidazole that compared to other empirical antibiotic, and 2.227.366,89 IDR for cefotaxime-erythromycin. It can be conclude that the combination of cefotaxime-erythromycin is more cost effective than cefotaxime-metronidazole.Key words: Empirical therapy, cost effectiveness, pharmacoeconomic, sepsis
Economic Evaluation of the Use of Cefotaxime and Ceftazidime in the Treatment of Pneumonia in Pediatric Patients Ruterlin, Valen; Sinuraya, Rano K.; Halimah, Eli; Barliana, Melisa I.; Hartini, Sri
Pharmacology and Clinical Pharmacy Research Vol 2, No 1
Publisher : Universitas Padjadjaran, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (229.785 KB) | DOI: 10.15416/pcpr.v2i1.15741

Abstract

The prevalence of pneumonia is particularly high among pediatric patients. Appropriate antibioticsselection is required to reduce mortality and morbidity rates associated with thesediseases. However, information on cost-effectiveness of empirical antibiotics treatment forpneumonia was limited. This study was aimed to evaluate cost-effectiveness of cefotaximeand ceftazidime for pneumonia in pediatric patients. This study was a retrospective crosssectional study conducted at a hospital in Bandung during January-December 2012. Datawere derived from medical records of pediatric pneumonia inpatients during study period.Cost was calculated based on direct medical cost, i.e., inpatient care, medical support, andmedicines that were used from admission until hospital discharge. The results showed thatthere was no statistical difference in the average medical cost of the treatment using cefotaxime(1,197,017 IDR) and ceftazidime (2,245,748 IDR). Incremental cost effectivenessratio (ICER) showed that cefotaxime is more cost effective than ceftazidime with greaterreduction of leukocytes level (576 IDR/mm3 ). The use of cefotaxime is recommended forthe treatment of pnuemonia in pediatric patients.Keywords: cost minimization, cost effectiveness, cefotaxime, ceftazidime, pneumonia
Evaluation of Medication Use Patterns among Geriatric Patients using World Health Organization Prescribing Indicators Puspitasari, Irma M.; Hanifah, Ani; Sinuraya, Rano K.
Pharmacology and Clinical Pharmacy Research Vol 4, No 2
Publisher : Universitas Padjadjaran, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (19.166 KB) | DOI: 10.15416/pcpr.v4i2.24527

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Geriatrics patients are paticularly suceptible to medication error due to complex clinical problems and multiple treatment. World Health Organization (WHO) published a set of prescribing indicators to promote rationale use of drug. This study aimed to evaluate medicine use pattern in geriatric patients at a primary care facility in Bandung, Indonesia, using WHO indicators. This research was conducted using cross sectional design with retrospective data collection. Medical presciption from geriatric patients aged 60-74 years old visiting primary care facility during 2013-2015 were selected. A total of 103.292 prescriptions were obtained in this study. The average number of drugs per encounter  was 2.1 (optimal range=1.6-1.8).   Vast majority (99.41%) of the drugs prescribed were generic drugs (optimal value=100%). The encounters with an antibiotics prescribed were 7.4% (optimal range=20.0-26.8%). Very few parenteral drugs were prescribed in this study setting (0.04%) (optimal range=13.4-24.1%). The drugs prescribed from essential drug list were 72.83% (optimal value=100%).  The most commonly prescribed drugs were paracetamol 500 mg, chlorpheniramine maleat 4 mg, amlodipine 5 mg, vitamin B complex, and glyceryl guaiacolat. The most frequently prescribed antibiotics were amoxicillin, cloramphenicol, cyprofloxacin, clindamycin, and oxytetracyclin.  In conclusion,  the medication use pattern in this study was below the WHO requirement. This finding called for a strategy to promote rational prescribing of medicines.  Keywords: geriatrics, WHO prescribing indicators, drug use patterns
INDUKSI PLURIPOTENT STEM CELL DENGAN MENGGUNAKAN OCT4, SOX2, KLF4, DAN C-MYC (FAKTOR YAMANAKA): PERKEMBANGAN DAN TANTANGAN Arifa, Irbah; Sinuraya, Rano K.
Indonesian Journal of Clinical Pharmacy Vol 9, No 1 (2020)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15416/ijcp.2020.9.1.56

Abstract

Sel punca embrionik memiliki kemampuan untuk membelah tanpa batas serta bersifat pluripotensi dan dapat berdiferensiasi menjadi sel dari tiga lapisan kecambah. Percobaan Takahashi dan Yamanaka pada tahun 2006 menunjukkan bahwa induced pluripotent stem cells (sel iPS) dapat diperoleh dengan penambahan sekumpulan faktor, yaitu Oct4, Sox2, Klf4, dan c-Myc (faktor Yamanaka). Penulisan tinjauan pustaka ini memiliki tujuan untuk meninjau perkembangan dan tantangan penggunaan faktor Yamanaka dalam pemerolehan sel iPS untuk kepentingan penggunaan klinis. Penelusuran pustaka dilakukan dengan menelusuri jurnal terpublikasi pada tahun 2006 hingga 2019 yang membahas tentang produksi sel iPS dengan faktor Yamanaka. Hasil penelusuran literatur menunjukkan bahwa faktor ini berperan sebagai faktor pionir yang dapat berikatan dengan kromatin dan menyebabkan remodelling wilayah kromatin serta menyebabkan aktivasi ataupun represi ekspresi dari gen. c-Myc berikatan pada gen yang terlibat dalam metabolisme seluler, regulasi siklus sel, dan jalur biosintetik. Oct4, Sox2, dan Klf4 menargetkan gen yang mengkodekan regulator perkembangan dan transkripsional. Mekanisme induksi sel somatik dengan faktor Yamanaka memerlukan penelusuran lebih lanjut. Sejauh ini, sel iPS dihasilkan dari berbagai macam tipe sel serta dapat berpotensi untuk mengobati berbagai penyakit. Uji klinis dari sel iPS telah disetujui oleh Food and Drugs Administration (FDA). Aplikasi dari sel iPS ini memiliki sejumlah rintangan, seperti tingkat efisiensi yang rendah, variabilitas yang tinggi, dan vektor yang digunakan dapat menyebabkan mutasi. Oleh karena itu, diperlukan penelitian lebih lanjut terkait metode yang digunakan agar diperoleh metode yang efisien, efektif, dan aman.Kata kunci: c-Myc, induced pluripotent stem cell, Klf4, Oct4, Sox2 Induction of Pluripotent Stem Cell Using Oct4, Sox2, Klf4, and c-Myc (Yamanaka Factors): Development and Future Challenges AbstractEmbryonic stem cells have the ability to split indefinitely and have pluripotent properties, also can differentiate into cells from three germ layers. Experiment by Takahashi and Yamanaka 2006 showed that induced pluripotent stem cells (iPS cells) can be obtained by addition of a set of factors, namely Oct4, Sox2, Klf4, and c-Myc (Yamanaka factors). This literature review aimed to review the development and challenges of the use of Yamanaka factors in the acquisition of iPS cells for the benefit of its clinical use. We conducted a systematic review of the studies published from 2006 until 2019 that assesed the generating of iPS cell with the assistance of Yamanaka factors. From this review, it is indicated that the factors act as a pioneering factor that can bind to chromatin and cause chromatin region remodelling, and lead to activation or repression of gene expression. c-Myc binds to genes involved in cellular metabolism, cell cycle regulation, and biosynthetic pathways. Oct4, Sox2, and Klf4 target genes that encode developmental and transcriptional regulators. Somatic cell induction mechanism with Yamanaka factors requires further investigation. Recently, iPS cells are produced from different cell types. It can potentially treat various diseases, including Mendelian and complex heredity disease. Clinical trials of iPS cells have been approved by the Food and Drugs Administration (FDA). The application of these iPS cells acquires a number of obstacles, such as low efficiency, high variability, and commonly used vectors can cause mutations. Therefore, further research is needed related to the methods used in order to obtain an efficient, effective and safe method.Keywords: c-Myc, induced pluripotent stem cell, Klf4, Oct4, Sox2