Vol. 7, Issue 2, Part C (2025)

The contemporary pharmaceutical landscape faces unprecedented challenges in ensuring patient safety while optimizing therapeutic efficacy, particularly with the increasing integration of herbal medicines alongside conventional pharmaceuticals. This comprehensive review examines the critical aspects of safety management, toxicity assessment, and herb-drug interaction monitoring in modern pharmaceutical practice. Drug toxicity mechanisms operate through complex pathways including direct cellular damage, immune-mediated responses, and disruption of physiological processes, with toxicity responsible for approximately one-third of drug candidate failures during development. Modern toxicological evaluation has evolved from descriptive approaches to incorporate sophisticated biomarkers, genomic profiling, and computational modeling for enhanced predictive accuracy. Herb-drug interactions present unique challenges through modulation of cytochrome P450 enzyme systems, particularly CYP3A4, CYP2D6, and CYP1A2, which metabolize approximately 75% of clinically used drugs. These interactions involve complex pharmacokinetic and pharmacodynamic mechanisms affecting drug absorption, distribution, metabolism, and excretion. Multiple factors influence drug safety and toxicity, including age, genetic polymorphisms, disease states, and environmental factors, necessitating personalized approaches to risk assessment. Current management strategies encompass systematic risk identification, comprehensive medication reconciliation, patient education, and implementation of clinical decision support systems. Regulatory frameworks continue to evolve, with international harmonization efforts promoting standardized safety assessment protocols. Emerging approaches include precision pharmacovigilance, artificial intelligence applications, digital health technologies, and physiologically-based pharmacokinetic modeling. The future of pharmaceutical safety lies in integrating multiple data sources for personalized risk assessment, ultimately optimizing patient outcomes while minimizing adverse events through collaborative, technology-enhanced approaches.