Abstract: Animal-derived ingredients (ADIs) account for up to 75% of prescription drugs, triggering clinical risks such as alpha-gal syndrome (AGS), ethical-religious conflicts, and supply transparency issues. This calls for a systematic evaluation of ADIs and accelerated development of animal-free alternatives (AFAs). This critical review synthesizes evidence from the biomedical, regulatory, and ethical literature to analyze the persistence of ADIs, map their risk stratification (biological and religious), and evaluate progress in AFAs. ADIs persist due to their functional, regulatory, and biocompatibility advantages in various medical products. Methodologically, the proposed dual risk stratification framework integrates immunological risk profiles, specifically targeting the galactose-α-1,3-galactose epitope, with Halal jurisprudential criteria for categorizing pharmaceutical ingredients. Although various AFAs (plant-based, recombinant, and synthetic) have been developed and supported by global regulatory initiatives, significant challenges in scalability, cost, and bioequivalence remain. The transition to AFAs is crucial and increasingly technically feasible. A unified framework that integrates scientific, ethical, and religious analysis is needed to accelerate the adoption of safe and inclusive AFAs, while ensuring patient autonomy and safety. Keywords: animal-derived ingredients, immunogenicity, pharmaceutical ethics, halal pharmaceuticals, risk assessment, excipient safety
Herdiana et al. (Sun,) studied this question.