Oxidative stress is a central pathological process driving the onset and progression of multiple chronic diseases, characterized by excessive accumulation of reactive oxygen species and imbalance of endogenous antioxidant defenses. Puerarin, a natural isoflavone glycoside extracted from Gegen (Puerariae Lobatae Radix), exhibits potent multi-target antioxidant activities. Accumulating evidence indicates that puerarin alleviates oxidative stress and cell death processes such as ferroptosis, pyroptosis and apoptosis by directly scavenging free radicals, activating endogenous antioxidant systems, inhibiting pro-oxidant enzymes, modulating key signaling pathways such as nuclear factor erythroid 2-related factor 2 (Nrf2), mitogen-activated protein kinase (MAPK), and protein kinase B (Akt), and improving the functional homeostasis of cellular organelles including mitochondria, endoplasmic reticulum, and lysosomes. This review systematically summarizes the multi-target antioxidant mechanisms of puerarin, its current clinical applications, pharmacokinetic limitations, and recent advances in novel drug delivery systems, aiming to provide a theoretical basis for the development of puerarin as a precision-targeted therapeutic agent for oxidative stress-related diseases.

puerarin  /  antioxidant stress  /  clinical application  /  pharmacokinetics  /  drug delivery systems