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CAT'S CLAW (Uncaria tomentosa)

HEALTH CARE PROFESSIONAL INFORMATION

CLINICAL SUMMARY Derived from the bark of the tree. In vitro studies show that its pentacyclic oxindole alkaloids enhance phagocytosis, display immunomodulatory properties specifically against NFkB and TNFa, and alleviate inflammation (9) (10) (11) (12). However, no human studies have been conducted to evaluate efficacy. Reported adverse reactions include hypotension and diarrhea. An additive effect with anticoagulants or hypotensives is possible; therefore caution should be exercised (8). Cat’s claw should be avoided in patients with autoimmune disorders (e.g. systemic lupus erythematosus).

SCIENTIFIC NAME Uncaria tomentosa

ALSO KNOWN AS Una de gato, life-giving vine of Peru, hawk's claw

PURPORTED USES

  • Birth control
  • Cancer treatment
  • GI disorders
  • HIV and AIDS
  • Inflammation
CONSTITUENTS
  • Oxindole alkaloids: Isopteropodine, pteropodine, rhynchophylline, mytraphylline, speciphylline
  • Indole alkaloidal glucosides: Cadambine, 3-dihydrocadambine, and 3-isodihydrocadambine
  • Hirsutine
  • Quinovic acid glycosides
  • Tannins
  • Polyphenols
  • Catechins
  • Beta sitosterol

(1) (2)

MECHANISM OF ACTION The oxindole alkaloids are claimed to have immunostimulating properties in vitro to increase phagocytotic activity and synthesis of WBCs (9) and enhance T-helper cell function (11). The major alkaloid rhynchophylline is claimed to be anti-hypertensive, relax the endothelial cells of blood vessels, dilate peripheral blood vessels, inhibit sympathetic nervous system activities, lower the heart rate and lower blood cholesterol. The alkaloid mytraphylline has diuretic properties, and hirsutine inhibits urinary bladder contractions and possesses local anesthetic (3) (5) (9). The anti-inflammatory activity may be caused by the inhibition of TNF-alpha production (10) (12). Uncaria tomentosa water extracts have been shown to enhance DNA repair after chemotherapy-induced damage (14).

ADVERSE REACTIONS Common: May cause diarrhea and lower blood pressure. Case report: Acute renal failure in a patient with systemic lupus erythematosus (SLE) (7)

DRUG INTERACTIONS Antihypertensives: Cat's claw may cause an additive or synergistic hypotensive effect. Anticoagulants / Antiplatelets: Cat's claw may have an additive anticoagulant effect. CYP3A4: In vitro, cat's claw inhibits CYP3A4, indicating that it theoretically may increase the serum levels of drugs such as protease inhibitors, nonnucleoside reverse-transcriptase inhibitors, cyclosporine, some benzodiazepines, and many others. (8)

LITERATURE SUMMARY AND CRITIQUE Animal and in vitro data exist in cancer, immunostimulant, inflammation, and antiviral studies. Human studies are lacking, and further research is needed.

REFERENCES (1) Wirth C, et al. Pharmacologically active procyanidines from the bark of Uncaria tomentose. Phytomedicine 1997;4:265-6. (2) Hemingway SR, Phillipson JD. Proceedings: alkaloids from south American species of Uncaria (Rubiaceae). J Pharm Pharmacol 1974;26(suppl):113. (3) Rizzi R, et al. Mutagenic and antimutagenic activities of Uncaria tomentosa and its extracts. J Ethnopharmacol 1993;38:63-77. (4) Paulsen SM. Use of herbal products and dietary supplements by oncology patients--Informed decisions? Highlights Oncol Pract 1998;15:94-106. (5) Aquino R, et al. Plant metabolites: New compounds and anti-inflammatory activity of Uncaria tomentosa. J Nat Prod 1991;54:453-9. (6) Keplinger K, et al. Uncaria tomentosa: ethnomedicinal use and new pharmacological, toxicological and botanical results. J Ethnopharmacol 1999; 64:23-34. (7) Hilepo JN, et al. Acute renal failure caused by ‘cat’s claw’ herbal remedy in a patient with systemic lupus erythematosus. Nephron 1997;77:361. (8) Scott GN, Elmer GW. Update on natural product-drug interactions. Am J Health-Syst Pharm 2002;59:339-47. (9) Sheng Y, Bryngelsson C, Pero R. Enhanced DNA repair, immune function and reduced toxicity of C-MED-100, a novel aqueous extract from Uncaria tomentosa. J Ethnopharmacol 2000;69:115-26. (10) Sandoval M, et al. Cat's claw inhibits TNFalpha production and scavenges free radicals: role in cytoprotection. Free Radic Biol Med 2000;29:71-8. (11) Riva L, et al. The antiproliferative effects of Uncaria tomentosa extracts and fractions on the growth of breast cancer cell line. Anticancer Res 2001;21:2457-61. (12) Sandoval M, et al. Anti-inflammatory and antioxidant activities of cat's claw (Uncaria tomentosa and Uncaria guianensis) are independent of their alkaloid content. Phytomedicine 2002;9:325-37. (13) Mur E, et al. Randomized double blind trial of an extract for the pentacyclic alkaloid-chemotype of Uncaria tomentosa for the treatment of rheumatoid arthritis. J Rheumatol 2002;29:678-81. (14) Sheng Y, et al. DNA repair of aqueous extracts of Uncaria tomentosa in a human volunteer study. Phytomedicine 2001;8:275-82. (15) Budzinski JW, et al. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273-82.

Written: 10/26/2001 Updated: 06/22/2004


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PAU D'ARCO (Tabebuia impetiginosa, Tabebuia avellanedae, Tabebuia heptaphylla)

HEALTH CARE PROFESSIONAL INFORMATION

CLINICAL SUMMARY Derived from the bark of the tree. This herb has been used traditionally to treat cancer and infections. No clinical studies support its use for these claims. The quinone compounds are known to possess toxic effects and therefore this product should not be recommended. Reported adverse events include nausea, vomiting, dizziness and anemia (4). Use of this product may increase the activity of anticoagulants (5).

SCIENTIFIC NAME Tabebuia impetiginosa, Tabebuia avellanedae, Tabebuia heptaphylla

ALSO KNOWN AS Ipe, lapacho, purple lapacho, trumpet bush and taheebo

PURPORTED USES

  • Cancer treatment
  • Candida yeast infection
  • Parasitic infections
  • Respiratory infections
CONSTITUENTS
  • Quinone compounds: Lapachol, beta-lapachone, xyloidone (naphthoquinones) and tabebuin (anthroquinone) are considered to be the active ingredients.
  • Flavonoids: Quercetin
  • Alkaloids: Tecomine, hydroxybenzoic acid, and steroidal saponins

(1) (2)

MECHANISM OF ACTION Unknown. Lapachol and beta-lapachone have demonstrated antibacterial, antifungal (fungistatic), and anti-malarial activity. (2) (3)

WARNINGS Quinone compounds are known to possess toxic effects. The effectiveness of pau d’arco for the treatment of cancer or any other condition remains unproven and must not be recommended.

ADVERSE REACTIONS Reported: Nausea, vomiting, dizziness, anemia, bleeding, and discoloration of urine (4)

DRUG INTERACTIONS Anticoagulants / Antiplatelets: Pau d'arco may potentiate effects. (5)

LAB INTERACTIONS May increase PT / APTT / INR

LITERATURE SUMMARY AND CRITIQUE Adequate clinical studies have not been performed on pau d’arco to confirm efficacy for any claim. Block JB, et al. Early clinical studies with lapachol. Cancer Chemother Rep 1974;4:27-8. A phase I clinical trial in 21 patients with non-leukemic tumors or chronic myelocytic leukemia who had relapsed. Pau d’arco did not demonstrate any clinical efficacy. Lapacho was given to 19 non-leukemic tumors and 2 CML patients at a dose range of 250-3750 mg daily for 5 days and up to 3000 mg daily for 21 days. Results showed the status of the patients to be neither unchanged nor worse.

REFERENCES (1) Willard T. A Textbook of Natural Medicine. Edinburgh (England): Churchill Livingstone; 1998. (2) Oswald EH. Lapacho. Br J Phytotherapy 1994;3:112-7. (3) Guiraud P, et al. Comparison of antibacterial and antifungal activities of lapachol and beta-lapachone. Planta Med 1994;60:373-4. (4) Foster S, et al. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. New York: Haworth Herbal Press; 1999. (5) Brinker F. Herb Contraindications and Drug Interactions, 2nd ed. Sandy (OR): Eclectic Med Publications; 1998. (6) Dinnen RD, Ebisuzaki K. The search for novel anticancer agents: a differentiation-based assay and analysis of a folklore product. Anticancer Res 1997;17:1027-34. (7) Block JB, et al. Early clinical studies with lapachol. Cancer Chemother Rep 1974;4:27-8.

Written: 10/26/2001 Updated: 08/05/2004