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Aristolochia spp.

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Also listed as: Dutchman's pipe (Aristolochia spp.)
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Acretoside, Akebia mu tong, alkaloids, allantoin, arillatose B, aristofolin-E, aristolactam Ia, aristoliukine-C, Aristolochia bracteata, Aristolochia chilensis, Aristolochia chuan mu tong, Aristolochia clematitis, Aristolochia constricta, Aristolochia contorta Bunge, Aristolochia cretica, Aristolochia cucurbitifolia Hayata, Aristolochia cymbifera, Aristolochia debilis, Aristolochia durior, Aristolochia fangchi, Aristolochia longa, Aristolochia gibertii, Aristolochia gigantean, Aristolochia grandiflora, Aristolochia guang fang ji, Aristolochia indica, Aristolochia kaempferi, Aristolochia kwangsiensis, Aristolochia macedonica, Aristolochia macroura, Aristolochia ma dou ling, Aristolochia manshuriensis, Aristolochia manshuriensis Kom, Aristolochia maurorum, Aristolochia qing mu xiang, Aristolochia rigida, Aristolochia taliscana, Aristolochia westlandi, Aristolochia xun gu feng, Aristolochiae Debilis fructus, Aristolochiae Debilis radix, Aristolochiae Mollissimae radix, Aristolochiae Mollissimae ramulus, Aristolochia paucinervis Pomel, Aristolochia rugosa, Aristolochia spp., Aristolochia taliscana, Aristolochia triangularis, Aristolochia trilobata, Aristolochiaceae (family), aristolochic acid, aristolochic acid A, aristolochic acid I, aristolochic acid-Ia methyl ester, aristolochic acid II, aristolochic acid-III methyl ester, aristolochic acid IVa, aristolochic acid VII, aristololactam IV, aristololactam IVa, aristolochic acid nephropathy, aristomanoside, aristo-red, austrobailignan-7, Balkan nephropathy, Belgian slimmers' disease, benzenoids, beta-sitosterol, biflavonoid, birthwort, cepharanone C, columbin, crystalline magnoflorine, daucosterol, dehydrooxoperezinone, demethylaristofolin E, Dutchman's pipe, Dutchmanspipe, eicosanic acid, endemic (Balkan) nephropathy, endemic nephropathy, eupomatenoid-7, fang chi, fangchinoline, flavonoids, fragransin E1, guaco (Mexican Spanish), guan fang ji (Chinese), guan mu tong (Chinese), herba Aristolochia Mollissemae, ishwarane, isoquinoline alkaloids, licarin A, licarin B, lignoids, linoleic acid, longdan xieganwan, madolin-P, magnoflorine, mu tong (Chinese), N-glycosyl lactam, nitrophenanthrene carboxylic acids, palmitic acid, phenanthrene derivatives, phenylpropanoid glucose esters, pinitol, protopine, raiz de guaco (Mexican Spanish), Saussurea mu xiang, snakeroot, sodium 3,4-dimethoxybenzoate, sodium 7-hydroxyl-8-methoxyaristolate, steroids, sterols, sitogluside, talaumidin, terpenes, tetrandrine, tubeflower.
  • Combination product examples: 707 Gastropathy Capsules, Chi Kuan Yen Wan, Guan Zin Su He Wan, Guanxin Suhe Jiaonang, Internal Dissolution Pills, Kuanhsin Suhowan, Mei Bou Gin Mei Yuen, Pilule Cortex Eucommiae Et Os Tigridis, Tienchi Hugu Wan, Tri-snakegall and Fritillary Powder, Zuo Gu Shen Jin Tong Wan.

Background
  • Aristolochia spp. are found in diverse climates worldwide, but not in Australia. Because the aristolochic acid in Aristolochia spp. is known to cause kidney damage, the U.S. Food and Drug Administration (FDA) advises consumers to immediately discontinue use of any botanical products containing aristolochic acid. Currently, Britain's Committee on Safety of Medicines prohibits Aristolochia spp. in all unlicensed medicines, and it may only be obtained by prescription from a licensed doctor or dentist.
  • In many areas, Aristolochia spp. are used in ethnomedicine for conditions such as cancer, wounds, and intestinal worms. Since the 1950s, some Aristolochia spp. have been used as substitutes in Chinese herbal medicine for certain Akebia spp., Saussurea (Auklandia) spp., Clematis spp., and Stephania tetrandra. In fact, when nine samples of fangji (Stephania tetrandra) were purchased from Hong Kong herbal shops and analyzed for aristolochic acids, all of the samples contained aristolochic acids. Stephania tetrandra does not contain aristolochic acids.
  • During 1990-1992, a Belgium clinic prescribed a Chinese herbal weight-loss remedy that substituted Aristolochia fangchi for Stephania tetrandra. Many of the patients developed a progressive kidney disorder called aristolochic acid nephropathy. Doses higher than 200 grams were linked to a higher risk of urinary tract cancer.
  • It is believed that the seeds of Aristolochia clematitis that have been accidentally harvested along with wheat from fields in Bosnia, Bulgaria, Croatia, Romania, and Serbia may be the cause of endemic (Balkan) nephropathy and a high rate of endemic kidney failure in certain areas.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Alzheimer's disease, anthelmintic (treatment for parasitic worms), antibacterial, antifungal, anti-inflammatory, antioxidant, antiplatelet, antispasmodic, cancer, Crohn's disease, eczema, fluid retention, high blood pressure, immunosuppression, infections, insecticide, labor induction, low back pain, parasitic infection (trypanosomes), rheumatic disorders, snake bite, weight loss, withdrawal from narcotics (opiates), wound healing.

Dosing

Adults (18 years and older)

  • There is no proven safe or effective dose for Aristolochia spp. in adults.
  • Note: Because the aristolochic acid in Aristolochia spp. is known to cause kidney damage, the U.S. Food and Drug Administration (FDA) advises consumers to immediately discontinue use of any botanical products containing aristolochic acid. Currently, Britain's Committee on Safety of Medicines prohibits Aristolochia spp. in all unlicensed medicines, and it may only be obtained by prescription from a licensed doctor or dentist. In case reports, use of Aristolochia spp. has dose-dependently lead to tubulointerstitial fibrosis, Fanconi syndrome, rapidly progressive nephropathy, chronic renal insufficiency, and urothelial cancer in humans due to its aristolochic acid content. There is also a case report of liver damage linked to Aristolochia.

Children (under 18 years old)

  • There is no proven safe or effective dose for Aristolochia spp. in children.
  • Note: Because the aristolochic acid in Aristolochia spp. is known to cause kidney damage, the U.S. Food and Drug Administration (FDA) advises consumers to immediately discontinue use of any botanical products containing aristolochic acid. Currently, Britain's Committee on Safety of Medicines prohibits Aristolochia spp. in all unlicensed medicines, and it may only be obtained by prescription from a licensed doctor or dentist. In case reports, use of Aristolochia spp. has dose-dependently lead to tubulointerstitial fibrosis, Fanconi syndrome, rapidly progressive nephropathy, chronic renal insufficiency, and urothelial cancer in humans due to its aristolochic acid content. There is also a case report of liver damage linked to Aristolochia.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in individuals with known allergy/hypersensitivity to Aristolochia spp., its constituents, or members of the Aristolochiaceae family.

Side Effects and Warnings

  • Because the aristolochic acid in Aristolochia spp. is known to cause kidney damage or failure, the U.S. Food and Drug Administration (FDA) advises consumers to immediately discontinue use of any botanical products containing aristolochic acid. Currently, Britain's Committee on Safety of Medicines prohibits Aristolochia spp. in all unlicensed medicines, and it may only be obtained by prescription from a licensed doctor or dentist. In case reports, use of Aristolochia spp. has dose-dependently lead to tubulointerstitial fibrosis, Fanconi syndrome, rapidly progressive nephropathy, chronic renal insufficiency, and urothelial cancer in humans due to its aristolochic acid content. There is also a case report of liver damage linked to Aristolochia.
  • Aristolochia may also reduce the immune response.
  • When nine samples of fangji (Stephania tetrandra), a commonly used traditional Chinese medicine whose name has also been used to describe several other species of plant drugs, were purchased from Hong Kong herbal shops and analyzed for aristolochic acids, all of the samples contained aristolochic acids. However, Stephania tetrandra does not contain aristolochic acids.

Pregnancy and Breastfeeding

  • Because the aristolochic acid in Aristolochia spp. is known to cause kidney damage or failure, the U.S. Food and Drug Administration (FDA) advises consumers to immediately discontinue use of any botanical products containing aristolochic acid. Currently, Britain's Committee on Safety of Medicines prohibits Aristolochia spp. in all unlicensed medicines, and it may only be obtained by prescription from a licensed doctor or dentist. In case reports, use of Aristolochia spp. has dose-dependently lead to tubulointerstitial fibrosis, Fanconi syndrome, rapidly progressive nephropathy, chronic renal insufficiency, and urothelial cancer in humans due to its aristolochic acid content. There is also a case report of liver damage linked to Aristolochia.
  • In animal studies, Aristolochia stimulated uterine contractions.

Interactions

Interactions with Drugs

  • Aristolochic acid in Aristolochia spp. is known to cause kidney damage or failure. Therefore, it may increase the side effects of drugs that are broken down by the kidneys.
  • Aristolochia spp. may increase the risk of bleeding when taken with drugs that increase the risk of bleeding.
  • Aristolochia spp. may lower blood pressure. Caution is advised in patients taking agents that lower blood pressure.
  • Aristolochia spp. may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. Patients using any medications should check the package inserts, and speak with their qualified healthcare professionals, including pharmacists, about possible interactions.
  • Using dexfenfluramine, fenfluramine or tobacco may affect the development of urothelial cancer due to the aristolochic acid found in Aristolochia spp.
  • Aristolochia spp. may also interact with antibiotics, antifungals, anti-inflammatory agents, antiprotozoals, anticancer agents, antispasmodic agents, antivenins, immunosuppressants, methadone, muscarinic antagonists, opiates, oxytocics, and neurotrophic drugs.

Interactions with Herbs and Dietary Supplements

  • Aristolochic acid in Aristolochia spp. is known to cause kidney damage or failure. Therefore, it may increase the side effects of herbs or supplements that contain aristolochic acid or that are broken down by the kidneys.
  • Aristolochia spp. may increase the risk of bleeding when taken with herbs or supplements that increase the risk of bleeding.
  • Aristolochia spp. may lower blood pressure. Caution is advised in patients taking herbs or supplements that lower blood pressure.
  • Aristolochia spp. may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. Patients using any agents should check the package inserts, and speak with their qualified healthcare professionals, including pharmacists, about possible interactions.
  • Using tobacco may affect the development of urothelial cancer due to the aristolochic acid found in Aristolochia spp.
  • Aristolochia spp. may also interact with antibacterials, antifungals, anti-inflammatory agents, antiparasitics, anticancer agents, antioxidants, antispasmodic agents, antivenins, immunosuppressants, muscarinic antagonists, opiates, oxytocics, neurotrophic herbs or supplements, and Ginkgo biloba.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Balachandran, P, Wei, F, Lin, RC, et al. Structure activity relationships of aristolochic acid analogues: toxicity in cultured renal epithelial cells. Kidney Int 2005;67(5):1797-1805.
  2. Camporese, A, Balick, MJ, Arvigo, R, et al. Screening of anti-bacterial activity of medicinal plants from Belize (Central America). J Ethnopharmacol 2003;87(1):103-107.
  3. Capasso, A, Piacente, S, De Tommasi, N, et al. The effect of isoquinoline alkaloids on opiate withdrawal. Curr Med Chem 2006;13(7):807-812.
  4. Chan, TY, Tam, HP, Lai, CK, et al. A multidisciplinary approach to the toxicologic problems associated with the use of herbal medicines. Ther Drug Monit 2005;27(1):53-57.
  5. Hranjec, T, Kovac, A, Kos, J, et al. Endemic nephropathy: the case for chronic poisoning by aristolochia. Croat Med J 2005;46(1):116-125.
  6. Laing, C, Hamour, S, Sheaff, M, et al. Chinese herbal uropathy and nephropathy. Lancet 7-22-2006;368(9532):338.
  7. Lo, SH, Wong, KS, Arlt, VM, et al. Detection of Herba Aristolochia Mollissemae in a patient with unexplained nephropathy. Am J Kidney Dis 2005;45(2):407-410.
  8. Meinl, W, Pabel, U, Osterloh-Quiroz, M, et al. Human sulphotransferases are involved in the activation of aristolochic acids and are expressed in renal target tissue. Int J Cancer 3-1-2006;118(5):1090-1097.
  9. Mongelli, E, Pampuro, S, Coussio, J, et al. Cytotoxic and DNA interaction activities of extracts from medicinal plants used in Argentina. J Ethnopharmacol 2000;71(1-2):145-151.
  10. Nok, AJ, Sallau, BA, Onyike, E, et al. Columbin inhibits cholesterol uptake in bloodstream forms of Trypanosoma brucei-A possible trypanocidal mechanism. J Enzyme Inhib Med Chem 2005;20(4):365-368.
  11. Ruffa, MJ, Ferraro, G, Wagner, ML, et al. Cytotoxic effect of Argentine medicinal plant extracts on human hepatocellular carcinoma cell line. J Ethnopharmacol 2002;79(3):335-339.
  12. Velazquez, E, Tournier, HA, Mordujovich, de Buschiazzo, Saavedra, G, et al. Antioxidant activity of Paraguayan plant extracts. Fitoterapia 2003;74(1-2):91-97.
  13. Wu, TS, Leu, YL, and Chan, YY. Constituents from the stem and root of Aristolochia kaempferi. Biol Pharm Bull 2000;23(10):1216-1219.
  14. Zhang, CY, Wang, X, Su, T, et al. New aristolochic acid, aristololactam and renal cytotoxic constituents from the stem and leaves of Aristolochia contorta. Pharmazie 2005;60(10):785-788.
  15. Zhou, S, Koh, HL, Gao, Y, et al. Herbal bioactivation: the good, the bad and the ugly. Life Sci 1-9-2004;74(8):935-968.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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