Orally,
gotu kola is used for reducing fatigue, anxiety, depression, improving memory
and intelligence, Alzheimer's disease, venous insufficiency including varicose
veins, wound healing, and increasing longevity.
It is
also used for the common cold and influenza, swine flu, sunstroke, tonsillitis,
pleurisy, urinary tract infection (UTI), hepatitis, jaundice, abdominal
pain,diarrhoea, indigestion, gastritis, peptic ulcer disease, dysentery,
trauma, shingles,leprosy, cholera, syphilis, psychiatric disorders, epilepsy, asthma,
anaemia, and diabetes. Gotu kola is also used for contraception, amenorrhea,
elephantiasis, systemic lupus erythematosus (SLE), tuberculosis, memory loss,
and as an aphrodisiac. Topically, gotu kola is used for wound healing and
reducing scars. Parenterally, gotu kola is used for bladder lesions associated
with schistosomiasis.
Safety:
POSSIBLY
SAFE ...when used topically and appropriately.
Gotu kola
has been used safely in a cream and ointment for up to 8weeks (27, 28). ...when used
orally.
Gotu kola has been used safely in trials lasting up to 12 months (7, 17, 18, 19, 20, 21, 22, 23, 24,
25, 26). However,
there is concern that gotu kola might cause hepatotoxicity in some
patients (29). PREGNANCY: POSSIBLY SAFE ...when
used topically and appropriately (28, 31). There is insufficient reliable information
available about the safety gotu kola when used orally during pregnancy; avoid
using.
LACTATION:
Insufficient reliable information available; avoid using.
Effectiveness:
POSSIBLY
EFFECTIVE
Venous
insufficiency. Taking gotu kola orally for 4-8 weeks seems to improve measures
of circulation and decrease symptoms such as edema (7, 11, 18, 19, 21, 25).
INSUFFICIENT
RELIABLE EVIDENCE to RATE
Atherosclerosis.
There is preliminary evidence that taking gotu kola orally for 12 months might
help stabilize low-density atherosclerotic plaques. Stabilizing these plaques
might reduce the risk of rupture and embolism (17,24).
Deep vein
thrombosis (DVT). Gotu kola helps prevent thrombosis related to long-distance
flights.Preliminary evidence suggests that gotu kola might decrease edema, and
improve measures of circulation in patients traveling on airplanes for more
than 3 hours (22); however, it is not known if t
his
actually results in a decreased incidence of clots. Diabetic microangiopathy.
Taking gotu kola orally for 6-12 months might help increase measures of
circulation, and decrease edema in patients with diabetic microangiopathy (20, 23).
Keloids.
There is some evidence that applying an extract of gotu kola, known as
madecassol, topically might help reduce keloids and hypertrophic scarring (30).
Psoriasis.
Some evidence suggests that applying gotu kola topically might help reduce
symptoms of psoriasis (6).
Scarring:
Preliminary evidence suggests that applying a specific gotu kola cream (Alpha
centella, not available in the US) twice daily for 6-8weeks following suture
removal might help reduce scarring in patients without a history of keloid
formation (27).
Schistosomiasis.
There is some evidence that using gotu kola parenterally might help bladder
lesions of schistosomiasis (bilharzial infections) (10).
Stretch
marks (striae gravidarum). Preliminary evidence suggests that applying a specific
mixture of gotu kola, vitamin E, and collagen-elastin hydrolysates in a cream
(Trofolastin, not available in the US) daily during the second and third
trimesters of pregnancy until labor might reduce stretch marks (31). There is also preliminary
evidence that another specific mixture of gotu kola, vitamin E, essential fatty
acids, hyaluronic acid, elastin, and menthol in an ointment (Verum, not
available in the US) might help decrease the formation of stretch marks during
pregnancy (28).
Wound
healing. Preliminary evidence suggests that applying gotu kola topically might
help improve wound healing (7). More evidence
is needed to rate gotu kola for these uses.
Mechanism of Action:
The
applicable parts of gotu kola are the above groundparts. The primary
constituents responsible for the pharmacological effects are thought to be the
saponin-containing triterpene acids, 1% to 8%; and their sugar esters,
including asiatic acid, madecassic acid, asiaticoside A (madecassoside), and
asiaticoside B (26). Gotu kola also contains
essential oils; flavonoids; and flavone derivatives including quercetin and kaempferol, sesquiterpenes,
stigmasterol, sitosterol, and isothankuniside (713).
In vitro
evidence suggests that gotu kola might bind cholecystokinin (CCK) and GABA
receptors, which might be responsible for reported anxiolytic effects of gotu
kola (6, 26). The effects on GABA might also
results in sedative, anticonvulsant, and analgesic effects (7). There is some evidence that
taking gotu kola orally might to reduce the startle response in healthy
volunteers (26).
Some
researchers think the asiaticoside derivatives, asiatic acid, asiaticoside 6, and
SM2, might have a role in Alzheimer's disease. Preliminary evidence that they
might protect neurons from beta-amyloid toxicity (3).
The
triterpenoid saponins (e.g., asiaticoside, madecassoside) seem to increase wound
healing and decrease venous pressure in venous insufficiency (2. 5, 11). Asiaticoside and other
terpenoids might have anti-inflammatory activity (27, 32). The terpenoid extract seems to improve connective
tissue re
modeling
by increasing fibroblast activity, stimulating collagen synthesis, increasing
epithelial turnover over, and decreasing capillary permeability (16,17,19). Gotu kola is thought to increase
the production of type I collagen in scar formation over type II. Type II
collagen is associated with hypertrophic scarring (27).
The
terpenoid extract might help stabilize arterial plaques by increasing collagen
within plaques. Plaques with low collagen content are structurally weak and are
associated with an increased risk of rupture and embolism (17, 24)). There is also some evidence
that asiaticosides might promote wound healing by stimulating collagen and
glycosaminoglycan synthesis (4, 5). There's
preliminary evidence that asiaticosides might also have preventive and
therapeutic effects on gastrointestinal ulcers (7, 8). Anti-ulcer mechanisms may be due to strengthening
action on gastric mucosal lining and suppression of damaging effects of free
radicals (8).
Preliminary
evidence suggests that purified isothankuniside might decrease fertility.
However, a crude extract of gotu kola does not reduce fertility (13). Gotu kola extracts also seem to
have antibacterial activity in vitro against Pseudomonas pyocyaneus,
Trichoderma mentagrophytes, and Entamoeba histolytica. It also seems to have
antiviral activity againstHerpes simplex type II (7).
There is
some interest in using gotu kola to treat cancer. Dried powder extracts of gotu
kola exhibit cytotoxic and anti-tumor properties in preliminary studies.
Normal
lymphocytes are not harmed, which suggests gotu kola exerts selective toxicity
towards tumor cells (9).
There are
some case reports of hepatotoxicity. The triterpenoids contained in gotu kola
are theorized to be responsible for this adverseeffect (29).
Adverse Reactions:
Orally,
gotu kola is usually well-tolerated when used in typical doses (17, 18, 19, 20, 22, 23, 24, 25,
26). However,
in some patients it can cause gastrointestinal upset and nausea (7). Theoretically, gotu kola might
also cause drowsiness (7). There are at least three cases
of hepatotoxicity associated with gotu kola. In one case, a 61-year-old woman
developed elevated liver function tests (LFTs) including AST, ALT, alkaline
phosphatase, and total bilirubin after taking gotu kola tablets for 30 days.
Liver biopsy showed granulomatous acute hepatitis, suggesting an immune
mediated hepatitis. LFTs improved when gotu kola was discontinued. Months later
the patient took gotu kola again and developed elevated LFTs again after 2
weeks. In another case, a 52-year-old woman developed symptoms of hepatitis and
increased LFTs after taking gotu kola for 3 weeks. Biopsy indicated chronic
hepatitis and granulomas,areas of necrosis, and cirrhotic transformation. LFTs
normalized after discontinuation of gotu kola.
In a
third case, a 49-year-old woman developed symptoms of hepatitis and elevated
LFTs 2 months after starting gotu kola. Biopsy revealed granulomatous
hepatitis. LFTs normalized after discontinuation of gotu kola (27). Researchers did not perform
laboratory analysis of the products taken in these cases to determine if they
were free of hepatotoxic contaminants. Therefore, it is not
possible
to rule out product contamination. The doses of gotu kola taken by these
patients is unknown. Therefore, it is not known if higher doses are more likely
than lower doses to cause hepatotoxicity. In a clinical trial where liver
function was monitored, patients taking gotu kola 120 mg/day for 6 months, no
changes in hepatic function were observed (20).
Topically,
gotu kola can cause allergic contact dermatitis, characterized by erythema,
itching, papules, and a burning sensation (1,7, 12). Gotu kola may also cause eczema when applied
topically (14, 15).
Interactions with Herbs & Supplements:
HEPATOTOXIC
HERBS AND SUPPLEMENTS: There is some concern that gotu kola might cause
hepatotoxicity in some patients (29).
Theoretically, concomitant use with other potentially hepatotoxic products
might increase the risk of developing liver damage. Some of these products
include
androstenedione,
chaparral, comfrey, DHEA, germander, niacin, pennyroyaloil, red yeast, and others.
HERBS AND
SUPPLEMENTS WITH SEDATIVE PROPERTIES: Theoretically, concomitant use with herbs
that have sedative properties might enhance therapeutic and adverse effects (7). Some of these supplements
include 5-HTP, calamus, California poppy, catnip, hops, Jamaican dogwood, kava,
St. John's wort, skullcap, valerian, yerba mansa, and others.
Interactions with Drugs:
Topically,
gotu kola can cause allergic contact dermatitis, characterized by erythema,
itching, papules, and a burning sensation (1,7, 12). Gotu kola may also cause eczema when applied
topically (14, 15).
Interactions with Herbs & Supplements:
HEPATOTOXIC
HERBS AND SUPPLEMENTS: There is some concern that gotu kola might cause
hepatotoxicity in some patients (29).
Theoretically, concomitant use with other potentially hepatotoxic products
might increase the risk of developing liver damage. Some of these products
include androstenedione, chaparral, comfrey, DHEA, germander, niacin,
pennyroyal oil, red yeast, and others.
HERBS AND
SUPPLEMENTS WITH SEDATIVE PROPERTIES: Theoretically, concomitant use with herbs
that have sedative properties might enhance therapeutic and adverse effects (7). Some of these supplements
include 5-HTP, calamus, California poppy, catnip, hops, Jamaican dogwood,kava,
St. John's wort, skullcap, valerian, yerba mansa, and others.
Interactions with Drugs:
CNS
DEPRESSANTS <<interacts with>> GOTU KOLA
Interaction
Rating = Major Do not take this combination.
Severity
= High • Occurrence = Probable • Level of Evidence = D
Theoretically,
concomitant use of gotu kola with drugs with sedative properties might cause
additive effects and side effects (7). Some sedative drugs include clonazepam (Klonopin),
lorazepam (Ativan), phenobarbital (Donnatal), zolpidem (Ambien), and others.
HEPATOTOXIC
DRUGS <<interacts with>> GOTU KOLA
Interaction
Rating = Moderate Be cautious with this combination.
Severity
= High • Occurrence = Possible • Level of Evidence = D
There is
some concern that gotu kola might cause hepatotoxicity in some patients (29). Theoretically, concomitant use with other
potentially hepatotoxic drugs might increase the risk of developing liver
damage. Some of these drugs include acarbose (Precose, Prandase), amiodarone
(Cordarone), atorvastatin (Lipitor), azathioprine (Imuran), carbamazepine
(Tegretol), cerivastatin (Baycol), diclofenac (Voltaren), felbamate (Felbatol),
fenofibrate (Tricor), fluvastatin (Lescol), gemfibrozil (Lopid), isoniazid,
itraconazole, (Sporanox), ketoconazole (Nizoral), leflunomide (Arava),
lovastatin (Mevacor), methotrexate (Rheumatrex), nevirapine (Viramune), niacin,
nitrofurantoin (Macrodantin), pioglitazone (Actos), pravastatin (Pravachol),
pyrazinamide, rifampin (Rifadin), ritonavir (Norvir), rosiglitazone (Avandia),
simvastatin (Zocor), tacrine (Cognex), tamoxifen, terbinafine (Lamisil),
valproic acid, and zileuton (Zyflo).
Interactions with Foods:
None
known.
Interactions
with Lab Tests:
None
known.
Interactions with Diseases or Conditions:
LIVER
DISEASE: There is concern that gotu kola might be linked to cases of
hepatotoxicity (29). Theoretically, gotu kola might
exacerbate liver problems in patients with existing liver disease such as hepatitis.
Advise these patients to avoid taking gotu kola.
SURGERY:
Gotu kola has CNS depressant effects. Theoretically, gotu kola might cause additive
CNS depression when combined with anesthesia and other medications during and
after surgical procedures. Tell patients to discontinue gotu kola at least 2
weeks before elective surgical procedures.
Dosage/Administration:
ORAL: For
atherosclerosis, 60 mg of gotu kola extract three times daily has been used (17, 24). For diabetic microangiopathy, 60
mg of gotu kola extract twice daily has been used (20, 23). For venous insufficiency, 60-180
mg daily of gotu kola extract has been used (18, 19, 21, 25). For deep vein thrombosis (DVT) prevention while
flying, 120 mg of gotu kola extract 3 days before the flight, the day of the
flight, and the day after have been used (22).
TOPICAL:
For wound healing, 1% gotu kola creams have been used (7). For scars, gotu kola has been
used in combination with the extract from Bulbine frutescens (Alpha centella
cream, not available in the US) for 6-8weeks (27).
For
preventing stretch marks in pregnancy, gotu kola has been used in combination
with several other ingredients (Trofolastin and Verum). Trofolastin cream (not
available in the US) is a mixture of gotu kola, vitamin E, and collagen-elastin
hydrolysates (21). Verum ointment (not availablein
the US) contains gotu kola, vitamin E, essential fatty acids, hyaluronic acid,
elastin, and menthol (28).
Editor's Comments:
Gotu kola
is a commonly used herb in Tradition Chinese and Ayurvedic medicine (26). The
terpenoid extract of gotu kola is sometimes referredto as TTFCA (total
terpenoid fraction of Centella asiatica) and Centellase. Avoid confusion with
cola nut (Cola acuminata), and swamp pennywort (Centella cordifolia). Centella
cordifolia is often misidentified as Centella asiatica (gotu kola).
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