Aloe barbadensis

Herbal medicinal product for short-term use in occasional constipation.

HMPC: Well-established use: Internal use of Cape and Curaçao Aloe for the short-term treatment of occasional constipation
ESCOP: Cape and Curaçao Aloe: for the short-term treatment of occasional constipation.
Commission E: Cape and Curaçao Aloe: for constipation

Aloe is the stabilized juice from aloe leaves of various aloe species. Aloe species. This juice has an anti-inflammatory and antibacterial effect and is mainly used in cosmetics.
The pharmaceutically used extracts are designated according to their origin:

• Curacao Aloe (Aloe barbadensis) consists of the thickened juice of the leaves of Aloe barbadensis Miller, which can be administered in appropriate applications and dosages.
• Cape Aloe (Aloe capensis), consists of the thickened juice of the leaves of Aloe ferox in particular.

Both drugs differ gradually in the composition of their active ingredients. They contain anthranoids (name for naturally occurring anthracene derivatives) such as aloin, the main active ingredient with a strong laxative effect (aloin is localized outside the water storage tissue of the leaves under the leaf bark). Aloin has antiangiogenic and cytotoxic activities, resulting in its antitumor effect.

Furthermore, the chromone derivatives aloesin, aleoson, aloenin (a bitter substance) and in rather low concentration (<1%) the 1,8 dihydroxyanthroquinone derivative aloe-emodin (see below emodins) are found. According to Ph.Eur. 2, Aloe capensis (Cape aloe) contains at least 18% aloin, Aloe barbadensis (Curacao aloe) at least 28% aloin.

The pharmaceutical drug Aloe is obtained as an extract from Aloe vera, the official parent plant, by evaporation to drying.

The following starting substrates are obtained by 2 gradually different ways of processing the extract:

• Aloe hepatica: Obtained by slow, gentle evaporation in the sun or in a vacuum as a matt brown, liver-coloured solid product (so-called "Aloe hepatica type").
• Aloe lucida: Formed by rapid evaporation as a deep brown, glassy solid product (so-called "Aloelucida type").

Aloe has a very bitter taste, is not very soluble in cold water and very soluble in hot water.

The following are referred to as medicinal products:

• Curaçao Aloe (Barbados Aloe) is made from Aloe barbadensis Miller (Aloe vera Linné) and contains the strongly laxative 1,8-dihydroxyanthracene derivative Aloin as its essential ingredient.
• Cape Aloe (Aloe capensis) is mainly extracted from Aloe ferox Miller Art.

Most in vitro skin protection studies examine the wound healing ability of Aloe vera and its active ingredients. The immortalized human keratinocyte cell line HaCaT, the primary normal human epidermal keratinocyte cell line HEKa, and fibroblast cell lines are the most commonly used. Various studies have shown that Aloe vera and its major constituents (aloesin, aloin, and emodin) exert their protective effects mainly through antioxidant and anti-inflammatory mechanisms. Thus, Aloe vera upregulated the expression of TFGβ1, bFGF, and Vegf-A in fibroblasts and increased the proliferation and differentiation of keratinocytes through the stability of the lysosomal membrane (Sánchez M et al. 2020). Moreover, an Aloe vera solution at low concentrations (≤175 μg/mL) has been shown to promote healing in wounds by increasing the activity of type IV collagen degradation in a cell model using primary cultures of corneal epithelial cells. In addition, aloesin protected the skin by decreasing IL-8 production, DNA damage, lipid peroxidation, and ROS formation, and increasing GSH content and SOD activity. The compound aloesin promoted wound healing by increasing cell migration via phosphorylation of Cdc42 and Rak1, cytokines, and growth factors. In addition to this healing activity, it was found that aloe polysaccharide (20, 40, and 80 µg/mL for 24 hours) could be a useful agent in psoriasis, as evidenced by the inhibition of TNF-α levels and IL-8 and IL-12 protein expression in the human keratinocyte cell line HaCaT (Sánchez M et al. (2020). In addition, a UV-induced mouse model showed that Aloe vera gel powder increases epidermal growth factor and hyaluronan synthase and reduces the expression of matrix metalloproteinases (types 2, 9, and 13). Aloe sterols are involved in this UV protection. Similarly, Aloe vera was observed to protect against X-rays through antioxidant mechanisms (increased antioxidant enzyme activity and GSH content, and decreased ROS production and lipid peroxidation). Of the isolated compounds, studies with the compounds aloe-emodin and aloe-sin have shown that their healing effects are due to angiogenic properties.

Systemic effects: 1,8-dihydroxyanthracene derivatives have a strong laxative effect. The beta-glycosidic bound glycosides are probably prodrugs which are catalysed to aloe amondine anthrone by bacterial enzymes only in the colon. Aloe-emondine anthrone is the actual active substance with the laxative properties.

External effects: With external application (ointments and gels) the anti-inflammatory and antiseptic effects are used.

Aloe is an integral part of phytotherapy and modern cosmetics. When used externally (ointments and gels), the juice of aloe is said to have a positive effect on itching from insect bites.

Aloe extracts are also used in toothpastes.

Other indications are sunburn (aloe gel), acne vulgaris and psoriasis vulgaris and lichen planus mucosae.

Other indications are sunburn (aloe gel), acne vulgaris and psoriasis vulgaris and lichen planus mucosae.

Due to its antiseptic property, aloe vera is also suitable for wound treatment.

Due to its antiseptic property, aloe vera is also suitable for wound treatment.

As a laxative 0.2-0.25g Cape Aloe. As a bittering agent 0.05-0.1g Cape Aloe. Forms of application are Pilulae laxantes, Extractum Aloes siccum normatum (Ph.Eur.2): Tinctura Aloes.

Single dose: Herbal preparation corresponding to 10 - 30 mg of hydroxyanthracene derivatives, to be taken once daily at night.

Duration of use Do not use for more than 1 week, not more often than up to two to three times/week.

Side effects of systemic administration: crampy gastrointestinal symptoms, with prolonged use possible disturbances in water and electrolyte balance; potassium losses. Risk of neprotoxicity (proteinuria, hematuria). The therapeutic importance of "aloe" in systemic therapy has decreased significantly, since better tolerated substances exist for the indications.

Cave: Carcinogenic effect of the leaves due to the contained ingredients - only short-term use ! according to EMA only 1 week!

Toxicologically relevant is mainly the top layer of the leaves of Aloe arborescens due to the content of plant anthranoids: suspected genotoxic and carcinogenic effect: https://www.bfr.bund.de/cm/343/nahrungsergaenzungsmittel-mit-anthranoidhaltigen-aloe-ganzblattzubereitungen-bergen-gesundheitliche-risiken.pdf

https://www.krebsinformationsdienst.de/aktuelles/2017/news107-gesundheitsrisiken-aloe-produkte.php

Allergy to individual components of the plant or the preparation.

Do not use in case of ileus, acute or persistent gastrointestinal complaints, nausea and vomiting.

Use during pregnancy: genotoxic risk of some anthranoids, e.g. emodin and aloe-emodin.

Use during lactation.

Fertility data are not available.

Cardiac glycosides, antiarrhythmics, QT prolonging drugs, diuretics, adrenocorticosteroids, licorice root: caution: consult doctor before taking concomitantly with aloe preparations.

Due to the possible hypokalemia enhancement of the action of cardiac glycosides, interaction with antiarrhythmic drugs.

Caution: simultaneous administration of diuretics, adrenal corticosteroids and liquorice root: increase of alium loss!

Phoenix Kalophön Ointment

1. https://arzneipflanzenlexikon.info/aloe.php
2. https://www.ema.europa.eu/en/documents/herbal-monograph/final-european-union-herbal-monograph-aloe-barbadensis-mill-aloe-various-species-mainly-aloe-ferox_en.pdf
3. Kessing R (2019) Herbal agents for topical application. Der Privatarzt 9: 42-43

4. Rajar DU et al (2008) Efficacy of aloe vera gel in the treatment of vulval lichen planus. J Coll Physicians Surg Pak18:612-4.

5. Sánchez M et al. (2020) Pharmacological Update Properties of Aloe Vera and its Major Active Constituents. Molecules 25:1324.

6. Wenigmann M. (2017) Phytotherapy medicinal drugs, phytopharmaceuticals, application. Urban & Fischer, pp.66-67