Aristolochia
- Scientific Name
- Aristolochia auricularia, Aristolochia clematitis, Aristolochia fangchi, Aristolochia heterophylla, Aristolochia kwangsiensis, Aristolochia manshuriensis, Aristolochia moupinensis, Aristolochia reticulata, Aristolochia serpentaria, other Aristolochia species. Family: Aristolochiaceae.
- Family
- Aristolochiaceae
- Other Common Names
-
Aristoloche, Aristoloche Clématite, Aristoloche de Texas, Aristoloche de Virginie, Aristoloche des Vignes, Aristoloche Vulgaire, Aristoloquia, Birthwort, Guan Mu Tong, Guang Fang Ji, Long Birthwort, Pelican Flower, Poison de Terre, Pomerasse, Ratelaine, Rateline, Red River Snakeroot, Sangree Root, Sangrel, Sarrasine, Serpentaire, Serpentaire de la Rivière Rouge, Serpentaria, Snakeroot, Snakeweed, Texas Snakeroot, Virginia Serpentary, Virginia Snakeroot
Overview
Aristolochia refers to plants of the Aristolochia genus. Aristolochia species have a history of use in traditional Chinese medicine. Despite historical claims of efficacy, aristolochia contains a known toxic constituent called aristolochic acid (32328, 94872). Because of its toxic effects, the US Food and Drug Administration (FDA) considers all products containing aristolochic acid to be unsafe and adulterated. The FDA will detain, without physical examination, any product which contains plants known or suspected to contain aristolochic acid, or which might be adulterated with plants known to contain aristolochic acid. Each detained product is released only after the manufacturer provides direct, analytical evidence that it is free of aristolochic acid (6118). Aristolochia products have also been banned in Canada, Germany, Austria, France, Great Britain, Belgium, and Japan (367, 32307). Despite these bans, aristolochic acid-containing supplements, as well as guidance for the harvesting and preparation of wild aristolochia, remain available on the internet (100336). Additionally, the Pharmacopeia of the People's Republic of China continues to allow for the use of three herbal remedies containing aristolochia (102937).
History
Aristolochia has a long history of use in traditional Chinese medicine, commonly in the form of a preparation called "GuanMu Tong" (32328, 94872).
In the late 1990s and early 2000s, the FDA, Health Canada, and other regulatory agencies began efforts to ban or regulate the sale of aristolochia supplements due to documented cases of nephrotoxicity associated with aristolochia and its constituent, aristolochic acid (367, 6118, 32307). Despite these efforts, aristolochic acid-containing supplements remain available for purchase online (100336).
People Use This For
Orally, aristolochia is used as an aphrodisiac, anticonvulsant, immune stimulant, to promote menstruation, and to treat snakebite. It is also used to treat allergic gastrointestinal colic and gallbladder colic. Other uses include arthritis, gout, rheumatism, eczema, weight loss, and wound treatment.
Unsafe when used orally. Aristolochia contains aristolochic acid, which is nephrotoxic and carcinogenic (6073, 6118, 32318, 32330). The US Food and Drug Administration (FDA) considers all products containing aristolochic acid to be unsafe and adulterated (6118).
PREGNANCY AND LACTATION: Unsafe when used orally; avoid using (6118).
General
Orally, use of aristolochia can cause end-stage renal failure and urothelial carcinoma of the bladder (12782). These adverse effects are well documented (564, 6073, 12783, 12784, 12785, 12786, 12787, 32318, 32320, 32326)(32330, 32337, 32338, 32339, 32351, 32353, 32363, 32373, 32374, 32375)(32376, 94872, 100337). A case of hepatotoxicity associated with aristolochia use has also been reported (32383).
Hepatic
In one case report, aristolochia was associated with hepatotoxicity (32383).
Renal
Orally, use of aristolochia can cause end-stage renal failure and urothelial carcinoma of the bladder (12782). There have been more than 100 cases of nephropathy, referred to as "Chinese herb nephropathy", characterized by interstitial fibrosis and associated with tea believed to be adulterated with aristolochia. This was originally reported in Belgium with accidental substitution of aristolochia for another herb. Of these cases, 43 progressed to end stage renal failure requiring dialysis or transplantation (564, 6073) and 18 developed urothelial carcinomas of the bladder, ureter, and/or renal pelvis (6073). Many cases of nephropathy and end stage renal failure associated with aristolochia use have been reported worldwide (12783, 12784, 12785, 12786, 12787, 32318, 32320, 32326, 32330, 32337, 32338, 32339, 32351, 32353, 32363, 32373, 32374, 32375, 32376, 94872, 100337). Aristolochic acid is the constituent in aristolochia that causes renal damage (32336, 94872). The risk of developing urothelial carcinoma seems to be related to cumulative intake of the herb (6073).
There is insufficient reliable information available about the effectiveness of aristolochia.
Adult
No typical dosage.
Standardization & Formulation
There is insufficient reliable information available about the standardization of aristolochia.
NEPHROTOXIC DRUGS
- Interaction Rating
- Moderate Be cautious with this combination.
- Severity
- HIGH
- Occurrence
- POSSIBLE
- Level of Evidence
- D (Theoretical based on pharmacology)
Aristolochia is nephrotoxic. There are numerous cases of nephropathy and renal failure associated with aristolochia use (12783, 12784, 12785, 12786, 12787, 32318, 32320). Theoretically, combining aristolochia with potentially nephrotoxic drugs might have additive adverse effects on kidney function. However, this interaction has not yet been reported in humans. Close monitoring of renal function in patients taking aristolochia with nephrotoxic drugs may be warranted.
Some potentially nephrotoxic drugs include cyclosporine (Neoral, Sandimmune); aminoglycosides including amikacin (Amikin), gentamicin (Garamycin, Gentak, others), and tobramycin (Nebcin, others); nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil, Motrin, Nuprin, others), indomethacin (Indocin), naproxen (Aleve, Anaprox, Naprelan, Naprosyn), piroxicam (Feldene); and numerous others.
None known.
RENAL DISEASE
Aristolochia causes interstitial fibrosis and might accelerate renal failure in people with pre-existing renal disease (12782).
None known.
Some in vitro research shows that aristolochic acid has mutagenic effects involving the induction of certain oncogenes and the suppression of P53, a tumor suppressor gene (32342, 102937). Additional in vitro research shows that sulphotransferases can increase these mutagenic effects (32342).
The World Health Organization's International Agency for Research on Cancer (WHO-IARC) classifies aristolochic acid as a human class I carcinogen with genotoxic activity (102937).
There is insufficient reliable information available about the pharmacokinetics of aristolochia.
General
The applicable parts of aristolochia are the above ground parts and root. Aristolochia contains the nephrotoxic and carcinogenic constituent aristolochic acid (32395).
Anti-inflammatory activity
Traditionally, aristolochia extracts are used for various skin conditions. Some in vitro suggests that aristolochia extracts can reduce inflammation, possibly by inhibiting cyclooxygenase (COX)-2 (12678). Additoinally, aristolochia extract has been shown to reduce ear edema in mice (32321).
Antimicrobial activity
Aristolochia has been traditionally used for the treatment of wounds and skin infections in some countries (32305, 32331). Various aristolochia species have shown antimicrobial activity in in vitro studies. Some of these species include Aristolochia monticola (32367), Aristolochia brevipes (32367), Aristolochia paucinervis Pomel leaves (32305, 32312, 32313, 32314), Aristolochia cymbifera (32341), Aristolochia trilobata (32331), Aristolochia contorta (32333). Antimicrobial activity against common pathogens such as Escherichia coli, Pseudomonas aeruginosa, Staphylococcus spp., Enterococcus faecalis, Helicobacter pylori, Staphylococcus aureus, Bacillus subtilis, and Streptococcus faecalis (32357). Aristolochia monticola and Aristolochia brevipes have also demonstrated antifungal activity against Candida albicans in vitro (32367).
Antineoplastic activity
Aristolochia species have been used traditionally for cancer in some countries (31170, 32308, 32366, 32367). Some in vitro research shows that certain aristolochia species have cytotoxic activity against certain cancer cell lines. These species include Aristolochia longa (32357, 32377), Aristolochia tubflora (32378), Aristolochia brevipes (32367), Aristolochia contorta (32345), and Aristolochia triangularis (32366).
However, aristolochic acid, a constituent of aristolochia, is a known carcinogen that can increase the risk for urothelial carcinoma (6073). The World Health Organization's International Agency for Research on Cancer (WHO-IARC) classifies aristolochic acid as a human class I carcinogen with genotoxic activity (102937).
Antivenom effects
Aristolochia has been traditionally used to treat snakebites. One animal study has shown that aristolochia extract can reduce symptoms of toxicity in mice exposed to lethal doses of spitting cobra and puff-adder venom (32380). Aristolochia seems to reduce the hemorrhagic, hemolytic, and phospholipase effects of spitting cobra venom (30971, 32381).
Cardiovascular activity
Some animal research shows that magnoflorine, a compound isolated from aristolochia (Aristolochia bracteata) seeds decreases blood pressure in rabbits (32369). The mechanism of this effect is unclear.
Genitourinary effects
Aristolochia species are nephrotoxic. Aristolochic acid and possibly other aristolochia constituents damage DNA, which causes fibrotic destruction of the kidney and development of tumors (12782, 32349, 32340, 32327, 32370, 32315, 12785, 32362).
Traditionally, aristolochia has been used to promote menstruation, and some laboratory research shows that certain aristolochia constituents may have effects on the genitourinary system. The compounds magnoflorine and aristolochic acid from aristolochia have been shown to induce uterine contractions, in vitro (32369). An opposite effect has been observed in animal research, with an ethanolic aristolochia extract reducing the amplitude of oxytocin-induced uterine contractions (32361).
Classes
Nephrotoxic AgentsReferences
See Monograph ReferencesLiterature Review Current Through: 3/8/2024, Last Updated: 12/12/2025
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