Bael Non-Alcohol [Discontinued] by Hawaii Pharm

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Asthma. Clinical research in patients with asthma shows that taking 100 mg of a specific product (AlvioLife) containing a 1:1 combination of bael fruit and boswellia gum resin extracts twice daily for 8 weeks improves activity, asthma symptoms, and emotions compared with placebo. The improvement in the maximum speed of expiration was approximately double that of placebo. The amount of air exhaled during a forced breath was not improved (99299). It is unclear if these effects are due to bael, boswellia, or the combination.
• Shigellosis. Preliminary clinical research shows that taking dried bael fruit powder 6 grams daily for 3 days does not reduce the number of stools in patients with diarrhea due to shigellosis (33330). More evidence is needed to rate bael for these uses.

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There is insufficient reliable information available about the safety of bael.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Evidence from animal research suggests that extracts of bael seed and leaf can reduce blood glucose levels (33316,33325). Theoretically, bael might have additive effects with antidiabetes drugs and increase the risk of hypoglycemia. Monitor blood glucose levels closely. Dose adjustments might be necessary.  Details Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others.

CHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Bael leaf extract shows acetylcholinesterase (AChE) inhibitory activity in vitro (99296). Theoretically, bael might have additive effects with cholinergic drugs and increase the risk of cholinergic side effects.  Details Cholinergic drugs include bethanechol (Urecholine), donepezil (Aricept), echothiophate (Phospholine Iodide), edrophonium (Enlon, Reversol, Tensilon), neostigmine (Prostigmin), physostigmine (Antilirium), pyridostigmine (Mestinon, Regonol), succinylcholine (Anectine, Quelicin), and tacrine (Cognex).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Bael extract and its constituent marmesinin inhibited cytochrome P450 1A2 (CYP1A2) activity in vitro (99300). So far, this interaction has not been reported in humans. Theoretically, bael might increase levels of drugs metabolized by CYP1A2.  Details Some drugs metabolized by CYP1A2 include amitriptyline (Elavil), haloperidol (Haldol), ondansetron (Zofran), propranolol (Inderal), theophylline (Theo-Dur, others), verapamil (Calan, Isoptin, others), and others. Use bael cautiously or avoid in patients taking these drugs.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Bael and its constituents marmelosin and marmesinin inhibited cytochrome P450 3A4 (CYP3A4) activity in vitro (99300). So far, this interaction has not been reported in humans. Theoretically, bael might increase levels of drugs metabolized by CYP3A4.  Details Some drugs metabolized by CYP3A4 include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and numerous others. Use bael cautiously or avoid in patients taking these drugs.

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General ...Consuming large amounts of bael may cause gastrointestinal upset and constipation (18).

Gastrointestinal ...Orally, consuming large amounts of bael may cause gastrointestinal upset and constipation (18).

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