Aloe

Authors: Prof. Dr. med. Peter Altmeyer, Prof. Dr. med. Martina Bacharach-Buhles

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Last updated on: 08.06.2021

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Synonym(s)

Aloe barbadensis extract; Aloe Emodin; Bear bile; Succus Aloes inspissatus

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

HMPC: Internal use of Cape and Curaçao Aloe for the short-term treatment of occasional constipation: well-established use PhytopharmaconESCOP
: 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 of aloe leaves of various aloe species. Aloe species. This juice has anti-inflammatory and antibacterial properties and is used mainly 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.

Ingredients
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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 located outside the water storage tissue of the leaves under the leaf bark).

Furthermore, the chromone derivatives aloesin, aleosone, aloenin (a bitter substance) as well as in rather low concentration (<1%) the 1.8 dihydroxyanthroquinone derivative aloe-emodine (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.

Occurrence
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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.

Spectrum of action
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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.

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

Further indications are sunburn (Aloe gel), acne vulgaris and psoriasis vulgaris. Due to its antiseptic properties, aloe vera is also suitable for wound treatment.

Dosage
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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.

Undesirable effects
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Side effects of systemic administration: crampy gastrointestinal symptoms, with prolonged use possible disturbances in water and electrolyte balance; potassium losses. Risk of neprotoxicity (proteinuria, haematuria). The therapeutic importance of "aloe" in system therapy has decreased considerably, 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 especially the upper 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

Contraindication
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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.

Interactions
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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!

Trade names
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Phoenix Kalophön Ointment

Literature
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  1. https://arzneipflanzenlexikon.info/index.php?en_pflanzen=85
  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