Terminalia

Terminalia

• The bark of Terminalia arjuna has been used in India for more than 3000 years, primarily as a heart remedy. An Indian physician named Vagbhata has been credited as the first to use this product for heart conditions in the seventh century A.D. People today use T. arjuna for disorders of the heart and blood vessels (cardiovascular disease), including heart disease and related chest pain, high blood pressure, and high cholesterol. It is also used as "a water pill," and for earaches, dysentery, sexually transmitted diseases (STDs), diseases of the urinary tract, and to increase sexual desire. Its useful phytoconstituents are: Triterpenoids, ẞ-sitosterol, flavonoids, and glycosides.

Mechanism of Action:

• Triterpenoids and flavonoids are considered to be responsible for its beneficial antioxidant cardiovascular properties. The drug has shown promising effect on ischemic cardiomyopathy. Bark stem of T. arjuna possesses diuretic, ino-tropic, and chronotropic properties. The inotropic effect is considered to be mediated through the high concentration of Ca" present in the plant.

Dosage:

• Clinical studies have been conducted in cardiovascular disorders using T. arjuna bark extract at doses of 500 mg every 8 h for up to 3 months. Dosages for other Terminalia species have not been clinically defined.

Evidence:

• In a recent study the anti-ischemic effect of bark powder was evaluated in 30 patients of stable angina/post-infarct angina (500 mg tds). The authors observed that the mean anginal frequency decreased significantly, along with a significant decrease in systolic blood pressure (SBP), improvement in ECG changes, and reduction in plasma cortisol and serum cholesterol levels.

Precautions:

• Mild side effects like nausea, gastritis, headache, body ache, constipation, and insomnia have been reported. No hematological, renal, or metabolic toxicity has been reported even after more than 24 months of its administration. However, high amounts of the plant extract should not be consumed, as it may induce hepatotoxicity as well as hypothyroidism.

Interactions:

• Not much data is available to comment on the effect of T. arjuna on cyto-chrome P450 (CYP450) enzyme. Results from a recent in vitro study indicate that T. arjuna extracts contain constituents that can potently inhibit the activ-ity of CYP1A