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PRODUCT REVIEW
Year : 2016  |  Volume : 7  |  Issue : 5  |  Page : 39-42

A review on safety and efficacy of products containing Longifolia


1 Faculty of Pharmacy, Universiti Teknologi MARA, Selangor, Malaysia
2 Faculty of Pharmacy, Universiti Teknologi MARA, Selangor; Vector-borne Diseases Research Group (VERDI), Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARA, Selangor, Malaysia
3 Department of Hospital and Clinical Pharmacy, Faculty of Pharmacy, Cyberjaya University College of Medical Sciences (CUCMS), Selangor, Malaysia

Date of Web Publication26-May-2016

Correspondence Address:
Abdul Hafeez Ahmad Hamdi
Level 11, FF1 Building, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2045-080X.183036

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  Abstract 

Eurycoma longifolia (commonly called tongkat ali) is a flowering plant in the family Simaroubaceae, native to Indonesia, Malaysia, and, to a lesser extent, Thailand, Vietnam and also Laos. The roots extract of E. longifolia, is a well-known traditional herbal medicine in Asia used for many purposes such as sexual dysfunction, aging, malaria, cancer, diabetes, anxiety, aches, constipation, exercise recovery, fever, increased energy, increased strength, leukemia, osteoporosis, stress, syphilis and glandular swelling. The roots are also used as an aphrodisiac, antibiotic, appetite stimulant and health supplement. It is very important to conserve this valuable medicinal plant for the health benefit of future generations. The purpose of this review article is to evaluate and summarize the existing literatures regarding the efficacy and safety of products which contain E. longifolia as its main ingredient. In summary, based on the literature evaluated in this review article, products which contain tongkat ali showed a clinical benefit on improving erectile dysfunction as well as a good safety profile. We recommend consumers to check the level of the bioactive compound “eurycomanone” as their guide before choosing any E. longifolia product.

Keywords: Eurycoma longifolia, pharmacological efficacy, quassinoids, safety, traditional herbal medicine


How to cite this article:
Hamdi AH, Ming LC, Kassab YW. A review on safety and efficacy of products containing Longifolia. Arch Pharma Pract 2016;7, Suppl S1:39-42

How to cite this URL:
Hamdi AH, Ming LC, Kassab YW. A review on safety and efficacy of products containing Longifolia. Arch Pharma Pract [serial online] 2016 [cited 2019 Sep 15];7, Suppl S1:39-42. Available from: http://www.archivepp.com/text.asp?2016/7/5/39/183036


  Introduction Top


Sexual health plays an important role in the quality of life of both genders. In males, erectile dysfunction (ED) can lead to dissatisfaction in sexual life and deterioration of sexual well-being.[1] In Malaysia, one of the most popular herbs, Eurycoma longifolia from the Simaroubaceae family, also known traditionally as tongkat ali, has been reputed for the improvement of the quality of life and sexual well-being in men; however, clinical trials to support the traditional use of E. longifolia are limited.[2]

Tongkat ali is used as a dietary supplement claimed to enhance sexual and physical vitality and to improve testosterone deficiency in hypogonadism males and various sexual and reproductive disorders. It also claimed to improve fatigue recovery among sporting individuals and increase physical strength and reduce mental stress by reducing cortisol in both men and women (MIMS online).


  Clinical Pharmacology Top


The plant parts in E. longifolia are rich in various bioactive compounds such as eurycomaoside, eurycolactone, eurycomalactone, eurycomanone, and pasakbumin-B, which are alkaloids and quassinoids.[3] However, eurycomanone is the highest concentrated quassinoid in the root extract of E. longifolia that increases testosterone steroidogenesis at the Leydig cells by inhibiting aromatase conversion of testosterone to estrogen and at a high concentration, may also involve phosphodiesterase inhibition.[4]


  Pharmacokinetics Top


Absorption

Following oral administration of eurycomanone, its Cmax and Tmax values were detected as 0.33 ± 0.03 µg/ml and 4.40 ± 0.98 h, respectively. The absolute bioavailability of the compound is 10.5%.[5]



Elimination

Eurycomanone has biological half-life of 1.00 ± 0.26 h and its mean elimination rate constant (Ke) is 0.88 ± 0.19 h. It clearance is 0.39 ± 0.08 L/h/kg.[5]

Distribution

Furthermore, the compound appeared to be well distributed in the extravascular fluids because of its relatively high volume of distribution (Vd).[6] Its volume of distribution (Vd) is 0.68 ± 0.30 L/kg.[7]


  Methodology Top


Search criteria

Articles published in English from 2009 to 2015 were sought using Science Direct and PubMed databases. The keywords located in the title, abstract, or subject used to select articles were “Eurycoma longifolia”, “tongkat ali” and “Long Jack”. A total of 29 articles were reviewed.

Safety and efficacy

In a randomized, double-blind, placebo-controlled study, E. longifolia was compared with placebo for the improvement of quality of life and sexual well-being in men. The findings showed significant improvement in erectile functioning of the treatment group. Results also showed a significant increase in serum testosterone levels, total international index of erectile function score, erectile function score, and volume of the sperm, sperm motility, and sperm concentration in the subjects who took E. longifolia. In this study, one subject was hospitalized under the treatment group, but it was not due to the treatment.[2]

Another randomized, double-blind, placebo-controlled study showed significant improvement in sexual performance across several clinically important parameters. The study showed an increase in total testosterone, scores for the sexual intercourse attempt diary, erection hardness scale, sexual health inventory of men, and aging male symptom scale in the treatment group. No serious adverse events were reported from this study.[8]

A systematic review of randomized, double-blind, placebo-controlled study evaluating the efficacy of E. longifolia found significant benefit in the treatment group with E. longifolia. There are no significant differences of adverse events found between treatment and placebo groups.[9]


  Potential Risk to General Public Top


E. longifolia is one of the most common herbal products in the market, and it has become a very valuable product in the herbal industry. Products containing that E. longifolia has gained its reputation as a sexual performance enhancer based on traditional uses. Because of good demand from the public, there are various products in the market with different dosage forms. Such as capsule or pill, formulated drinks, and packaged root chips.

Suppliers and manufacturers sometimes manipulate this situation by producing a fake product of E. longifolia by putting too little concentration of E. longifolia herbs to gain more profits. This is usually done by either adding the stem, instead of the root of E. longifolia or putting too much filler such as wheat and rice into their product.

Due to the popularity of E. longifolia, discrepancy in labeling the product can occur where a product is named as E. longifolia even though E. longifolia is not the main ingredient in the product. Even worst, some E. longifolia products may not even contain any bioactive component of E. longifolia.

It is very usual for E. longifolia manufacturer to claim the quality of their products based on extraction ratio. Quality products-containing E. longifolia are based on the level of eurycomanone, the major compound in E. longifolia that should be around 0.8–1.5% w/v.[10] Study of detection and quantification of eurycomanone levels in tongkat ali herbal products found that out of 41 products, 17 (42%) products did not contain eurycomanone compound in their product.[10]

Due to this, the quality of products which claim E. longifolia as its main product needs to be regulated to ensure that customers get the best of their purchased products.


  Drug Herbs Interactions Top


There are also reported scientific data on the interaction between E. longifolia and certain drugs. However, limited clinical studies were conducted to investigate drug-herb interaction. In one study, the bioavailability of propranolol is significantly decreased when consumed together with E. longifolia. The interaction is due to a reduction in absorption, rather than an increase in propranolol's metabolism. Although the pharmacodynamics of propranolol was not affected in healthy volunteers, caution is still advisable with co-administration of the drug and the herb.[11]


  Recommendations And Conclusions Top


In summary, based on the results of our review, products which contain E. longifolia as its main ingredient have a clinical benefit on improving ED and good safety profile based on the randomized control trial data. When consumer plans to consider taking any E. longifolia product, they should refer level of bioactive compound which is eurycomanone in their product.

Financial support and sponsorship

This work was supported by Research Acculturation Grant Scheme: RAGS/1/2014/SKK07/UITM//7. The authors would like to express their gratitude to Ministry of Higher Education and Universiti Teknologi MARA (UiTM), Malaysia for financial support for this research.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kotirum S, Ismail SB, Chaiyakunapruk N. Efficacy of Tongkat Ali (Eurycoma longifolia) on erectile function improvement: Systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2015;23:693-8.  Back to cited text no. 1
    
2.
Ismail SB, Wan Mohammad WM, George A, Nik Hussain NH, Musthapa Kamal ZM, Liske E. Randomized clinical trial on the use of PHYSTA freeze-dried water extract of Eurycoma longifolia for the improvement of quality of life and sexual Well-Being in Men. Evid Based Complement Alternat Med 2012;2012:429268.  Back to cited text no. 2
    
3.
Bhat R, Karim AA. Tongkat ali (Eurycoma longifolia Jack): A review on its ethnobotany and pharmacological importance. Fitoterapia 2010;81:669-79.  Back to cited text no. 3
    
4.
Low BS, Choi SB, Abdul Wahab H, Das PK, Chan KL. Eurycomanone, the major quassinoid in Eurycoma longifolia root extract increases spermatogenesis by inhibiting the activity of phosphodiesterase and aromatase in steroidogenesis. J Ethnopharmacol 2013;149:201-7.  Back to cited text no. 4
    
5.
Low BS, Teh CH, Yuen KH, Chan KL. Physico-chemical effects of the major quassinoids in a standardized Eurycoma longifolia extract (Fr 2) on the bioavailability and pharmacokinetic properties, and their implications for oral antimalarial activity. Nat Prod Commun 2011;6:337-41.  Back to cited text no. 5
    
6.
Wizneh FM, Asmawi MZ. Eurycoma longifolia Jack (Simarubaceae); Advances in Its Medicinal Potentials Pharmacognosy J 2014;6:1-9.  Back to cited text no. 6
    
7.
Low BS, Ng BH, Choy WP, Yuen KH, Chan KL. Bioavailability and pharmacokinetic studies of eurycomanone from Eurycoma longifolia. Planta Med 2005;71:803-7.  Back to cited text no. 7
    
8.
Udani JK, George AA, Musthapa M, Pakdaman MN, Abas A. Effects of a proprietary freeze-dried water extract of Eurycoma longifolia (Physta) and Polygonum minus on sexual performance and Well-Being in Men: A Randomized, Double-Blind, Placebo-Controlled Study. Evid Based Complement Alternat Med 2014;2014:179529.  Back to cited text no. 8
    
9.
Kotirum S, Ismail SB, Chaiyakunapruk N. Efficacy of Tongkat ali (Eurycoma longifolia) on erectile function improvement: Systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2015;23:693-8.  Back to cited text no. 9
    
10.
Vejayan J, Norhidayah A, Yusoff MM. Detection and quantification of eurycomanone levels in Tongkat ali herbal products. J Appl Sci2015;15:999-1005.  Back to cited text no. 10
    
11.
Salman SA, Amrah S, Wahab MS, Ismail Z, Ismail R, Yuen KH, et al. Modification of propranolol's bioavailability by Eurycoma longifolia water-based extract. J Clin Pharm Ther 2010;35:691-6.  Back to cited text no. 11
    




 

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