Rauwolfia

Background & General Info

Rauwolfia serpentina, or snake root plant, is an evergreen shrub indigenous to tropical and subtropical regions of Europe, Africa, Asia, Australia, and the Central and South Americas, particularly in moist, deciduous forests. ^[1] This plant is commonly known by a variety of local names where it grows such as as sarpagandha, chandrabagha, chotachand, chandrika, and harkaya. ^[2] The genus Rauwolfia was named after Dr. Leonhard Rauwolf, a German physician in 16th century who studied this plant during his travel in India, whereas the species name serpentina comes from the long, tapering, snake-like roots of the plant. ^[3]

Rauwolfia - Botany

Reaching a height of 60 and 90 cm, Rauwolfia serpentina is characterized by its elliptical or lanceolate, pale green leaves that are arranged in whorls of three to five. This evergreen, woody plant possesses a 30–50-centimeter-long prominent tuberous, soft taproot and bears several shiny, black or purple, round fruits. It has small pink or white flowers. ^[1]

Rauwolfia - History & Traditional Use

In Indian folk medicine, Rauwolfia serpentina has been in use for centuries to treat various disorders and conditions such as snake and insect bites, fever, malaria, abdominal pain, and dysentery and is utilized as a uterine stimulant, febrifuge, and remedy for insanity. Indian manuscripts that date back to 1000 B.C. mention this plant and refer it as “sarpagandha” and “chandrika”. ^[4] In the 1940s, Rauwolfia serpentina became a popular herb of choice for hypertension among physicians throughout India, and in the 1950s, this spread globally, reaching Western countries such as the United States and Canada. ^[1]

Rauwolfia - Herbal Uses

Rauwolfia serpentina is a popular alternative remedy for hypertension and neurological disorders. ^[5] In Ayurvedic and Western medicinal systems, the herb is celebrated also as a famous treatment of insomnia, anxiety, schizophrenia, and insanity, and its root extract can be very helpful in relieving discomforts of the gastrointestinal tract such as diarrhea, dysentery, cholera, and colic. ^[6]

Rauwolfia - Constituents / Active Components

The entire plant, particularly its stems and leaves, contains an abundance of indole alkaloids, with the highest concentration being in the bark of the root. Reserpine, one of the primary alkaloids of Rauwolfia serpentina, has been known to be in greatest concentration in the roots and lowest in the stems and leaves. The glucoalkaloid raucaffricine has also been identified as a constituent of the plant. ^[7] Other major alkaloids identified in Rauwolfia serpentina include ajmaline, ajmalicine, ajmalimine, deserpidine, indobine, indobinine, reserpine, reserpiline, rescinnamine, rescinnamidine, serpentine, serpentinine, and yohimbine. ^[2]

Rauwolfia - Medicinal / Scientific Research

Cardiovascular:

In an early study published in the journal Circulation, fifteen individuals suffering from coronary artery disease and angina pectoris received alternate courses of Rauwolfia serpentina fraction and placebo. Findings indicated an improvement in fourteen patients according to independent clinical evaluations and data from daily report card, whereas electrocardiogram results of seven patients became normal. Alseroxylon, a complex extract from Rauwolfia serpentina, elicited a curiously prolonged therapeutic effect. ^[8]

Antihypertensive:

Douglas Lobay, a naturopathic physician, recommends the use of low-dose Rauwolfia as a safe and effective form of management of hypertension and an adjunct to pharmaceuticals commonly employed in high blood pressure treatment. ^[1] A very early study by Vakil (1949) provided data wherein a reduction in systolic and diastolic blood pressures among 85% and 81% of patients with essential hypertension following treatment with Rauwolfia. ^[9]

A Cochrane Database Review was conducted in 2009 of evidence from randomized controlled trials searched in CENTRAL, EMBASE, and MEDLINE databases and conclusively found reserpine to be effective in lowering systolic blood pressure. Its dose-related hypotensive effect was said to be “roughly to the same degree as other first-line antihypertensive drugs.” In this review, four randomized controlled trials involving 237 study participants overall demonstrated a statistically significant decrease in systolic blood pressure among patients taking reserpine compared to placebo, with effect on systolic blood pressure having been achieved with 0.5 mg/day or greater. None of these four trials reported withdrawal due to adverse effects. ^[10]

Antidiabetic:

The promising effect of Rauwolfia serpentina against diabetes is a current point of focus in research using both alloxan-treated and normoglycemic mice. Qureshi et al. (2009) demonstrated the hypoglycemic, hypolipidemic, and hepatoprotective properties of methanol root extract of Rauwolfia serpentina in rats with alloxan-induced diabetes. A marked decrease in the glucose levels (94–106 mg/dL) was observed in tested rats as compared to diabetic controls, as well as a significant reduction in levels of triglycerides (p<0.01), total cholesterol, and alanine aminotransferase (p<0.05). ^[6]

Azmi and Qureshi (2016) demonstrated that the methanol root extract of Rauwolfia serpentina significantly enhanced the percent body weight of experimental mice and improved biochemical and hematological markers such as their serum insulin, total cholesterol, triglycerides, low-density lipoprotein, very low-density lipoprotein, high-density lipoprotein-cholesterols, total hemoglobin, glycosylated hemoglobin, hepatic glycogen, and coronary risk and fasting insulin resistance indices. Comparing the tested animals with the diabetic controls, the methanol extract also suppressed the activity of 3-hydroxy-3-methylglutaryl coenzyme A reductase, a rate-controlling enzyme that plays a role in the metabolic pathway that produces cholesterol. The 14-day oral treatment of Rauwolfia serpentina extract led to findings that indicate its efficacy to improve carbohydrate and lipid homeostasis by either suppressing the absorption of fructose in the intestine or lowering insulin resistance among mice with fructose-induced type 2 diabetes. ^[5]

Antidiarrheal:

The methanol extract from Rauwolfia serpentina leaves had been found in a 2012 study to display significant antidiarrheal activity at doses of 100, 200, and 400 mg/kg. With experimental diarrhea having been stimulated by castor oil in mice, all doses of the leaf extract dose-dependently lowered the mice’s intestinal weight and fluid volume and significantly decreased the intestinal transit based on charcoal meal test. ^[11]

Rauwolfia - Contraindications, Interactions, And Safety

Alkaloids specifically known to exist in Rauwolfia plants are contraindicated for individuals with previously demonstrated hypersensitivity to these compounds; patients with a history of mental depression, particularly suicidal tendencies; patients suffering from active peptic ulcer disease or ulcerative colitis; and patients undergoing electroconvulsive therapy. Sedation and inability to concentrate and perform complex tasks are the two most common adverse effects of Rauwolfia treatment, but nasal congestion, increased gastric secretion, and mild diarrhea can also happen due to reserpine’s sympatholytic property and its enhancement of parasympathetic activities. In addition, reserpine has been purported to possibly cause mental depression, which can result in suicide; this is the primary reason why the use of Rauwolfia serpentina preparations should be terminated at the first sign of depression. ^[12]

References:

[1] D. Lobay, "Rauwolfia in the treatment of hypertension," Integrative Medicine: A Clinician’s Journal, vol. 14, no. 3, p. 40–46, 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566472/

[2] R. Kumari, B. Rathi, A. Ranic and S. Bhatnagar, "Rauvolfia serpentina L. Benth. ex Kurz.: Phytochemical, pharmacological and therapeutic aspects," International Journal of Pharmaceutical Sciences Review and Research, vol. 23, no. 2, p. 348–355, 2013. https://www.globalresearchonline.net/journalcontents/v23-2/56.pdf

[3] V. Tyler, L. Brady and J. Robbers, Pharmacognosy, 9th ed., Philadelphia: Lea & Febiger, 1988, p. 222–225. www.jpharmsci.org/article/S0022-3549(15)39479-X/pdf

[4] E. Yarnell and K. Abascal, "Treating hypertension botanically," Alternative and Complementary Therapies, vol. 7, no. 5, p. 284–290, 2001. https://online.liebertpub.com/doi/pdf/10.1089/107628001753312121

[5] M. Azmi and S. Qureshi, "Rauwolfia serpentina improves altered glucose and lipid homeostasis in fructose-induced type 2 diabetic mice," Pakistan Journal of Pharmaceutical Sciences, vol. 29, no. 5, p. 1619–1624, 2016. https://www.ncbi.nlm.nih.gov/pubmed/27731821

[6] S. Qureshi, A. Nawaz, S. Udani and B. Azmi, "Hypoglycaemic and hypolipidemic activities of Rauwolfia serpentina in alloxan-induced diabetic rats," International Journal of Pharmacology, vol. 5, p. 323–326, 2009. https://scialert.net/fulltext/?doi=ijp.2009.323.326

[7] C. Ruyter, M. Akram, I. Illahi and J. Stöckigt, "Investigation of the alkaloid content of Rauwolfia serpentina roots from regenerated plants," Planta Medica, vol. 57, no. 4, p. 328–330, 1991. https://www.ncbi.nlm.nih.gov/pubmed/17226170

[8] B. I. Lewis, R. I. Lubin, L. E. January and J. B. Wild, "Rauwolfia serpentina in the treatment of angina pectoris," Circulation, vol. 14, p. 227–232, 1956. https://www.ncbi.nlm.nih.gov/pubmed/13356475

[9] R. Vakil, "A clinical trial of Rauwolfia serpentina in essential hypertension," British Heart Journal, vol. 11, no. 4, p. 350–355, 1949. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC503638/

[10] S. Shamon and M. Perez, "Blood pressure lowering efficacy of reserpine for primary hypertension," Cochrane Database of Systematic Reviews, vol. 7, no. 4, p. CD007655, 2009. https://www.ncbi.nlm.nih.gov/labs/articles/27997978/

[11] I. Ezeigbo, M. Ezeja, K. Madubuike, D. Ifenkwe and e. al., "Antidiarrhoeal activity of leaf methanolic extract of Rauwolfia serpentina," Asian Pacific Journal of Tropical Biomedicine, vol. 2, no. 6, p. 430–432, 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609332/

[12] N. H. Mashour, G. I. Lin and W. H. Frishman, "Herbal medicine for the treatment of cardiovascular disease: clinical considerations," Archives of Internal Medicine, vol. 158, no. 20, p. 2225–2234, 1998. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/210378

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