Gotu kola (Centella asiatica Linn.) and Total Triterpenic Fraction of Centella asiatica (TTFCA)

RELATED TERMS

Antanan gede, asiaticoside, Asiatic pennywort, asiatischer wassernabel, bavilacqua, Blasteostimulina©, brahmi, brahmi-buti, brahmi manduc(a) parni, calingan rambat, Centasium©, Centalase©, Centellase©, Centella coriacea, Centella asiatica triterpenic fraction (CATTF), coda-gam, Emdecassol©, Fo-Ti-Teng©, gagan-gagan, gang-gagan, HU300, hydrocotyle, Hydrocotyle asiastica, hydrocolyte asiatique, idrocotyle, Indian pennywort, Indian water navelwort, indischer wassernabel, kaki kuda, kaki kuta, kerok batok, kos tekosan, lui gong gen, Madecassol©, marsh penny, pagaga, panegowan, papaiduh, pegagan, pepiduh, piduh, puhe beta, rending, sheep rot, talepetrako, tete kadho, tete karo, thankuni, thick-leaved pennywort, titrated extract from Centella asiatica (TECA), total triterpenic fraction of Centella asiatica (TTFCA), Trofolastin©, tsubo-kusa, tungchian, tungke-tunfke, water pennyrot, white rot.

BACKGROUND

Gotu kola is from the perennial creeping plant, Centella asiatica (formerly known as Hydrocotyle asiatica), which is a member of the parsley family. It is native to India, Madagascar, Sri Lanka, Africa, Australia, China, and Indonesia.

Gotu kola has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Gotu kola is mentioned in the Shennong Herbal, compiled in China roughly 2,000 years ago, and has been widely used medicinally since 1700 AD. It has been used to treat leprosy in Mauritius since 1852; to treat wounds and gonorrhea in the Philippines; and to treat fever and respiratory infections in China.

The most popular use of gotu kola in the United States is the treatment for varicose veins or cellulitis. Preliminary evidence suggests short-term efficacy (6-12 months) of the total triterpenic fraction of Centella asiatica (TTFCA) in the treatment of "chronic venous insufficiency" (a syndrome characterized by lower extremity swelling, varicosities, pain, itching, atrophic skin changes, and ulcerations, possibly due to venous valvular incompetence or a post-thrombotic syndrome).

While quality human evidence on the efficacy of gotu kola is still lacking, gotu kola can now be found worldwide as a component of skin creams, lotions, hair conditioners, shampoos, tablets, drops, ointments, powders, and injections. Gotu kola is not related to the kola nut (Cola nitida, Cola acuminata). Gotu kola is not a stimulant and does not contain caffeine.

EVIDENCE TABLE

Conditions

Uses disclaimer: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.	Grade*
Chronic venous insufficiency/varicose veins Chronic venous insufficiency (CVI) is a term more commonly used in Europe than the United States. It describes a syndrome characterized by lower extremity swelling, varicosities, pain, itching, atrophic skin changes, and ulcerations. Multiple small trials suggest that the total triterpenoid fraction of Centella asiatica (TTFCA) (from gotu kola) may have small to moderate benefits on objective and subjective parameters associated with chronic venous insufficiency. However, further research is necessary before a strong recommendation can be made.	B
Anxiety In Ayurvedic (traditional Indian) medicine, gotu kola is said to develop the crown chakra, the energy center at the top of the head, and to balance the right and left hemispheres of the brain. Preliminary evidence has demonstrated anxiolytic properties of gotu kola, although this activity may or may not apply to humans. Although preliminary findings are promising, more study is needed in this area.	C
Cognitive function Study results on gotu kola and liver disease are mixed. Further research is needed before a recommendation can be made.	C
Diabetic microangiopathy Preliminary studies have suggested beneficial effects of the total triterpenoid fraction of Centella asiatica (TTFCA) on subjective and objective parameters of venous insufficiency of the lower extremities. However, additional study is needed in this area.	C
Liver cirrhosis Study results on gotu kola and liver disease are mixed. Further research is needed before a recommendation can be made.	C
Wound healing Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this are to make a strong recommendation.	C
*Key to grades: A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).

TRADITION

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below. Abscesses, airline flight-induced lower extremity edema, Alzheimer's disease, amenorrhea, anemia, antidepressant, anti-fertility agent, anti-infective, antioxidant, antivenom, aphrodisiac, asthma, bladder lesions, blood purifier, bronchitis, bruises, burns, cancer, cellulitis, cerebrovascular disease, cholera, colds, corneal abrasion, dehydration, diarrhea, diuretic, dysentery, eczema, elephantiasis, energy, epilepsy, eye diseases, fatigue, fever, fungal infections, gastric ulcers, gastric ulcer prophylaxis, gastritis, gonorrhea, hair growth promoter, hemorrhoids, hepatic disorders, hepatitis, herpes simplex virus-2, high blood pressure, hot flashes, immunomodulator, inflammation, influenza, jaundice, keloid formation prevention, leprosy, leukoderma, libido, longevity, malaria, memory enhancement, menstrual disorders, mental disorders, mood disorders, neuroprotection, pain, periodontal disease, peripheral vasodilator, physical exhaustion, psoriasis, radiation-induced behavioral changes, respiratory infections, restless leg syndrome, rheumatism, scabies, scar healing, scleroderma, shigellosis, shingles (post-herpetic neuralgia), skin diseases, skin graft donor wounds, snakebites, striae gravidarum (stretch marks), sunstroke, syphilis, systemic lupus erythematosus, tonsillitis, tuberculosis, urinary retention, urinary tract infection, vaginal discharge, vascular fragility, venous disorders.

DOSING

disclaimer: The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (over 18 years old)

There is no proven effective dose for gotu kola in adults. For chronic venous insufficiency, varicose veins, or venous hypertension, various dosing regimens have been studied, including 60-120 milligrams daily Centellase© (TTFCA); 30 milligrams twice daily Centellase©; 30 milligrams three times daily TTFCA; 60mg twice daily TTFCA; 60 milligrams TTFCA three times daily. Preliminary studies suggest a dose-dependent response, with better results using 60 milligrams three times daily TTFCA. TECA (titrated extract from Centella asiatica) has also been studied, at a dose of 60-120 milligrams daily. For diabetic microangiopathy, 60 milligrams twice daily of TTFCA (total triterpenic fraction of Centella asiatica) has been studied. Combination products such as CognoBlend© have been studied for liver cirrhosis and cognitive enhancement.

Children (under 18 years old)

There is no proven effective dose for gotu kola in children.

SAFETY

disclaimer: The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in individuals with a known allergy or hypersensitivity to gotu kola or any of its constituents, including asiaticoside, asiatic acid, or madecassic acid. There are numerous reports of allergic contact dermatitis after topical gotu kola use. Allergic contact dermatitis has been reported after the use of topical Blasteostimulina© cream, containing Centella asiatic extract, and after the application of topical Madecassol© ointment.

Side Effects and Warnings

Studies suggest that gotu kola has few side effects when taken by mouth. Reported symptoms include stomach upset and nausea. In animal research, large doses of gotu kola cause drowsiness, increase cholesterol levels, and raise blood sugar levels. Individuals with diabetes or high cholesterol should avoid gotu kola. Use caution if driving or operating heavy machinery while taking gotu kola as it may cause drowsiness. Asiaticoside, an ingredient of gotu kola, may have weak cancer-causing effects when applied to the skin. There is also a report of night eating syndrome associated with gotu kola.

Gotu kola is not related to the kola nut (Cola nitida, Cola acuminata). Gotu kola is not a stimulant and does not contain caffeine.

Pregnancy and Breastfeeding

In animal studies, gotu kola reduces the ability of a female to become pregnant, but it is not known if this effect occurs in humans. Gotu kola is not recommended during pregnancy or breast-feeding because there is little safety and efficacy information available.

INTERACTIONS

disclaimer: Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

In theory, gotu kola may increase the amount of drowsiness caused by sedating drugs. Examples include benzodiazepines such as lorazepam (Ativan©); barbiturates such as phenobarbital; narcotics such as codeine; and alcohol. Caution is advised while driving or operating heavy machinery.

In animals, gotu kola can raise blood sugar levels. Patients taking medications for diabetes or using insulin should be monitored closely by a qualified health care professional while using gotu kola. Dosing adjustments may be necessary.

In theory, gotu kola may increase cholesterol levels and may work against the activity of cholesterol-lowering drugs.

Although not well studied in humans, gotu kola may also interact with drugs taken for Alzheimer's disease, anxiety, or cancer. Gotu kola may have anti inflammatory, antibacterial or antiviral effects. Caution is advised when taking gotu kola with other medications that have similar effects. Gotu kola may also interact with drugs that relax and dilate the blood vessels, allowing increased blood flow (vasodilators).

Gotu kola may also interact with the way other drugs are broken down by the liver. It may also cause liver damage. Consult a qualified healthcare professional including a pharmacist, to check for interactions.

Gotu kola may have a positive interaction when taken with diuretics (water pills) or hormones.

Interactions with Herbs and Dietary Supplements

In theory, gotu kola may increase the amount of drowsiness caused by some herbs or supplements. Caution is advised while driving or operating heavy machinery.

Although not well studied in humans, gotu kola may raise blood sugar and may therefore counteract the effects of products that lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Studies in animals suggest that gotu kola may increase cholesterol levels. It may therefore interfere with the effectiveness of lipid-lowering agents such as fish oil, garlic, or niacin.

Although not well studied in humans, gotu kola may also interact with drugs taken for Alzheimer's disease, anxiety, or cancer. Gotu kola may have anti inflammatory, antibacterial antioxidant or antiviral effects. Caution is advised when taking gotu kola with other medications that have similar effects. Gotu kola may also interact with drugs that relax and dilate the blood vessels, allowing increased blood flow (vasodilators).

Gotu kola may also interact with the way other drugs are broken down by the liver. It may also increase the risk of liver damage when used with other liver damaging herbs or supplements. Consult a qualified healthcare professional including a pharmacist, to check for interactions.

Although not well studied in humans, gotu kola may have a positive interaction when taken with diuretics (water pills). It may also have a positive interaction with herbs and supplements with hormonal effects.

Gotu kola may have additive affects when taken concomitantly with herbs that stimulate the immune system, such as astragalus, ginger, goldenseal, or propolis. Gotu kola may have additive effects when taken with herbs and supplements that increase blood flow, such as aconite, black cohosh, fenugreek, or garlic.

ATTRIBUTION

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

• Belcaro G, Laurora G, Cesarone MR, et al. Efficacy of Centellase (R) in the treatment of venous hypertension evaluated by a combined microcirculatory model. Curr Ther Res 1989;46(6):1015-1026.
• Belcaro GV, Grimaldi R, Guidi G, et al. Treatment of diabetic micorangiopathy with TTFCA. A microcirculatory study with laser-Doppler flowmetry, P02/PC02, and capillary permeability measurements. Curr Ther Res 1990;47(3):421-428.
• Belcaro GV, Rulo A, Grimaldi R. Capillary filtration and ankle edema in patients with venous hypertension treated with TTFCA. Angiology 1990;41(1):12-18.Belcaro GV, Grimaldi R, Guidi G. Improvement of capillary permeability in patients with venous hypertension after treatment with TTFCA. Angiology 1990;41(7):533-540.
• Bradwejn J, Zhou Y, Koszycki D, et al. A double-blind, placebo-controlled study on the effects of Gotu Kola (Centella asiatica) on acoustic startle response in healthy subjects. J Clin Psychopharmacol 2000;20(6):680-684.
• Carlson JJ, Farquhar JW, DiNucci E, et al. Safety and efficacy of a ginkgo biloba-containing dietary supplement on cognitive function, quality of life, and platelet function in healthy, cognitively intact older adults. J Am Diet.Assoc 2007;107(3):422-432. View abstract
• Cesarone MR, Incandela L, De Sanctis MT, et al. Evaluation of treatment of diabetic microangiopathy with total triterpenic fraction of Centella asiatica: a clinical prospective randomized trial with a microcirculatory model. Angiology 2001;52(10 suppl 2):S49-S54. View abstract
• Cesarone MR, Incandela L, De Sanctis MT, et al. Flight microangiopathy in medium- to long-distance flights: prevention of edema and microcirculation alterations with total triterpenic fraction of Centella asiatica. Angiology 2001;52(10 suppl 2):S33-S37. View abstract
• Cesarone MR, Belcaro G, De Sanctis MT, et al. Effects of the total triterpenic fraction of Centella asiatica in venous hypertensive microangiopathy: a prospective, placebo-controlled, randomized trial. Angiology 2001;52(10 suppl 2):S15-S18. View abstract
• De Sanctis MT, Belcaro G, Incandela L, et al. Treatment of edema and increased capillary filtration in venous hypertension with total triterpenic fraction of Centella asiatica: A clinical, prospective, placebo-controlled, randomized, dose-ranging trial. Angiology 2001;52(10 suppl 2):S55-S59. View abstract
• Incandela L, Belcaro G, De Sanctis MT, et al. Total triterpenic fraction of Centella asiatica in the treatment of venous hypertension: a clinical, prospective, randomized trial using a combined microcirculatory model. Angiology 2001;52(10 suppl 2):S61-S67. View abstract
• Incandela L, Cesarone MR, Cacchio M, et al. Total triterpenic fraction of Centella asiatica in chronic venous insufficiency and in high-perfusion microangiopathy. Angiology 2001;52(10 suppl 2):S9-S13. View abstract
• Incandela L, Belacaro G, Cesarone MR, et al. Treatment of diabetic microangiopathy and edema with total triterpenic fraction of Centella asiatica: a prospective, placebo-controlled randomized study. Angiology 2001;52(10 suppl 2):S27-S31. View abstract
• Kaziulin AN, Petukhov AB, Kucheriavyi IuA. [Efficiency of includes of bioactive substances in diet of patient with hepatic encephalopathy]. Vopr.Pitan. 2006;75(2):40-44. View abstract
• Ramanathan M, Sivakumar S, Anandvijayakumar PR, et al. Neuroprotective evaluation of standardized extract of Centella asciatica in monosodium glutamate treated rats. Indian J Exp Biol 2007;45(5):425-431. View abstract

disclaimer: Natural Standard Bottom Line Monograph, Copyright © 2011 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions. disclaimer: While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy. disclaimer: The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

Copyright © 2011 Natural Standard (www.naturalstandard.com)

Copyright © 2011 Natural Standard (www.naturalstandard.com)