Acemannan

Aloe/Drug Interactions:

  • AnestheticsAnesthetics: There is a single, poorly described case report of excess bleeding in a surgical patient receiving the anesthetic agent sevoflurane and oral aloe (47).
  • AntidiabeticsAntidiabetics: In human research and a review, compared to the placebo group following treatment, participants administered Aloe vera showed reduced mean glucose level (41; 40; 45; 46), although conflicting evidence exists (44). Laboratory studies have documented beta-cell stimulation and subsequent drops in blood glucose in mice (42; 43).
  • AntifungalsAntifungals: In in vitro research, an extract of fresh Aloe vera leaves inhibited the mycelial growth of Botrytis gladiolorum, Fusarium oxysporum f.sp. gladioli, Heterosporium pruneti, and Penicillium gladioli (7).
  • Anti-inflammatoriesAnti-inflammatories: In vivo, Aloe vera gel (97.5%) significantly reduced UV-induced erythema after 48 hours, superior to 1% hydrocortisone in placebo gel. In contrast, 1% hydrocortisone in cream was more efficient than Aloe vera gel (88).
  • AntilipemicsAntilipemics: In a review, compared to baseline, participants receiving Aloe vera showed decreased levels of total cholesterol (15.4-15.5%), low-density lipoprotein (LDL) cholesterol (18.2-18.9%), and triglycerides (25.2-31.9%) (46). Information regarding between-group differences was lacking. In human research, aloe has demonstrated further antilipemic effects (45; 64).
  • AntineoplasticsAntineoplastics: There is preliminary evidence from a small case-control study that aloe consumption may reduce the risk of developing lung cancer (118). Numerous laboratory studies suggest that aloe-emodin (an anthraquinone glycoside) and aloe extracts may have cytotoxic or anticancer effects (119; 120; 121; 122). In human research, OXA-related neurotoxicity was lower in participants given chemotherapy plus aloe vs. chemotherapy alone (63).
  • AntiretroviralsAntiretrovirals: Preliminary reports suggest that AZT levels may be boosted by aloe ingestion, although data remain scant in this area (50).
  • AntiviralsAntivirals: Acemannan, the major carbohydrate fraction in aloe gel, has been shown in vitro to possess immunostimulant and antiretroviral activities (65; 66; 67). Preliminary reports suggest that AZT levels may be boosted by aloe ingestion, although data remain scant in this area (50). According to a review, aloe cream purportedly cured a higher percentage of patients with genital herpes compared to placebo (46).
  • Cardiac glycosidesCardiac glycosides: In theory, low levels of serum potassium (due to aloe latex laxative overuse) could interfere with cardiac glycosides or other antiarrhythmic agents.
  • Cardiovascular agentsCardiovascular agents: In theory, use of oral aloe with herbs that affect heart rhythm may increase the risk of dehydration, potassium depletion, and electrolyte imbalance.
  • ContraceptivesContraceptives: Aqueous extracts of Aloe barbadensis Mill. Syn. have been investigated for their antifertility activity in animal research, but the authors did not observe any anti-implantation activity (123). In in vitro research, lyophilized Aloe barbadensis proved to be spermicidal due to the multiple microelements (boron, barium, calcium, chromium, copper, iron, potassium, magnesium, manganese, phosphorus, and zinc) that were toxic to the sperm tail, causing instant immobilization (24). Aloe's fertility effects in humans are unclear.
  • Dermatologic agentsDermatologic agents: In human research, Aloe barbadensis Miller extracts increased the water content of the stratum corneum of the arms, although transepidermal water loss was not altered (72). According to a review, significantly more psoriasis patients treated with Aloe vera were considered cured after treatment vs. those receiving placebo cream (46). According to a review, however, Aloe vera treatment lacked a statistically significant effect on maximum dermatitis (46). In human research, complete response was lacking for all subjects with psoriasis in the study (115). However, Aloe vera treatment reduced Psoriasis Area Severity Index (PASI) scores more than triamcinolone over eight weeks, and was equal to triamcinolone in reducing Dermatology Life Quality Index (DLQI) scores.
  • DiureticsDiuretics: In theory, use of oral aloe with other diuretics may increase the risk of dehydration, potassium depletion, and electrolyte imbalance.
  • Gastrointestinal agentsGastrointestinal agents: According to anecdotal reports, occasional abdominal cramping and diarrhea with oral aloe use may occur.
  • HepaticsHepatics: In human research, aloe reduced markers of fibrosis and inflammation in patients with liver fibrosis (60).
  • HepatotoxinsHepatotoxins: In human research, there are case reports of acute hepatitis after taking oral aloe (52; 1; 53; 54).
  • Hormonal agentsHormonal agents: The methanolic extracts from Aloe species contain hydroxyanthraquinones, such as emodin, which are phytoestrogens with an affinity to human estrogen receptors (124).
  • Hydrophilic agentsHydrophilic agents: Limited evidence suggests that 0.5% extract from Aloe vera in a hydrophilic cream is an effective treatment for genital herpes and psoriasis vulgaris (73).
  • Insulin preparationsInsulin preparations: Based on the laxative properties of oral aloe latex, prolonged use may cause potassium depletion and act additively with insulin to reduce serum potassium levels. Concomitant use of insulin with oral forms of aloe may increase hypoglycemic effects, according to preliminary human data (41; 40). One animal study suggested that stimulation of beta-cells is responsible for this effect of aloe, thus the interaction might not apply to type 1 diabetics, in whom beta-cells have been destroyed.
  • LaxativesLaxatives: Theoretically, concomitant use of oral aloe latex and other laxatives may exacerbate hypokalemia, dehydration, metabolic alkalosis, or other electrolyte abnormalities.
  • Neurologic agentsNeurologic agents: In human research, OXA-related neurotoxicity was lower in participants given chemotherapy plus aloe vs. chemotherapy alone (63).
  • Non-potassium-sparing diuretics (loop diuretics, thiazide diuretics)Non-potassium-sparing diuretics (loop diuretics, thiazide diuretics): Based on the laxative properties of oral aloe latex, prolonged use may cause potassium depletion. Hypokalemia may be exacerbated by simultaneous applications of thiazide diuretics.
  • Oral corticosteroids, oral hydrocortisoneOral corticosteroids, oral hydrocortisone: Based on the laxative properties of oral aloe latex, prolonged use may cause potassium depletion. Hypokalemia may be exacerbated by simultaneous application of steroids.
  • Radioprotective agentsRadioprotective agents: In laboratory research, aloe polysaccharides may have a radioprotective effect on nonmalignant cells via modulation of the cell cycle (125; 126).
  • SevofluraneSevoflurane: There is a poorly described single case report of excess bleeding in a surgical patient receiving the anesthetic agent sevoflurane and oral aloe (47).
  • SteroidsSteroids: In theory, use of oral aloe with steroids may increase the risk of dehydration, potassium depletion, and electrolyte imbalance.
  • SunscreenSunscreen: In human and animal research, incorporation of sunscreen microspheres into Aloe vera gel may increase the sunscreen formulation's efficacy more than four times (127).
  • Thyroid hormonesThyroid hormones: Aloe has been linked to thyroid dysfunction, according to one case report (48).
  • Topical hydrocortisoneTopical hydrocortisone: Concomitant topical use of aloe may enhance absorption of hydrocortisone, although there is limited evidence in this area (49).
  • Vulnerary agentsVulnerary agents: According to a review, aloe demonstrated wound-healing effects (46).
  • Zidovudine (AZT)Zidovudine (AZT): Preliminary reports suggest that AZT levels may be boosted by aloe ingestion, although data remain scant in this area (50).

    • Aloe/Herb/Supplement Interactions:

  • AnestheticsAnesthetics: There is a single, poorly described case report of excess bleeding in a surgical patient receiving the anesthetic agent sevoflurane and oral aloe (47).
  • AntifungalsAntifungals: According to in vitro data, an extract of fresh Aloe vera leaves inhibited the mycelial growth of Botrytis gladiolorum, Fusarium oxysporum f.sp. gladioli, Heterosporium pruneti, and Penicillium gladioli (7).
  • Anti-inflammatoriesAnti-inflammatories: In vivo, Aloe vera gel (97.5%) significantly reduced UV-induced erythema after 48 hours, being superior to 1% hydrocortisone in placebo gel. In contrast, 1% hydrocortisone in cream was more efficient than Aloe vera gel (88).
  • AntilipemicsAntilipemics: According to a review, compared to baseline, participants receiving Aloe vera showed decreased levels of total cholesterol (15.4-15.5%), low-density lipoprotein (LDL) cholesterol (18.2-18.9%), and triglycerides (25.2-31.9%) (46). Information regarding between-group differences was lacking. In human research, aloe demonstrated further antilipemic effects (45; 64).
  • AntineoplasticsAntineoplastics: There is preliminary evidence from a small case-control study that aloe consumption may reduce the risk of developing lung cancer (118). Numerous laboratory studies suggest that aloe-emodin (an anthraquinone glycoside) and aloe extracts may have cytotoxic or anticancer effects (119; 120; 121; 122).
  • AntioxidantsAntioxidants: Antioxidant properties have been attributed to aloesin derived from Aloe vera (9; 10; 11). In vitro, a polysaccharide from Aloe vera var. chinensis also showed free radical-scavenging and other antioxidant properties (128). In human research, when administered with vitamins C and B12, Aloe vera increased plasma oxygen radical absorbance capacity (ORAC) (20).
  • AntiviralsAntivirals: Acemannan, the major carbohydrate fraction in aloe gel, has been shown in vitro to possess immunostimulant and antiretroviral activities (65; 66; 67). According to a review, aloe cream purportedly cured a higher percentage of patients with genital herpes compared to placebo (46).
  • Cardiovascular agentsCardiovascular agents: In theory, use of oral aloe with herbs that affect heart rhythm may increase the risk of dehydration, potassium depletion, and electrolyte imbalance.
  • ContraceptivesContraceptives: Aqueous extracts of Aloe barbadensis Mill. have been investigated for their antifertility activity in animal research, but authors did not observe any anti-implantation activity (123). In in vitro research, lyophilized Aloe barbadensis proved to be spermicidal due to the multiple microelements (boron, barium, calcium, chromium, copper, iron, potassium, magnesium, manganese, phosphorus, and zinc) that were toxic to the sperm tail, causing instant immobilization (24). Aloe's fertility effects in humans are unclear.
  • Dermatologic agentsDermatologic agents: In human research, Aloe barbadensis Miller extracts increased the water content of the stratum corneum of the arms, although transepidermal water loss was not altered (72). According to a review, significantly more psoriasis patients treated with Aloe vera were considered cured after treatment vs. those receiving placebo cream (46). According to a review, however, Aloe vera treatment lacked a statistically significant effect on maximum dermatitis (46). In human research, complete response was lacking for all subjects with psoriasis in the study (115). However, Aloe vera treatment reduced Psoriasis Area Severity Index (PASI) scores more than triamcinolone over eight weeks. Both treatments were equally efficacious at reducing Dermatology Life Quality Index (DLQI) scores.
  • DiureticsDiuretics: In theory, use of oral aloe with other diuretics may increase the risk of dehydration, potassium depletion, and electrolyte imbalance.
  • Gastrointestinal agentsGastrointestinal agents: According to anecdotal reports, occasional abdominal cramping and diarrhea with oral aloe use may occur.
  • HepaticsHepatics: In human research, aloe reduced markers of fibrosis and inflammation in patients with liver fibrosis (60).
  • HepatotoxinsHepatotoxins: In human research, there are case reports of acute hepatitis from taking oral aloe (52; 1; 53; 54).
  • Hormonal agentsHormonal agents: The methanolic extracts from Aloe species contain hydroxyanthraquinones, such as emodin, which are phytoestrogens with an affinity for human estrogen receptors (124).
  • HydrophilicsHydrophilics: Limited evidence suggests that 0.5% extract from Aloe vera in a hydrophilic cream is an effective treatment of genital herpes and psoriasis vulgaris (73). Theoretically, Aloe vera may also interact with other hydrophilic agents and change their effectiveness.
  • Hyperglycemics and hypoglycemicsHyperglycemics and hypoglycemics: In human research and a review, compared to the placebo group following treatment, participants administered Aloe vera showed reduced mean glucose levels (41; 40; 45; 46), although conflicting evidence exists (44). Laboratory studies have documented beta-cell stimulation and subsequent drops in blood glucose in mice (42; 43).
  • LaxativesLaxatives: Theoretically, concomitant use of oral aloe latex and other laxatives may exacerbate hypokalemia, dehydration, metabolic alkalosis, or other electrolyte abnormalities.
  • Licorice root (Glycyrrhiza glabra)Licorice root (Glycyrrhiza glabra): Based on the laxative properties of oral aloe latex, prolonged use may result in potassium depletion. Hypokalemia may be exacerbated by simultaneous applications of licorice root.
  • Neurologic agentsNeurologic agents: In human research, OXA-related neurotoxicity was lower in participants given chemotherapy plus aloe vs. chemotherapy alone (63).
  • Radioprotective agentsRadioprotective agents: According to laboratory evidence, aloe polysaccharides may have a radioprotective effect on nonmalignant cells via modulation of the cell cycle (125; 126).
  • SteroidsSteroids: In theory, use of oral aloe with steroids, or phytosterols, may increase the risk of dehydration, potassium depletion, and electrolyte imbalance.
  • SunscreenSunscreen: In human and animal research, incorporation of sunscreen microspheres into Aloe vera gel may increase the sunscreen formulation's efficacy more than four times (127).
  • Thyroid agentsThyroid agents: Aloe has been linked to thyroid dysfunction, based on one case report (48).
  • Vitamin B12Vitamin B12: In human research, when administered with vitamins C and B12, Aloe vera increased plasma oxygen radical absorbance capacity (ORAC) (20). Aloe vera also increased plasma vitamin C. Aloe also increased serum vitamin B12 levels compared to baseline and placebo (p<0.01).
  • Vitamin CVitamin C: In human research, when administered with vitamins C and B12, Aloe vera increased plasma oxygen radical absorbance capacity (ORAC) (20). Aloe vera also increased plasma vitamin C and serum vitamin B12 levels. Aloe, however may slow the absorption of vitamin C (129).
  • Vitamin EVitamin E: Aloe may slow the absorption of vitamins C and E (129).
  • Vulnerary agentsVulnerary agents: According to a review, aloe demonstrated wound-healing effects (46).

    • Aloe/Food Interactions:

  • AbsorptionAbsorption: The high mucilage content in aloe taken orally may interfere with absorption of foods and orally administered drugs. Malabsorption may occur after prolonged oral use of aloe.
  • Vitamin B12-containing foodsVitamin B12-containing foods: In human research, when administered with vitamins C and B12, Aloe vera increased plasma oxygen radical absorbance capacity (ORAC) (20). Aloe vera also increased plasma vitamin C. Aloes increased serum vitamin B12 levels compared to baseline and placebo (p<0.01).
  • Vitamin C-containing foodsVitamin C-containing foods: In human research, when administered with vitamins C and B12, Aloe vera increased plasma oxygen radical absorbance capacity (ORAC) (20). Aloe vera also increased plasma vitamin C and serum vitamin B12 levels. Aloe, however may slow the absorption of vitamin C (129).
  • Vitamin E-containing foodsVitamin E-containing foods: Aloe may slow the absorption of vitamins C and E (129).

    • Aloe/Lab Interactions:

  • Apolipoprotein BApolipoprotein B: In human research, a statistically significant decrease in apolipoprotein B (16.85%, p<0.05) was noted after aloe treatment (64).
  • Fibrosis markersFibrosis markers: In human research, following treatment, the placebo group patients still had average fibrosis with inflammatory cell infiltration, but the aloe (AHM) group had reduced fibrosis and inflammatory cell infiltration compared to the placebo group (60). At the end of the study, participants with either hepatitis B or hepatitis C virus who were treated with AHM showed more significant reduction in the liver enzyme levels vs. the placebo group (p<0.05). After treatment, both the placebo and the AHM groups had significant decreases in malondialdehyde levels compared to baseline (p<0.05), but only the AHM group showed significant increase in glutathione levels (p<0.05). Before treatment, serum levels of transforming growth factor (TGF)-beta1, hyaluronic acid (HA), and matrix metalloproteinase (MMP)-2 were significantly elevated in patients with fibrosis compared to the healthy control group. After treatment, significant reductions in these fibrosis markers were experienced by participants in the placebo and AHM groups (p<0.05).
  • HbA1CHbA1C: In human research, compared to the placebo group following treatment, participants administered Aloe vera showed reduced HbA1C (?8.6 ? 24.0% change vs. -8.1 ? 18.0%) (45; 64).
  • LipidsLipids: In a review, compared to baseline, participants receiving Aloe vera showed decreased levels of total cholesterol (15.4-15.5%), low-density lipoprotein (LDL) cholesterol (18.2-18.9%), and triglycerides (25.2-31.9%). Information regarding between-group differences was lacking (46). In human research, aloe has demonstrated further antilipemic effects (45; 64).
  • Serum glucose levelsSerum glucose levels: Preliminary evidence from two poorly conducted human trials and animal data suggest that oral forms of aloe may lower blood sugar (41; 40; 42). In human research, compared to the placebo group following treatment, participants administered Aloe vera showed reduced mean glucose level (+5.2 ? 25.1% vs. -4.8 ? 14.7% change) (45).
  • Serum potassium levelsSerum potassium levels: Based on the laxative properties of oral aloe latex, prolonged use may cause potassium depletion, metabolic alkalosis, and dehydration.
  • Thyroid panelThyroid panel: Aloe has been linked to thyroid dysfunction, according to one case report (48).
  • Zidovudine levelsZidovudine levels: Preliminary reports suggest that AZT levels may be boosted by aloe ingestion, although data remain scant in this area (50).