Morinda citrifolia

Noni/Drug Interactions:

  • GeneralGeneral: In animal research, noni decreased gastric transit time (55).
  • AnalgesicsAnalgesics: In animal research, Morinda citrifolia and Tahitian Noni? Juice demonstrated central analgesic effects (62; 10), with some evidence of being dose dependent and 75% as strong as morphine, yet nonaddictive and side effect free (81).
  • Angiotensin II receptor antagonist (A2R blockers)Angiotensin II receptor antagonist (A2R blockers): Noni juice contains 56mEq/L of potassium (58; 59). AR2 blockers can also increase potassium. Theoretically, concomitant use of noni and angiotensin receptor blockers may increase the risk of hyperkalemia.
  • Angiotensin-converting enzyme (ACE) inhibitorsAngiotensin-converting enzyme (ACE) inhibitors: Noni juice contains 56mEq/L of potassium (58; 59). Angiotensin-converting enzyme (ACE) inhibitors may also increase potassium. Theoretically, concomitant use of noni and ACE inhibitors may increase the risk of hyperkalemia.
  • AnthelminticsAnthelmintics: In in vitro research, a noni leaf ethanol extract induced the paralysis and death of the human parasitic nematode worm Ascaris lumbricoides within 24 hours (82). In human research, topical application of a 1% Morinda citrifolia ointment demonstrated an "excellent" or "good" treatment response in 50% and 30% of individuals infected with Leishmania major, respectively (67).
  • AntiangiogenicsAntiangiogenics: In laboratory research, noni demonstrated antiangiogenic properties (83). In animal cancer models and cell lines, noni's antiangiogenic effects were more potent than the drug suramin (84).
  • AntiarthriticsAntiarthritics: In human research, noni juice alone or coadministered with physiotherapy improved neck pain and flexibility in individuals with cervical spondylosis (65). Tahitian Noni? Juice has also been shown to improve self-reported quality of life and reduce the use of over-the-counter pain relievers in individuals with knee osteoarthritis (OA) (77).
  • AntibioticsAntibiotics: In laboratory, in vitro, and ex vivo research, M. citrifolia juice and specific compounds from various parts of the noni plant demonstrated antibacterial effects (85; 86; 87; 88; 89; 90; 91).
  • AnticoagulantsAnticoagulants: Coumadin resistance was reported in a 41 year-old female consuming noni juice concomitantly with warfarin (43). The patient presented with decreased international normalized ratios (INRs). She was taking 7mg of warfarin on Monday and Wednesday and 6mg on other days, while also consuming 1-2 small glasses of a noni juice called "Noni Juice 4 Everything." This product contained more than 115 components, one of which was vitamin K.
  • Antidiabetic agentsAntidiabetic agents: Some noni juice products contain high amounts of sugar, which may raise blood sugar. Theoretically, these juice products may interfere with agents used to control blood sugar. Conversely, in a mice model of cerebral ischemia, Okinawa noni juice gradually decreased blood glucose levels (19), dose-dependently suppressed glucose intolerance (20), and increased serum insulin levels (51).
  • AntiemeticsAntiemetics: In human research, noni extract reduced the incidence of postoperative nausea within the first six hours of surgical recovery compared to placebo (2).
  • Antigingivitis agentsAntigingivitis agents: In human research, adjuvant Tahitian Noni? Juice reduced bleeding, diminished inflammation, and improved the papilla bleeding index of individuals with gingivitis vs. good oral hygiene practices alone, in spite of a lack of reduction in bacterial colonization (92).
  • AntihypertensivesAntihypertensives: In animal and human research, the total extract of the noni roots and various noni root and juice extracts (e.g., Tahitian Noni? Juice, noni fruit juice concentrate) showed hypotensive effects (44; 45; 46; 47; 48; 49; 50).
  • Anti-inflammatory agentsAnti-inflammatory agents: In animal and in vitro research, noni (e.g., fruit powder, fruit puree, Tahitian Noni? Juice, Costa Rican noni juice, Tahitian NoniT Equine EssentialsT) and various noni constituents (e.g., kaempferol) showed anti-inflammatory properties (93; 94; 95; 96; 97; 15; 16; 17; 10; 11; 13; 12). Also, in individuals with knee osteoarthritis, Tahitian Noni? Juice reduced levels of high-sensitive C-reactive protein (hs-CRP), a biomarker of inflammation (77).
  • Antilipemic agentsAntilipemic agents: In animal and human research, Tahitian Noni? Juice demonstrated anilipidemic effects (98; 99; 100).
  • AntineoplasticsAntineoplastics: In animal cancer models and cell lines, noni showed general cytotoxicity effects (101), which may be dose dependent (62); antiangiogenic effects more potent than the drug suramin (84); inhibitory effects on TPA-induced Epstein-Barr virus early antigen (EBV-EA) activation (13), Ras oncogene function (102), 12-O-tetradecanoylphorbol-13-acetate (TPA)- or epidermal growth factor (EGF)-induced cell transformation (103; 104), tumor necrosis factor-a (TNF-a) tumorigenesis (105), N-nitrosomethylbenzylamine (NMBA)-induced esophageal tumorigenesis (106), and activator protein-1 transactivation (107); and preventive effects when administered prior to cancer induction (95; 108; 109; 110). In human research, Tahitian Noni? Juice demonstrated a 44.9% decrease in procarcinogenic aromatic DNA adducts from baseline (111).
  • AntiviralsAntivirals: In preclinical research, one specific compound isolated from noni roots, 1-methoxy2-formyl-3-hydroxy anthraquinone, suppressed cytopathic effect of HIV-infected MT-4 cells in vitro, without inhibiting cell growth (112); however, other studies have lacked an effect (113).
  • Cytochrome P450-modifying agentsCytochrome P450-modifying agents: In animal research, noni increased CYP450 activity compared to negative controls (P450 reductase NADPH) (56).
  • Dental agentsDental agents: In extracted human teeth, ex vivo irrigation of root canals with M. citrifolia juice removed up to 80% of the smear layer (114) and demonstrated a 69% antimicrobial efficacy against Enterococcus faecalis (91).
  • Diuretics, potassium sparingDiuretics, potassium sparing: Noni juice contains 56mEq/L of potassium (58; 59). Potassium-sparing diuretics can also increase potassium. Theoretically, concomitant use of noni and potassium-sparing diuretics may increase the risk of hyperkalemia.
  • Gastrointestinal agentsGastrointestinal agents: In animal research, noni decreased gastric transit time (55).
  • HepatotoxinsHepatotoxins: In case reports, elevated liver enzymes and hepatotoxicity have been observed following the consumption of noni juice (e.g., Tahitian Noni? Juice) (3; 52; 53; 54; 4; 5; 6; 7; 8). However, a review by the European Food Safety Authority (EFSA) has stated that evidence is lacking in support of a causative relationship between the consumption of noni juice in typical dietary amounts (including the anthraquinones possibly present in commercial noni juice) and adverse liver effects in humans (9; 7).
  • ImmunosuppressantsImmunosuppressants: In animal and human research, Tahitian Noni? Juice increased the thymus wet weight vs. controls (62) and stimulated the activity of both interleukin (IL)-2 and natural killer (NK) cells vs. baseline (63).
  • Metabolic enzymesMetabolic enzymes: Noni fruit contains a natural precursor for xeronine, called proxeronine, which is hypothetically converted in the body to the alkaloid xeronine. It has been hypothesized that xeronine is able to modify the molecular structure of proteins and is a critical normal metabolic coregulator (115; 116). There is the potential for an interaction with metabolic agents, although clinical significance is unclear.
  • Neurologic agentsNeurologic agents: In animal research, Okinawa noni juice (ONJ) has demonstrated protective effects on ischemic stress-induced neuronal damage, as evidenced by a reduction in infarct volume and neurological deficit scores (19; 20; 21; 51).
  • Potassium saltsPotassium salts: Noni juice contains 56mEq/L of potassium (58; 59).
  • RanitidineRanitidine: In human research, oral pretreatment with aqueous M. citrifolia fruit extract 30 minutes prior to ranitidine administration enhanced the rate and the extent of ranitidine absorption, due in part to the activity of its active constituent, scopoletin (117).
  • UDP-glucuronosyl transferase (UGT) enzymesUDP-glucuronosyl transferase (UGT) enzymes: A review of in vitro and animal research has indicated that noni is rich in phytochemicals with UGT enzyme-modulating activity (57). Interactions with agents metabolized by the UGT enzyme system are therefore theoretically plausible.

    • Noni/Herb/Supplement Interactions:

  • GeneralGeneral: In animal research, noni decreased gastric transit time (55).
  • AnalgesicsAnalgesics: In animal research, Morinda citrifolia and Tahitian Noni? Juice demonstrated central analgesic effects (62; 10), with some evidence of being dose dependent and 75% as strong as morphine, yet nonaddictive and side effect free (81).
  • AnthelminticsAnthelmintics: In in vitro research, a noni leaf ethanol extract induced the paralysis and death of the human parasitic nematode worm Ascaris lumbricoides within 24 hours (82). In human research, topical application of a 1% Morinda citrifolia ointment demonstrated an "excellent" or "good" treatment response in 50% and 30% of individuals infected with Leishmania major, respectively (67).
  • AntiangiogenicsAntiangiogenics: In laboratory research, noni demonstrated antiangiogenic properties (83).
  • AntiarthriticsAntiarthritics: In human research, noni juice alone or coadministered with physiotherapy improved neck pain and flexibility in individuals with cervical spondylosis (65). Tahitian Noni? Juice has also been shown to improve self-reported quality of life and reduce the use of over-the-counter pain relievers in individuals with knee osteoarthritis (77).
  • AntibacterialsAntibacterials: In laboratory, in vitro, and ex vivo research, M. citrifolia juice and specific compounds from various parts of the noni plant demonstrated antibacterial effects (85; 86; 87; 88; 89; 90; 91).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Coumadin resistance was reported in a 41 year-old female consuming noni juice concomitantly with warfarin (43). The patient presented with decreased international normalized ratios (INRs). She was taking 7mg of warfarin on Monday and Wednesday and 6mg on other days, while also consuming 1-2 small glasses of a noni juice called "Noni Juice 4 Everything." This product contained more than 115 components, one of which was vitamin K.
  • AntiemeticsAntiemetics: In human research, noni extract reduced the incidence of postoperative nausea within the first six hours of surgical recovery compared to placebo (2).
  • Antigingivitis agentsAntigingivitis agents: In human research, adjuvant Tahitian Noni? Juice reduced bleeding, diminished inflammation, and improved the papilla bleeding index of individuals with gingivitis vs. good oral hygiene practices alone, in spite of a lack of reduction in bacterial colonization (92).
  • Anti-inflammatory agentsAnti-inflammatory agents: In animal and in vitro research, noni (e.g., fruit powder, fruit puree, Tahitian Noni? Juice, Costa Rican noni juice, Tahitian NoniT Equine EssentialsT) and various noni constituents (e.g., kaempferol) showed anti-inflammatory properties (93; 94; 95; 96; 97; 15; 16; 17; 10; 11; 13; 12). Also, in individuals with knee osteoarthritis, Tahitian Noni? Juice reduced levels of hs-CRP, a biomarker of inflammation (77).
  • AntilipemicsAntilipemics: In animal and human research, Tahitian Noni? Juice demonstrated anilipidemic effects (98; 99; 100).
  • AntineoplasticsAntineoplastics: In animal cancer models and cell lines, noni showed general cytotoxicity effects (101), which may be dose dependent (62); antiangiogenic effects more potent than the drug suramin (84); inhibitory effects on TPA-induced EBV-EA activation (13), Ras oncogene function (102), TPA- or EGF-induced cell transformation (103; 104), TNF-a tumorigenesis (105), NMBA-induced esophageal tumorigenesis (106), and activator protein-1 transactivation (107); and preventive effects when administered prior to cancer induction (95; 108; 109; 110). In human research, Tahitian Noni? Juice demonstrated a 44.9% decrease in procarcinogenic aromatic DNA adducts from baseline (111).
  • AntioxidantsAntioxidants: In preclinical and clinical research, noni (e.g., fresh juice, Tahitian Noni? Juice, TNJ) and isolated noni fractions demonstrated antioxidant effects (118; 118; 15; 119; 120; 121; 95; 122; 123; 124; 56; 125; 126; 127; 63; 128; 129).
  • AntiviralsAntivirals: In preclinical research, one specific compound isolated from noni roots, 1-methoxy2-formyl-3-hydroxy anthraquinone, suppressed the cytopathic effect of HIV-infected MT-4 cells in vitro, without inhibiting cell growth (112); however, other studies have lacked an effect (113).
  • Cytochrome P450-modifying agentsCytochrome P450-modifying agents: In animal research, noni increased CYP450 activity compared to negative controls (P450 reductase NADPH) (56).
  • Dental agentsDental agents: In extracted human teeth, ex vivo irrigation of root canals with M. citrifolia juice removed up to 80% of the smear layer (114) and demonstrated a 69% antimicrobial efficacy against Enterococcus faecalis (91).
  • DiureticsDiuretics: Noni juice contains 56mEq/L of potassium (58; 59). Some herbal diuretics can also increase potassium. Theoretically, concomitant use may increase the risk of hyperkalemia.
  • Gastrointestinal herbs and supplementsGastrointestinal herbs and supplements: In animal research, noni decreased gastric transit time (55).
  • Hepatotoxic agentsHepatotoxic agents: In case reports, elevated liver enzymes and hepatotoxicity has been observed following the consumption of noni juice (e.g., Tahitian Noni? Juice) (3; 52; 53; 54; 4; 5; 6; 7; 8). However, a review by the EFSA has stated that evidence is lacking in support of a causative relationship between the consumption of noni juice in typical dietary amounts (including the anthraquinones possibly present in commercial noni juice) and adverse liver effects in humans (9; 7).
  • HypoglycemicsHypoglycemics: Some noni juice products contain high amounts of sugar, which may raise blood sugar. Theoretically, these juice products may interfere with agents used to control blood sugar. Conversely, in a mice model of cerebral ischemia, ONJ gradually decreased blood glucose levels (19), dose-dependently suppressed glucose intolerance (20), and increased serum insulin levels (51).
  • HypotensivesHypotensives: In animal and human research, the total extract of the noni roots and various noni root and juice extracts (e.g., Tahitian Noni? Juice, noni fruit juice concentrate) shoed hypotensive effects (44; 45; 46; 47; 48; 49; 50).
  • ImmunostimulantsImmunostimulants: In animal and human research, Tahitian Noni? Juice increased the thymus wet weight vs. controls (62) and stimulated the activity of both IL-2 and NK cells vs. baseline (63).
  • Metabolic herbsMetabolic herbs: Noni fruit contains a natural precursor for xeronine, called proxeronine, which is hypothetically converted in the body to the alkaloid xeronine. It has been hypothesized that xeronine is able to modify the molecular structure of proteins and is a critical normal metabolic coregulator (115; 116).
  • Neurologic agentsNeurologic agents: In animal research, ONJ demonstrated protective effects on ischemic stress-induced neuronal damage, as evidenced by a reduction in infarct volume and neurological deficit scores (19; 20; 21; 51).
  • PotassiumPotassium: Noni juice contains 56mEq/L of potassium (58; 59).
  • UDP-glucuronosyl transferase (UGT) enzymesUDP-glucuronosyl transferase (UGT) enzymes: In vitro and animal research has indicated that noni is rich in phytochemicals with UGT enzyme-modulating activity (57). Interactions with agents metabolized by the UGT enzyme system are therefore theoretically plausible.
  • Vitamin KVitamin K: In a case report, ingestion of a vitamin K-fortified juice product containing noni and >115 components from several other plants demonstrated acquired coumarin resistance (43). Noni juice and/or fruit itself is not a source of vitamin K.

    • Noni/Food Interactions:

  • GeneralGeneral: In animal research, noni decreased gastric transit time (55).
  • Potassium-containing foodsPotassium-containing foods: Noni juice contains 56mEq/L of potassium (58; 59).
  • Vitamin K-containing foodsVitamin K-containing foods: In a case report, ingestion of a vitamin K-fortified juice product containing noni and >115 components from several other plants demonstrated acquired coumarin resistance (43). Noni juice and/or fruit itself is not a source of vitamin K.

    • Noni/Lab Interactions:

  • Blood glucoseBlood glucose: Some noni juice products contain high amounts of sugar, which may raise blood sugar. However, in a mice model of cerebral ischemia, ONJ gradually decreased blood glucose levels (19), dose-dependently suppressed glucose intolerance (20), and increased serum insulin levels (51).
  • Blood pressureBlood pressure: In animal and human research, the total extract of the noni roots and various noni root and juice extracts (e.g., Tahitian Noni? Juice, noni fruit juice concentrate) lowered blood pressure, although the mechanism for this effect is not clear (44; 45; 46; 47; 48; 49; 130).
  • Coagulation panelCoagulation panel: Coumadin resistance was reported in a 41 year-old female consuming noni juice concomitantly with warfarin (43). The patient presented with decreased INRs. She was taking 7mg of warfarin on Monday and Wednesday and 6mg on other days, while also consuming 1-2 small glasses of a noni juice called "Noni Juice 4 Everything." This product contained more than 115 components, one of which was vitamin K.
  • C-reactive protein (CRP)C-reactive protein (CRP): In animal, in vitro, and human research, noni (e.g., fruit powder, fruit puree, Tahitian Noni? Juice, Costa Rican noni juice, Tahitian NoniT Equine EssentialsT) and various noni constituents (e.g., kaempferol) showed anti-inflammatory properties (93; 94; 95; 96; 97; 15; 16; 17; 10; 11; 13; 12; 77).
  • Lactate dehydrogenase levelsLactate dehydrogenase levels: In a case report, noni elevated lactate dehydrogenase levels (54).
  • Lipid panelLipid panel: In animal and human research, Tahitian Noni? Juice demonstrated antilipemic effects (98; 99; 100).
  • Liver enzyme levelsLiver enzyme levels: In case reports, elevated liver enzymes and hepatotoxicity have been observed following the consumption of noni juice (e.g., Tahitian Noni? Juice) (3; 52; 53; 54; 4; 5; 6; 7; 8).
  • PotassiumPotassium: Noni juice contains 56mEq/L of potassium (58; 59).
  • Virus titersVirus titers: In in vitro research, noni may have either no effect (113) or suppressive effects on HIV (112).
  • White blood cell countWhite blood cell count: In animal and human research, Tahitian Noni? Juice enlarged the thymus (62) and stimulated the activity of both IL-2 and NK cells (63).