Guggul

Guggul/Drug Interactions:

  • AntiarthriticsAntiarthritics: In human research, guggul has demonstrated antiarthritic effects, including improved symptom scores on the Western Ontario and McMaster Universities (WOMAC) scale, reduced pain ratings on a visual analog scale, and increased walking distance during a performance-based six-minute walk test (46; 76; 75). Guggul combination therapy has also demonstrated antiarthritic effects (78; 79; 80).
  • AntibioticsAntibiotics: The essential oil, chloroform extract, and seven sesquiterpenoid compounds isolated from the oleo-gum-resin of Commiphora mukul have displayed a wide range of inhibitory activity against both Gram-positive and Gram-negative bacteria (22).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Guggulipid administration has been associated with the inhibition of platelet aggregation and increased fibrinolysis (19; 34; 35; 36). A case report has been published documenting antagonism of the anticoagulant effect of warfarin caused by the use of guggul (24).
  • AntidiabeticsAntidiabetics: In animal research, guggulipid demonstrated peroxisome proliferator-activated receptor-alpha (PPAR-alpha), PPAR-gamma, and liver X receptor-alpha (LXR-alpha) agonist activity (47). Commipheric acid, a fractionated component of guggulipid, was also found to activate PPAR-alpha and PPAR-gamma.
  • Anti-inflammatoriesAnti-inflammatories: In animal and human research, guggul exerted anti-inflammatory effects (81; 82; 83; 84; 85; 86; 87; 88; 89; 78; 79; 80; 75; 46; 28). Possible effects on high-sensitivity C-reactive protein (hs-CRP) have also been observed in clinical research (21). The anti-inflammatory effect of gum of the medicinal plant Commiphora mukul has been studied in peripheral blood mononuclear cells (27).
  • Antilipemic agentsAntilipemic agents: In human and animal research, guggul reduced total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides, and increased high-density (HDL) cholesterol (13; 14; 19; 10; 11; 12; 15; 16; 17; 18; 20; 21; 72; 55; 56; 90; 74; 71; 73; 58; 53; 59; 91). Other human research, however, demonstrated somewhat conflicting results (21; 57; 58; 53; 59). Animal and in vitro experimentation has shown that guggulsterones are antagonists of the farnesoid X receptor (FXR) and the bile acid receptor (BAR), nuclear hormones that are involved with cholesterol metabolism and bile acid regulation (10; 92; 93). A case report has noted rhabdomyolysis as a potential rare adverse effect of the use of Commiphora mukul to reduce cholesterol (60), though it is unclear if guggulipid affects the action of other agents used for cholesterol reduction.
  • AntineoplasticsAntineoplastics: Guggulsterone has caused apoptosis in cancer cells in vitro (29; 30; 31).
  • Antiobesity agentsAntiobesity agents: Guggul has been commonly noted as one of the components of various traditional Ayurvedic formulations to treat obesity (25; 31; 26). In human research, both guggul monotherapy and combination therapy demonstrated weight loss effects (14; 94; 95; 96).
  • Beta-blockersBeta-blockers: Coadministration of guggulipid decreased the bioavailability of the beta-blocker propranolol in humans (62; 59).
  • Calcium-channel blockersCalcium-channel blockers: In humans, coadministration of guggulipid decreased the bioavailability of the calcium channel blocker diltiazem (62; 59).
  • Cardiovascular agentsCardiovascular agents: In human research, coadministration of Commiphora mukul and Inula racemosa (Puhkarmool) improved lipid profile, normalized electrocardiogram (ECG) output, and mitigated symptoms of dyspnea and chest pain in patients with ischemic heart disease (97; 98; 91). Additionally, coadministration of guggulipid has decreased the bioavailability of the beta-blocker propranolol and the calcium channel blocker diltiazem in humans (62; 59).
  • Cytochrome P450-metabolized agentsCytochrome P450-metabolized agents: In vitro, guggulipid induced cytochrome P450 3A4 and interacted with the pregnane X receptor (61), which may alter subsequent protein cofactor interactions.
  • Dermatologic agentsDermatologic agents: Hypersensitivity skin reactions and generalized skin rash have been reported with oral and topical use of guggul (21; 67; 68; 69; 52; 58; 53; 59).
  • Drugs used for osteoporosisDrugs used for osteoporosis: In lab research, guggulsterone inhibited osteoclastogenesis (37).
  • Gastrointestinal agentsGastrointestinal agents: Guggul and guggulipid have been associated with stomach discomfort both clinically and anecdotally (54; 52; 58; 53), as well as diarrhea, loose stools, nausea, vomiting, eructation, and hiccup (59).
  • Hormonal agentsHormonal agents: In vitro, concurrent use of large amount of guggulsterones activated estrogen receptors and may increase the risk of adverse effects (61). In vitro, stereoisomers of the plant sterol, guggulsterone, have demonstrated hormone modulating effects (26).
  • Neurologic agentsNeurologic agents: In animal research, guggulipid induced a dose-dependent improvement in scopolamine-induced deficits in passive avoidance test and inhibited streptozotocin-induced deficits in memory (38). Also, cases of headache, restlessness, and apprehension have been reported in clinical trials of guggul (58; 59).
  • Thyroid hormonesThyroid hormones: In animal research, guggulsterone Z stimulated thyroid function (48; 49; 50). However, results from human research indicated a lack of difference in thyroid-stimulating hormone (TSH) levels with the use of guggul (21).

    • Guggul/Herb/Supplement Interactions:

  • AntiarthriticsAntiarthritics: In human research, guggul has demonstrated antiarthritic effects, including improved symptom scores on the WOMAC scale, reduced pain ratings on a visual analog scale, and increased walking distance during a performance-based six-minute walk test (46; 76; 75). Guggul combination therapy has also demonstrated antiarthritic effects (78; 79; 80).
  • AntibacterialsAntibacterials: The essential oil, chloroform extract, and seven sesquiterpenoid compounds isolated from the oleo-gum-resin of Commiphora mukul have displayed a wide range of inhibitory activity against both Gram-positive and Gram-negative bacteria (22).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Guggulipid administration has been associated with the inhibition of platelet aggregation and increased fibrinolysis (19; 34; 35; 36). A case report has been published documenting antagonism of the anticoagulant effect of warfarin caused by the use of guggul (24).
  • Anti-inflammatoriesAnti-inflammatories: In animal and human research, guggul exerted anti-inflammatory effects (81; 82; 83; 84; 85; 86; 87; 88; 89; 78; 79; 80; 75; 46; 28). Possible effects on hs-CRP have also been observed in clinical research (21). The anti-inflammatory effect of Commiphora mukul gum has been studied in peripheral blood mononuclear cells (27).
  • AntilipemicsAntilipemics: In human and animal research, guggul reduced total cholesterol, LDL cholesterol, and triglycerides, and increased HDL cholesterol (13; 14; 19; 10; 11; 12; 15; 16; 17; 18; 20; 21; 72; 55; 56; 90; 74; 71; 73; 58; 53; 59; 91). Other human research, however, demonstrated somewhat conflicting results (21; 57; 58; 53; 59). Animal and in vitro experimentation have shown that guggulsterones are antagonists of the farnesoid X receptor (FXR) and the bile acid receptor (BAR), nuclear hormones that are involved with cholesterol metabolism and bile acid regulation (10; 92; 93). Case reports have noted rhabdomyolysis as a potential rare adverse effect of the use of Commiphora mukul to reduce cholesterol (60), though it is not clear if guggulipid affects the action of other agents used for cholesterol reduction.
  • AntineoplasticsAntineoplastics: Guggulsterone has caused apoptosis in cancer cells in vitro (29; 30; 31).
  • Antiobesity agentsAntiobesity agents: Guggul has been commonly noted as one of the components of various traditional Ayurvedic formulations to treat obesity (25; 31; 26). In human research, both guggul monotherapy and combination therapy have demonstrated weight loss effects (14; 94; 95; 96).
  • AntioxidantsAntioxidants: In lab and animal research, guggul extracts were reported to possess antioxidant properties (33; 99; 100). In animal research, guggulipid inhibited streptozotocin-induced deficits in memory; effects might be due to the antioxidant and anti-acetylcholinesterase activity of guggulipid (38).
  • Cardiovascular agentsCardiovascular agents: In human research, coadministration of Commiphora mukul and Inula racemosa (Puhkarmool) improved lipid profile, normalized ECG output, and mitigated symptoms of dyspnea and chest pain in patients with ischemic heart disease (97; 98; 91). Additionally, coadministration of guggulipid decreased the bioavailability of the beta-blocker propranolol and the calcium channel blocker diltiazem in humans (62; 59).
  • Cytochrome 450-metabolized agentsCytochrome 450-metabolized agents: In vitro, guggulipid induced cytochrome P450 3A4 and interacted with the pregnane X receptor (61), which may alter subsequent protein cofactor interactions.
  • Dermatologic agentsDermatologic agents: Hypersensitivity skin reactions and generalized skin rash have been reported with oral and topical use of guggul (21; 67; 68; 69; 52; 58; 53; 59).
  • Gastrointestinal agentsGastrointestinal agents: Guggul and guggulipid have been associated with stomach discomfort both clinically and anecdotally (54; 52; 58; 53), as well as diarrhea, loose stools, nausea, vomiting, eructation, and hiccup (59).
  • Green teaGreen tea: A case of fulminant liver failure necessitating liver transplantation was seen following the use of a mixed-ingredient dietary supplement and fat burner containing extracts of green tea, guggul, and usnic acid (64).
  • Hormonal agentsHormonal agents: In vitro, concurrent use of a large amount of guggulsterones activated estrogen receptors and may increase the risk of adverse effects (61). In vitro, stereoisomers of the plant sterol, guggulsterone, have demonstrated hormone-modulating effects (26).
  • HypoglycemicsHypoglycemics: In animal research, guggulipid demonstrated PPAR-alpha, PPAR-gamma, and LXR-alpha agonist activity (47). Commipheric acid, a fractionated component of guggulipid, was also found to activate PPAR-alpha and PPAR-gamma.
  • Inula racemosaInula racemosa: In human research, coadministration of Commiphora mukul and Inula racemosa (Puhkarmool) improved lipid profile, normalized ECG output, and mitigated symptoms of dyspnea and chest pain in patients with ischemic heart disease (97; 98; 91).
  • Neurologic agentsNeurologic agents: In animal research, guggulipid induced a dose-dependent improvement in scopolamine-induced deficits in passive avoidance test and inhibited streptozotocin-induced deficits in memory (38). Also, cases of headache, restlessness, and apprehension have been reported in clinical trials of guggul (58; 59).
  • Osteoporosis agentsOsteoporosis agents: In lab research, guggulsterone inhibited osteoclastogenesis (37).
  • Red yeast riceRed yeast rice: Acute hepatitis was reported in a 63 year-old woman who was using a lipid lowering product containing guggulsterol and red yeast rice extract (Equisterol?) for six months (63).
  • Thyroid agentsThyroid agents: In animal research, guggulsterone Z stimulated thyroid function (48; 49; 50). However, results from human research indicated a lack of difference in TSH levels with the use of guggul (21).
  • Usnic acidUsnic acid: A case of fulminant liver failure necessitating liver transplantation was seen following the use of a mixed-ingredient dietary supplement and fat burner containing extracts of green tea, guggul, and usnic acid (64).

    • Guggul/Food Interactions:

  • Green teaGreen tea: A case of fulminant liver failure necessitating liver transplantation was seen following the use of a mixed-ingredient dietary supplement and fat burner containing extracts of green tea, guggul, and usnic acid (64).

    • Guggul/Lab Interactions:

  • Coagulation panelCoagulation panel: Guggulipid administration has been associated with the inhibition of platelet aggregation and increased fibrinolysis (19; 34; 35; 36). A case report has been published documenting antagonism of the anticoagulant effect of warfarin caused by the use of guggul (24).
  • C-reactive proteinC-reactive protein: Possible effects on hs-CRP have been observed in clinical research (21).
  • Creatine kinaseCreatine kinase: A 55 year-old man taking an extract of 300mg of Commiphora mukul three times daily to lower his cholesterol level developed rhabdomyolysis with hemoglobinuria after two weeks of treatment (60). Laboratory tests showed creatine kinase levels of 14,4600 IU/L (reference range: 24-195).
  • Electrocardiogram (ECG)Electrocardiogram (ECG): In human research, coadministration of Commiphora mukul and Inula racemosa (Puhkarmool) normalized electrocardiogram ECG (97; 98; 91).
  • Hormone panelHormone panel: In vitro data indicate that both stereoisomers of the plant sterol, guggulsterone, E- and Z-guggulsterone, interacted with a number of hormone receptors (26). In vitro, concurrent use of a large amount of guggulsterones activated estrogen receptors and may increase the risk of adverse effects (61).
  • Lipid profileLipid profile: In human and animal research, guggul reduced total cholesterol, LDL cholesterol, and triglycerides, and increased HDL cholesterol (13; 14; 19; 10; 11; 12; 15; 16; 17; 18; 20; 21; 72; 55; 56; 90; 74; 71; 73; 58; 53; 59; 91). Other human research, however, has demonstrated somewhat conflicting results (21; 57; 58; 53; 59).
  • Liver function testsLiver function tests: A 55 year-old man taking an extract of 300mg of Commiphora mukul three times daily to lower his cholesterol level developed rhabdomyolysis with hemoglobinuria after two weeks of treatment (60). Laboratory tests showed aspartate aminotransferase 1,115 IU/L (10-35), and alanine aminotransferase 205 IU/L (10-35). Parameters returned to normal after the herbal preparation was discontinued. The Naranjo probability scale indicated guggul as the possible cause of rhabdomyolysis in this patient. Also, a case of fulminant liver failure necessitating liver transplantation was seen following the use of a mixed-ingredient dietary supplement and fat burner containing extracts of green tea, guggul, and usnic acid (64).
  • Serum glucose levelsSerum glucose levels: In animal research, guggulipid demonstrated PPAR-alpha, PPAR-gamma, and LXR-alpha agonist activity, which can contribute to antidiabetic effects (47). Commipheric acid, a fractionated component of guggulipid, was also found to activate PPAR-alpha and PPAR-gamma.
  • Thyroid function testsThyroid function tests: In animal models, guggulsterone Z stimulated thyroid function (48; 49; 50). However, results from human research indicated a lack of difference in TSH levels with the use of guggul (21).
  • UrinalysisUrinalysis: A 55 year-old man taking an extract of 300mg of Commiphora mukul three times daily to lower his cholesterol level developed rhabdomyolysis with hemoglobinuria after two weeks of treatment (60). Analysis of a urine sample was 2+ positive for hemoglobin.
  • WeightWeight: Weight reduction and chemical changes in reproductive organs have been observed in female rats (10). In human research, both guggul monotherapy and combination therapy demonstrated weight loss effects (14; 94; 95; 96).