Aloe vera (Connor Dowling , University of Mississippi School of Pharmacy

Aloe Vera

Scientific name: Aloe barbadensis miller Common names: aloe, true aloe

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Background

Aloe vera is a perennial succulent that has been used as a medication for thousands of years by many different cultures. From serving as a funerary gift to pharoahs as the "Plant of Immortality" to being cited by Greek physicians as Step 2 a treatment for wounds, balding, hemorrhoids, and ulcers.

Common Uses

Dermatologic: acne, burns, wounds, radiation trauma Gastrointestinal: weight loss, diabetes, hepatits, IBD, constipation Cosmetics: shampoos, sunscreens, moisturizers

Pharmacology and MOA

GI effects are associated with the aloe vera latex that is rich in cathartic anthraquinones, normally known as aloin, that act as colonic-specific stimulant laxatives that induce gut motility, transit, and inhibition of water and electrolyte secretion. Dermatologic antimicrobial activity likely stems from its polysaccharide content whereas its anti-inflammatory features come from salicylates, breakdown of bradykinin via carboxypeptidases, and inhibition of histamine release. Emollient features stem from the polysaccharide glucomannan.

Dosage Forms

Juices, capsules, softgels, ointments, creams, lotions, and more!

Dosing

As a laxative: once daily before bed with a max oral dose of 0.05 to 0.2 grams/day. Metabolic Syndrome: 500 mg BID x eight weeks Burns: topically every three days (gels) or twice daily for fresh aloe mucilage

Effectiveness

Due to the variety of different aloe vera species, there is a difference in the effectiveness between strands; thus, some aloe vera formulations may not be as effective as an emollient but could be a potent anti-inflammatory. Also, while aloe can act as a potent laxative, it’s stimulating mechanism of action can also lead to severe gut irritation leading to abdominal pains, cramps, and bloody stool.

Safety

Topical: Generally well-tolerated and safe! Laxatives: Not to be used under the age of 12, with an allergy to it, with an ileus of any kind, or with any undiagnosed abdominal pains. Reported abortificant, so avoid in pregnancies.

Toxicities

Step 2 Excessive laxative use can lead to severe dehydration and electrolyte imbalances, especially in prolonged use. Most common AE's include nausea, vomiting, diarrhea, abdominal cramps, and palpitations. Severe events include kidney damage, heart issues, GI hemorrhage, and fluid depletion. Bone deterioration and toxic hepatitis have also been reported.

Interactions

Potential hypokalemia from electrolyte imbalances could lead to digoxin toxicities. Significantly reduced blood glucose when used with Glyburide that could lead to hypoglycemia. Potentially raises risk of perioperative bleeding post-op if the anesthetic sevoflurane is used.

Professional Opinion

Topically, aloe vera is able to safely and effectively offer a myriad of benefits from burn and wound healing to cosmetic purposes. However, I would strongly discourage patients from routinely consuming aloe vera orally due to the side effects one may potentially incur. Other OTC laxatives would work just as if not more effectively without nearly the amount of side effects. ~ C. Dowling

References

1. Surjushe A, Vasani R, Saple DG. Aloe vera: a short review. Indian J Dermatol. 2008;53(4):163-166. doi:10.4103/0019-5154.44785 2. Aloe Vera. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/aloe-vera. Published August 2020. Accessed March 3, 2022. 3. Aloe. Natural Products Database. Hudson, OH: Lexicomp. http://online.lexi.com/. Updated November 30, 2020. Accessed March 3, 2022. 4. Plants-Aloe. Micromedex Solutions. Greenwood Village, CO: Truven Health Analytics. http://micromedex.com/. Updated August 21, 2017. Accessed March 4, 2022. 5. Aloe uses, benefits & dosage - drugs.com herbal database. Drugs.com. https://www.drugs.com/npp/aloe.html. Published December 2021. Accessed March 4, 2022. 6. Aloe. Micromedex Solutions. Greenwood Village, CO: Truven Health Analytics. http://micromedex.com/. Updated March 2008. Accessed March 4, 2022.