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 Subject : Natural Medicines Comprehensive Database.. 01/02/2018 04:32:53 AM 
Laura E Licari
Posts: 38
Hello everyone, I am trying to find clinical information on Moringa. Does anyone have access to the above database from Pharmacist's Letter? Or recommend another database to obtain evidence based information (if available) on herbals? Thanks! Laura
 Subject : Re:Natural Medicines Comprehensive Database.. 01/02/2018 06:02:38 AM 
Sam B An
Posts: 1
Hey Laura,
I got this from the Natural Products section of my LexiComp app. Hope this helps!

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Scientific Name
Moringa oleifera
Scientific Family
Common Name(s)
Ben oil
Benzoil tree
Drumstick tree
Horseradish tree
Clinical Overview: Uses
The roots of M. oleifera have traditionally been used as an antispasmodic, stimulant, expectorant, and diuretic. The bark has been used for its emmenagogue, abortifacient, antifungal, and antibacterial properties, and fried pods have been used in diabetes. Juice from the roots has been used as a cardiac tonic and as an antiepileptic and antiasthmatic treatment. However, only limited clinical trial information supports these uses.

Clinical Overview: Dosing
There is insufficient information to determine clinically safe doses of M. oleifera in humans.

Clinical Overview: Pregnancy/Lactation
Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.

Clinical Overview: Interactions
No adverse or toxic effects are associated with the dietary consumption of M. oleifera fruits and leaves.

Clinical Overview: Adverse Reactions
Potential adverse effects of M. oleifera are unknown.

Clinical Overview: Toxicology
No information is available regarding toxicity of M. oleifera fruit in humans.

M. oleifera is an evergreen tree that grows to approximately 8 to 9 m in height. The bark of the tree is soft and white from the inside and cork-like on the outside. The stem is thin and tall and the twigs finely hairy and green. The taste of its vesicant roots resembles that of horseradish. The leaves are longitudinally cracked, 30 to 75 cm in length, and glandular at joints. The leaflets are dark green at the top surface and pale underneath. The flowers are white and sweet smelling, with individual stalks approximately 90 cm in length. The plant's distinctive fruits are 90 cm in length and 12 mm broad, gradually tapering at the end; in many regions, the fruits are known as "drumsticks." The fruits split along the length to expose rows of black, oily seeds covered with paper-like rings.
The moringa tree is indigenous to India and grows widely on the foothills of the Himalayas. The plant is also widely cultivated in Pakistan, Bangladesh, Sri Lanka, Afghanistan, and most of Southeast Asia. M. oleifera is the most well known of the 13 species of the Moringa genus (family Moringaceae). The plant is used for food, medicinal purposes, fodder, dyes, and water clarification. The seeds are used to flocculate contaminants and purify drinking water, and are also consumed in broths; oil from the seeds is used for cooking.
M. oleifera contains many compounds of the rhamnose sugar and the distinctive glucosinolates and isothiocyanates niaziridin and niazirin. The stem bark contains 2 alkaloids, moringine and moringinine. Vanillin, beta-sitosterol, beta-sitostenone, 4-hydroxymellin, and octacosanoic are found in the stem of M. oleifera. The gum exudate from the tree contains L-arabinose, galactose, glucuronic acid, L-rhamnose, mannose, and xylose. Moringa flowers contain some flavonoid pigments, such as kaempherol, rhamnetin, isoquercitrin, and kaempferitrin. Gallic acid, chlorogenic acid, ellagic acid, and ferulic acid are present in the aqueous extracts of leaves, fruits, and seeds of M. oleifera. The plant contains a wide range of terpenoids, primary among which are alpha-phellandrene and p-cymene.
Uses and Pharmacology
In India and Southeast Asia, M. oleifera is used for the treatment of inflammation and infectious diseases, as well as cardiovascular, GI, hematological, and hepatorenal disorders. In the Philippines, it is known as "mother's best friend" because of its ability to increase milk production in breast-feeding mothers. The seeds can be consumed fresh as peas or pounded, roasted, or pressed into sweet, nondesiccating, high-quality oil, commercially known as Ben oil. The seed cake also serves as a natural coagulant for water treatment. Parts of the plant are used as decoctions for gargling in hoarseness and sore throat, since the plant is believed to have antiparalytic, antiviral, anti-inflammatory, and analgesic properties. Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates use of the dried root bark in goiter, glycosuria, and lipid disorders.
Animal data
Antihyperglycemic activity
Goto-Kakizaki Wistar rats were used as models for diabetes mellitus. Following overnight fasting, Wistar controls or Goto-Kakizaki male rats were given glucose 2 g/kg of body weight by oral gavage, with or without M. oleifera leaf powder 200 mg/kg of body weight. Glucose levels were measured for different time intervals, up to 120 minutes. In the absence of treatment, fasting plasma glucose levels (FPG) and postprandial plasma glucose (PPPG) levels at 120 minutes were greater in Goto-Kakizaki rats than in control rats. Treatment with M. oleifera leaf powder resulted in a lower glycemic response in Goto-Kakizaki and control rats. In Goto-Kakizaki rats, treatment reduced area under the curve (AUC) values by 23% (P < 0.05); it did not significantly affect these values in control rats. These observations suggest that M. oleifera treatment improves plasma glucose disposal only in diabetic rats. Another study established that the hypoglycemic effect of the M. oleifera plant extract was comparable to that of the antidiabetic drug glipizide administered at 2.5 mg/kg of body weight.
Antidyslipidemic activity
Two studies evaluated the therapeutic potential of M. oleifera leaves on induced dyslipidemia in rabbits receiving a high-cholesterol (5%) diet for 12 weeks. When these rabbits were concomitantly fed an M. oleifera aqueous leaf extract at the daily dose of 100 mg/kg of body weight for the duration of the protocol, the following were reduced: total cholesterol and lipoprotein cholesterol by about 50%, triglycerides by 75%, and carotic plaque formation by 97%. This protective effect was comparable to that of the statin drug simvastatin given at a daily dose of 5 mg/kg of body weight.
Anticancer properties were evaluated for bark, leaf, and seed extracts of M. oleifera in breast and colorectal cancer cell lines. The leaf and bark, but not seed, extracts demonstrated increased late apoptosis, decreased cell motility, and decreased cell survival.
In addition, the plant has also been shown to have antibacterial, anti-inflammatory, antioxidant, antifertility, hepatoprotective, cardiovascular, antiulcer, and antiallergic activity.
Helicobacter pylori infections
Various GI disorders have been associated with H. pylori including dyspepsia, duodenal and gastric ulcers, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Extracts of food and spice plants used in traditional Thai medicine for GI conditions were investigated for their antimicrobial effects on 18 strains of H. pylori. Of the 20 extracts tested, 9 inhibited the growth of all 18 strains. Moringa was found to have a minimal inhibitory concentration (MIC) of more than 100 mcg/mL and, therefore, is considered to be inactive. Amoxicillin (MIC range, 0.0039 to 0.25 mcg/mL) and metronidazole (MIC range, 64 to 124 mcg/mL) were used as controls.
Clinical data
The potential antidyslipidemic effect of M. oleifera was examined in 35 hyperlipidemic subjects (26 men and 9 women; total cholesterol levels greater than 180 mg/dL or triglycerides greater than 140 mg/dL). The control and experimental groups consisted of 18 subjects and 17 subjects, respectively. The experimental group received 4.6 g of dehydrated M. oleifera leaves daily (as four 550 mg tablets twice daily) for 50 days.

Compared to the control group, the experimental group experienced a 1.6% decrease in plasma total cholesterol (P < 0.05) and a 6.3% increase of high-density lipoprotein cholesterol, with nonsignificant trends toward lower low-density lipoprotein cholesterol, very low–density lipoprotein cholesterol, and triglycerides.
A controlled study of patients with untreated type 2 diabetes mellitus evaluated the effect of M. oleifera added to a standardized meal (after an overnight fast) on 1- and 2-hour PPPG, relative to the standard meal alone or to a 75 g oral glucose load. M. oleifera was compared to bitter gourd (Momordica charantia) and curry leaves (Murraya koenigii). Compared to the glucose load, standard meals with or without vegetable supplements induced a lower rise in PPPG (glycemic response) according to AUCs. However, when leaf-supplemented meals were compared with standard meals, only the M. oleifera leaf-supplemented meal elicited a lower response (−21%; P < 0.01).
Both glycemic and lipidemic effects were examined in type 2 diabetic patients (N = 46) receiving 8 g/day of M. oleifera. Both FPG and PPPG were reduced, by 28% and 26%, respectively, at 40 days. Total cholesterol, triglycerides, and low-density lipoprotein levels were reduced by 14%, 14%, and 29%, respectively, compared with those of the control group.

Hemoglobin A1C was reduced by 0.4% in another study of M. oleifera in type 2 diabetic patients, with an average reduction in FPG of 29% at 3 months; however, the exact dosage was not reported.
There is insufficient information to determine clinically safe doses of M. oleifera in humans. However, the fruits and leaves are consumed as food and are a part of a regular diet in India and other parts of South Asia. The various parts of M. oleifera are also incorporated into formulations marketed for a variety of human health disorders.
RNP Pregnancy/Lactation
Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.

Although M. oleifera is used for the treatment of a variety of disorders, no clinical studies have evaluated herb-herb interactions or herb-drug interactions with its use. In vitro testing revealed that components of M. oleifera extracts may inhibit both cytochrome P450 (CYP-450) 3A4 and P-glycoprotein, so concomitant use of drugs that are 3A4 substrates or P-gp dependent is discouraged.
Adverse Reactions
Animal test groups of rats were given M. oleifera extract in graded doses up to 3 g/kg of body weight and were observed for signs of toxicity and mortality for 60 days. The extract was practically nontoxic when given orally to rats; its median lethal dose (LD50) was determined to be higher than 3 g/kg body weight. Human studies have used dosages as high as 8 g/day.

Information regarding toxicity in humans is lacking.

1. Paliwal R, Sharma V, Pracheta. A review on horse radish tree (Moringa oleifera): A multipurpose tree with high economic and commercial importance. Asian J Biotechnol. 2011;3(4)317-328.

2. Mishra G, Singh P, Verma R , et al. Traditional uses, phytochemistry and pharmacological properties of Moringa oleifera plant: An overview. Der Pharmacia Lettre. 2011;3(2):141-164.

3. Anwar F, Latif S, Ashraf M, Gilani AH. Moringa oleifera: a food plant with multiple medicinal uses. Phytother Res. 2007;21(1):17-25.[PubMed 17089328]

4. Eilert U, Wolters B, Nahrstedt A. The antibiotic principle of seeds of Moringa oleifera and Moringa stenopetala. Planta Med. 1981;42(1):55-61.[PubMed 7255568]

5. Villasenor IM, Lim-Sylianco CY, Dayrit F. Mutagens from roasted seeds of Moringa oleifera. Mutat Res. 1989;224(2):209-212.[PubMed 2797036]

6. Faizi S, Siddiqui BS, Saleem R, Saddiqui S, Aftab K, Gilani AH. Isolation and structure elucidation of new nitrile and mustard oil glycosides from Moringa oleifera and their effect on blood pressure. J Nat Prod. 1994;57(9):1256-1261.[PubMed 7798960]

7. Singh GP, Sharma SK. Antimicrobial evaluation of leaf extract of Moringa oleifera Lam. Int Res J Pharm. 2012;3(4):212-215.

8. Bhattacharya SB, Das AK, Banerji N. Chemical investigations on the gum exudate from sajna (Moringa oleifera). Carbohydr Res. 1982;102(1):253-262.

9. Siddhuraju P, Becker K. Antioxidant properties of various solvent extracts of total phenolic constituents from three different agroclimatic origins of drumstick tree (Moringa oleifera Lam.) leaves. J Agric Food Chem. 2003;51(8):2144-2155.[PubMed 12670148]

10. Singh BN, Singh BR, Singh RL, et al. Oxidative DNA damage protective activity, antioxidant and anti-quorum sensing potentials of Moringa oleifera. Food Chem Toxicol. 2009;47(6):1109-1116.[PubMed 19425184]

11. Ogunbinu AO, Flamini G, Cioni PL, Adebayo MA, Ogunwande IA. Constituents of Cajanus cajan (L.) Millsp., Moringa oleifera Lam., Heliotropium indicum L. and Bidens pilosa L. from Nigeria. Nat Prod Commun. 2009;4(4):573-578.[PubMed 19476009]

12. The Ayurvedic Pharmacopoeia of India. Pt 1, Vol 2. New Delhi, India: Government of India, Ministry of Health and Family Welfare, Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy; 2008:155-157.

13. Ndong M, Uehara M, Katsumata S, Suzuki K. Effects of oral administration of Moringa oleifera Lam on glucose tolerance in Goto-Kakizaki and Wistar rats. J Clin Biochem Nutr. 2007;40(3):229-233.[PubMed 18398501]

14. Mbikay M. Therapeutic potential of Moringa oleifera leaves in chronic hyperglycemia and dyslipidemia: a review. Front Pharmacol. 2012;3:24.[PubMed 22403543]

15. Jaiswal D, Kumar Rai P, Kumar A, Mehta S, Watal G. Effect of Moringa oleifera Lam. leaves aqueous extract therapy on hyperglycemic rats. J Ethnopharmacol. 2009;123(3):392-396.[PubMed 19501271]

16. Chumark P, Khunawat P, Sanvarinda Y, et al. The in vitro and ex vivo antioxidant properties, hypolipidaemic and antiatherosclerotic activities of water extract of Moringa oleifera Lam. leaves. J Ethnopharmacol. 2008;116(3):439-446.[PubMed 18249514]

17. Al-Asmari AK, Albalawi SM, Athar MT, Khan AQ, Al-Shahrani H, Islam M. Moringa oleifera as an anti-cancer agent against breast and colorectal cancer cell lines [published online August 19, 2015]. PLOS One. 2015;10(8);e0135814.[PubMed 26288313]10.1371/journal.pone.0135814

18. Nambiar VS, Guin P, Parnami S, Daniel M. Impact of antioxidants from drumstick leaves on the lipid profile of hyperlipidemics. J Herb Med Toxicol. 2010;4(1):165-172.

19. William F, Lakshminarayanan S, Chegu H. Effect of some Indian vegetables on the glucose and insulin response in diabetic subjects. Int J Food Sci Nutr. 1993;44(3):191-196.

20. Stohs SJ, Hartman MJ. Review of the safety and efficacy of Moringa oleifera. Phytother Res. 2015;29(6):796-804.[PubMed 25808883]

21. Aworte C, Bouic P, Rosenkranz B. In vitro and in silico screening of Moringa oleifera for drug interactions on cytochrome P450 and P-glycoprotein. Naunyn Schmiedebergs Arch Pharmakol. 2016;389(1)(suppl 1):S96.

22. Singh D, Arya PV, Aggarwal VP, Gupta RS. Evaluation of antioxidant and hepatoprotective activities of Moringa oleifera Lam. leaves in carbon tetrachloride-intoxicated rats. Antioxidants (Basel). 2014;3(3):569-591.[PubMed 26785072]

23. Bhamarapravati S, Pendland SL, Mahady GB. Extractsof spice and food plants from Thai traditional medicine inhibit the growth of the human carcinogen Helicobacter pylori. In Vivo. 2003;17(6):541-544.[PubMed 14758718]

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

Revision Date
July 13, 2016
User Note
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 Subject : Re:Natural Medicines Comprehensive Database.. 01/02/2018 06:31:02 PM 
Amanda Pikul
Posts: 1
Hi Laura,

This information I have found on Natural Medicines. I hope this will be helpful!

1/2/2018 Natural Medicines - Professional
View 33 Products Containing: Moringa
View 1 Canadian Licensed Products Containing: Moringa
Scienti c Name
Moringa oleifera, synonym Moringa pterygosperma. Family: Moringaceae.
Moringa is native to the sub-Himalayan areas of India, Pakistan, Bangladesh, and Afghanistan, and is now widely cultivated in the tropics (16344,63728). Because it can be grown cheaply and easily, and the leaves retain a high vitamin and mineral content when dried, moringa is used in India and Africa in feeding programs to combat malnutrition (16341). The immature green pods (drumsticks) are prepared similarly to green beans, while the seeds are removed from more mature pods and cooked like peas or roasted like nuts. The leaves are cooked and used like spinach, and they are also dried and powdered for use as a condiment. The seed cake remaining after oil extraction is used as a fertilizer and also to purify well water and to desalinate sea water.
Also known as: Arango, Árbol de las Perlas, Behen, Ben Ailé, Ben Nut Tree, Ben Oléifère, Benzolive, Cané cier de l'Inde, Chinto Borrego, Clari er Tree, Drumstick Tree, Horseradish Tree, Indian Horseradish, Jacinto, Kelor Tree, Malunggay, Marango, Mlonge, Moringe de Ceylan, Mulangay, Murungakai, Narango, Nebeday, Paraíso Blanco, Perla de la India, Pois Quénique, Sahjna, Saijan, Saijhan, Sajna, San Jacinto, Shagara al Rauwaq, Shigru, Terebinto.
CAUTION: See separate listings for Horseradish and Morinda. History
People Use This For
Orally, moringa is used for anemia; arthritis and rheumatism; asthma; cancer; constipation; diabetes; diarrhea; epilepsy; gastritis; gastrointestinal ulcers; headache; heart problems; hypertension; kidney stones; menopausal symptoms; thyroid disorders; and bacterial, fungal, viral, and parasitic infections. It is also used as an anti-in ammatory, antioxidant, antispasmodic, aphrodisiac, contraceptive, diuretic, immune-stimulant, nutritional supplement, tonic, and to increase breast milk production.
Topically, moringa is used as an antiseptic and astringent. It is also used for treating abscesses, athlete's foot, dandruff, gingivitis, snake bites, warts, and wounds.
Moringa seed oil is used in foods, perfume, and hair care products, and as a machine lubricant.
LIKELY SAFE ...when used orally in food amounts. The leaves, fruit, and seeds are commonly used in foods (16341,16344,90573).
POSSIBLY SAFE ...when moringa leaf or seed is used orally and appropriately in medicinal amounts, short-term. Tablets and capsules containing moringa leaf have been used with apparent safety in clinical studies lasting up to 90 days (20578,90572,90572). A dried moringa seed kernel powder has also been used with apparent safety in doses of 3 grams twice daily for 3 weeks (19278). Although these studies suggest safety, a high quality assessment of safety has not been conducted.
POSSIBLY UNSAFE ...when moringa root or root extract are used orally. Moringa root contains spirochin, apotentially toxic alkaloid. Although this constituent has not been studied in humans, animal data shows that it can cause nerve paralysis (63764).
CHILDREN: POSSIBLY SAFE ...when moringa leaf is used orally and appropriately, short-term. Powdered dried moringa leaf has been used with apparent safety in doses of 15 grams twice daily for up to 2 months (90576); however, high quality, reliable assessment of safety in children has not been conducted.
PREGNANCY: POSSIBLY UNSAFE ...when the root, bark, or ower are used orally. Traditionally, moringa root bark and gum from moringa trunk bark have been used to induce abortion. When taken orally along with black peppercorns to induce abortion, moringa root bark may cause fatality (63764). Animal research shows that moringa ower can cause uterine contractions (94634); however, this has not been assessed in humans.
There is insuf cient reliable information about the safety of using other parts of moringa during pregnancy; avoid using.,-herbs-supplements/professional.aspx?productid=1242 1/6
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LACTATION: Insuf cient reliable information available. Moringa has been studied in lactating women with apparent safety for up to a week (20578,90571,90573), however, the effects and safety of moringa on breastfeeding infants have not been evaluated; avoid using.
Effectiveness See detailed evidence summary
Asthma. Preliminary clinical research shows that taking powdered dried moringa seed kernels 3 grams twice daily for 3 weeks reduces the severity of asthma symptoms including dyspnea, wheezing, chest tightness, and cough, and improves lung function compared to baseline in patients with mild to moderate asthma (19278). However, because this study did not include a control group, the signi cance of the bene ts is uncertain.
Diabetes. Preliminary clinical research shows that taking tablets containing powdered dried moringa leaf for 90 days along with sulfonylureas does not improve HbA1c compared to treatment with sulfonylureas alone in patients with type 2 diabetes (90572).
Lactation. The role of moringa in improving lactation is contradictory, as clinical research ndings have been inconsistent. One preliminary clinical study shows that taking speci c capsules containing moringa leaf (Natalac, Gruppo Medica Inc.) 250 mg twice daily on postpartum days 3-5 increases the volume of pumped breast milk by about 200 mL compared to placebo in mothers of premature infants who are not breastfeeding (20578). Other preliminary clinical research shows that taking speci c capsules containing moringa leaf (Pro-Lacta, Pascual Laboratories, Inc.) 350 mg twice daily starting on postpartum day 3 and continuing for one week does not signi cantly increase breastmilk expression compared to placebo in mothers of term infants who are breastfeeding (90571). Reasons for the discrepancies are not clear but may relate to the postnatal age of the infants or the method of breastmilk expression (i.e., pumping or breastfeeding). The strongest evidence comes from a pooled analysis of results from ve preliminary clinical studies, which shows that when started on postpartum day 3 moringa leaf increases breastmilk volume by about 120 mL per expression by day 7 compared to control (90573). However, due to methodological limitations of the included trials, the clinical signi cance of the effect is uncertain. Furthermore, the long-term effect of moringa supplementation on lactation is not clear.
Malnutrition. Preliminary clinical research shows that supplementing food with powdered dried moringa leaf 15 grams twice daily for 2 months increases the number of children with mild-to-moderate malnutrition who achieve at least 20% improvement in weight compared to control (90576).
Menopausal symptoms. Preliminary clinical research shows that taking fresh moringa leaves 7 grams with food daily for 3 months modestly improves menopausal symptoms such as hot ashes and sleeping problems in healthy postmenopausal women compared to no dietary additives (90575).
More evidence is needed to rate moringa for these uses.
Dosing & Administration
Asthma: Powdered dried moringa seed kernels 3 grams twice daily for 3 weeks have been used (19278).
Lactation: Capsules containing a speci c moringa leaf product (Natalac, Gruppo Medica Inc.) 250 mg twice daily on postpartum days 3-5 have been used by mothers of premature infants (20578).
Menopausal symptoms: Fresh moringa leaves 7 grams daily for 3 months have been used (90575).
Malnutrition: Powdered dried moringa leaf 15 grams twice daily for 2 months has been used (90576).
Standardization & Formulation
There is insuf cient reliable information available about the standardization of moringa.
Adverse Effects Report an Adverse Reaction to Moringa
General: Orally, moringa leaf and moringa seed have been used with apparent safety in
clinical research (19278,20578,90572,90572). No adverse effects have been reported; however, most studies have not conducted a thorough evaluation of safety outcomes.
Evidence from animal research suggests that certain constituents from roasted moringa seeds have mutagenic activity (63732,63734). In mice, the LD50 of moringa seed is reported to be 446.5 mg/kg body weight (63696).,-herbs-supplements/professional.aspx?productid=1242 2/6

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Moringa root contains spirochin. Spirochin is an alkaloid that has been reported to cause nerve paralysis in animal research (63764).
Interactions with Drugs
Interaction Rating = Moderate Be cautious with this combination. Severity = High • Occurrence = Possible • Level of Evidence = D
Animal research shows that moringa can lower blood glucose levels (12249,20571,20573,20574). Theoretically, moringa might have additive effects when used with antidiabetes drugs and increase the risk of hypoglycemia.
Some antidiabetes drugs include glimepiride (Amaryl), glyburide (Diabeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others.
Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate • Occurrence = Possible • Level of Evidence = D
Animal research shows that certain constituents of moringa have hypotensive effects (20575). Theoretically, moringa pod might have additive effects when used with antihypertensive drugs and increase the risk of hypotension. It is not clear if other parts of moringa have this effect.
Some antihypertensive drugs include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), amlodipine (Norvasc), hydrochlorothiazide (HydroDIURIL), furosemide (Lasix), and many others.
Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate • Occurrence = Possible • Level of Evidence = D
Preliminary in vitro evidence suggests that moringa inhibits cytochrome P450 3A4 (CYP3A4) (20576). Theoretically, use of moringa with drugs metabolized by CYP3A4 might increase drug levels and potentially increase the risk of adverse effects.
Some CYP3A4 substrates include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.
LEVOTHYROXINE (Synthroid, Levothroid, Levoxyl, and others)
Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate • Occurrence = Possible • Level of Evidence = D
Preliminary animal research suggests that moringa might reduce serum triiodothyronine (T3) concentrations by inhibiting the peripheral conversion of thyroxine (T4) to T3 (16348). Theoretically, moringa might reduce the effectiveness of synthetic T4 products such as levothyroxine, Synthroid, Levothroid, and Levoxyl.
Interactions with Herbs & Supplements
HERBS AND SUPPLEMENTS WITH HYPOGLYCEMIC POTENTIAL: Animal research suggests that moringa might lower blood glucose levels (12249,20571,20573,20574). Theoretically, moringa might have additive effects when used with other herbs and supplements that also lower glucose levels. This might increase the risk of hypoglycemia. Some herbs and supplements with hypoglycemic effects include alpha-lipoic acid, bitter melon, chromium, devil's claw, fenugreek, garlic, guar gum, horse chestnut, Panax ginseng, psyllium, Siberian ginseng, and others.
HERBS AND SUPPLEMENTS WITH HYPOTENSIVE EFFECTS: Animal research suggests that moringa might lower blood pressure (20575). Theoretically, combining moringa with other herbs and supplements with hypotensive effects might increase the risk of hypotension. Some of these herbs and supplements include andrographis, casein peptides, cat's claw, coenzyme Q-10, sh oil, L- arginine, lyceum, stinging nettle, theanine, and others.
Interactions with Foods
None known.
Interactions with Lab Tests
None known.
Interactions with Diseases
DIABETES: Animal research suggests that moringa might lower blood glucose levels (12249,20571,20573,20574). Theoretically, moringa should be used cautiously in patients with diabetes as it may increase the risk for hypoglycemia in patients on insulin or oral hypoglycemic medications.
HYPERTENSION: Animal research suggests that moringa might have hypotensive effects (20575). Theoretically, moringa might increase the risk of hypotension in people taking antihypertensive drugs. Advise patients taking antihypertensive medications to use,-herbs-supplements/professional.aspx?productid=1242 3/6

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moringa with caution.
HYPOTENSION: Animal research suggests that moringa might have hypotensive effects (20575). Theoretically, moringa might increase the risk of hypotension in people with low blood pressure.
HYPOTHYROIDISM: Animal research suggests that moringa might decrease the conversion of thryoxine (T4) to the active thyroid hormone triiodothyronine (T3) (16348). Theoretically, moringa might further reduce thyroid hormone levels in people with hypothyroidism or subclinical hypothyroidism. Additionally, moringa might reduce the effectiveness of thyroid hormone replacement therapy in people taking levothyroxine or other synthetic forms of T4.
Mechanism of Action
General: The applicable parts of moringa are the leaves, bark, owers, fruit, seeds, and roots. Moringa leaves are a rich source of vitamins A and C, beta-carotene, calcium, iron, potassium, protein, and essential amino acids such as methionine, cystine, tryptophan, and lysine (16343,16344). The fresh leaves have a total carotene content of 40 mg/100 grams, and retain 50% of this content when dried and stored for three months (16341). The ascorbic acid content of dried leaves is between 700-1400 mg per 100 grams (16343). The leaves also contain niazirin and niazirinin which are nitrile glycosides, beta-sitosterol and its glucopyranoside derivatives, glycerol-1-(9-octadecanoate), and mustard oil glycosides including 4-[(4'-0-acetyl-alpha-L-rhamnosyloxy)benzyl] isothiocyanate, niaziminin A, and niaziminin B (16338,16339,16347). Other isothiocyanates and the related compound, niazimicin are also present (16338).
The essential oil contains zeatin, quercetin, beta-sitosterol, caffeoylquinic acid, pterygospermin, and kaempferol (16338). The leaves are also rich in antioxidant phenolic compounds such as quercetin and kaempferol.
Moringa seeds contain 38% to 42% oil. The oil contains tocopherols, sterols, and fatty acids. The main sterols present are campesterol, stigmasterol, beta-sitosterol, delta-5-avenasterol, and clerosterol. About 76% of the total fatty acid content is the mono-unsaturated oleic acid, with linoleic, palmitic, stearic, arachidic and behenic acids also present (16340). The residue of the seeds remaining after oil extraction has a protein content of 26% to 32% (16340). This residue and the seed kernels are able to remove contaminants, including lead, iron and cadmium, from drinking water (16340,16349).
Moringa root contains the alkaloids moringine, which is identical to benzylamine, and moringinine (16338,16339). The fruit, also called the pod or drumstick, contains proteins, fats, carbohydrates, minerals, ber, vitamin A, carotene, nicotinic acid, ascorbic acid, tocopherol, estrogenic substances and beta-sitosterol (16342,16345).
Moringa owers contain avonoids such as quercetin, kaempferol, rhamnetin, isoquercitrin, and kaempferitrin (16343).
Analgesic effects: Evidence from animal research shows that moringa root and leaf extract have antinociceptive and anti- in ammatory effects (63679,63775,63776). This may explain why moringa has been used traditionally for chronic pain conditions, such as arthritis.
Antiarsenic effects: Evidence from in vitro and animal research shows that the seeds of moringa can prevent and reverse the effects of arsenic exposure (16349,63683,63719,63731). It is thought that arsenic may be removed by binding to sulfhydryl-containing amino acids such as cysteine and methionine present in the protein-rich seeds. Also, antioxidants such as vitamins A, C and E, beta- carotene, beta-sitosterol, quercetin and kaempferol present in the seeds may protect against oxidative damage (16349).
Antiasthmatic effects: Moringa has been studied for use in asthma. In animal asthma models, moringa seed extract may decrease airway in ammation, acetylcholine-induced bronchoconstriction, and immune-mediated in ammatory response (63684,63686,63705,63727,63793).
Antibacterial effects: Moringa has antibacterial effects and has been used to treat bacteria in the water in efforts to make it potable. A substance called pterygospermin isolated from the root is reported to have antibacterial properties (16339,16344,63643,63710). However, not all research is positive. While moringa seed has been shown to have short-term antibacterial activity against heterotrophic bacteria and fecal coliforms in water (63660,63707,63737), regrowth of some bacteria strains appears to occur in the supernant water within 24 hours of treatment (63737). Also, adding one crushed moringa seed per 5 liters of water does not reduce bacteria counts to make the water drinkable, especially when compared to chlorine (63714).
In vitro, moringa extracts inhibit Staphylococcus aureus, Vibrio cholerae, Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus, coliform bacteria, and other strains (63637,63690,63716,63721,63726,63740,63778,63779).
Antifertility effects: Moringa is reported to have estrogenic, antiestrogenic, progestational, anti-progestational, and contraceptive activities (16338,63736,63766). Studies in animals indicate that root extracts initially increase estrogenic effects and then inhibit them, possibly by binding to receptors and then blocking them (16338). Extracts of both the root and bark can cause intense uterine contractions and have been used as abortifacients (16338). Preliminary animal research shows that moringa root and bark can prevent implantation (63735,63765), while leaf extract can result in abortion (63661).
Antifungal effects: In vitro research shows that essential oil from moringa leaf and ethanol extract of moringa seed have antifungal activity against Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton occosum, and Microsporum canis (16350).
Anti-in ammatory effects: Moringa has been used for its anti-in ammatory effects. Numerous animal studies show that moringa reduces in ammation and edema (63652,63658,63774,63775,63776,63781,63783,63785,63792).
Antineoplastic effects: Preliminary research indicates that several of the leaf and seed constituents, such as niazimicin, have anticancer properties (16338,16344,16345,33322,63624,63745). Applied topically, a fruit extract reduces the incidence and tumor burden of skin papillomas induced in animals (16345).
Antioxidant effects: Moringa contains anti-oxidant constituents such as quercetin, kaempferol, gallic acid, chlorogenic acid, ellagic acid, ferulic acid, rutin, quercetin glucoside, kaempferol rhamnoglucoside, procyanidin, and vanillin (16343,63693,63697,63698,63715). In vitro studies indicate that leaf extracts can scavenge superoxide radicals, prevent peroxidation of lipid membranes, inhibit oxidation,-herbs-supplements/professional.aspx?productid=1242 4/6

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of rat hepatic microsomes, and inhibit peroxidation of linoleic acid and lipids (16343,63633,63680,63704,63787,63794).
Antiplatelet effects: In vitro moringa leaf extract signi cantly inhibits platelet aggregation induced by adenosine diphosphate,
collagen, and epinephrine (63763).
Antispasmodic effects: Evidence from animal research shows that moringa seeds inhibits chemically induced spasms of the
duodenum by up to 67% (63652). This may explain the use of moringa as an antispasmodic agent.
Antiviral effects: Preliminary research in animals shows that moringa extract delays the development of skin lesions, prolongs mean
survival times, and reduces mortality after infection with herpes simplex-1 virus (HSV-1) (63653).
Cardiovascular effects: Moringa root contains the alkaloids moringine, which is identical to benzylamine, and moringinine (16338,16339). Moringinine has cardiac stimulant, hypertensive, and other sympathomimetic effects (16338,63752). The root can also cause hypotension, bradycardia, and both positive and negative inotropic effects in animals, while high doses can cause kidney and liver dysfunction (16338).
Certain constituents of moringa leaf have shown hypotensive effects such as beta-sitosterol, nitrile glycosides, and mustard oil glycosides (16347,63742).
Chelating effects: Moringa has been used to clean water. Moringa seeds, husks, and pods have been shown to adsorb chromium, cadmium, and nickel (63667). Moringa seeds have been used as a biosorbent for removal of arsenic, cadmium, lead, zinc, copper, cobalt, chromium, and silver ions from aqueous solutions, including polluted water (63659,63664,63669,63688,63702,63723,63730,63762).
Galactagogue effects: Moringa leaf has been used traditionally as a galactagogue (63756,63757). Moringa leaf can increase maternal serum prolactin levels, which can increases milk production (63769,63770).
Gastrointestinal effects: In animal ulcer models such as aspirin-induced gastric ulcers and acetic acid-induced chronic gastric ulcers, moringa ower bud and leaf extracts decrease the ulcer index and increased healing (63678,63741,63784,63785). The mechanism may involve modulation of 5-HT3 receptors on gastric tissue (63718).
Genitourinary effects: Preliminary data suggests an extract of moringa root has diuretic activity, and may help dissolve and prevent formation of kidney stones composed of oxalate, calcium, and phosphate (16339,63652,63786).
Hepatoprotective effects: Preliminary animal data suggests that extracts of the stem bark leaf, and/or seed of moringa protect against carbon tetrachloride, rifampin, and acetaminophen induced hepatotoxicity (63703,63774,63682).
Immune effects: Animal models show that moringa seed extract reduces delayed hypersensitivity reactions, immediate hypersensitivity reactions (such as anaphylactic shock), and humoral antibody response (63687,63713).
Insecticidal effects: Moringa seed extract delays development and induces mortality of larva of yellow fever mosquito (63696,63700).
Lipid effects: Preliminary animal research suggests that a cooked and dried extract of moringa fruit can lower serum lipids by a similar amount to lovastatin, possibly due to its beta-sitosterol content (16342). Other animal research shows that moringa leaf extract can lower cholesterol levels and atherosclerotic plaque formation comparably to simvastatin or pravastatin (63680,63717). Additional preliminary research shows that moringa leaf extract can lower serum cholesterol levels in animal models fed a high-fat diet (16346,63629).
Neurologic/CNS effects: Moringa may have neuroprotective effects. Preliminary animal research suggests that moringa root extract inhibits penicillin-induced seizure by altering levels of serotonin, dopamine, and norepinephrine in different regions of the brain (63656).
Ocular effects: Preliminary data from animals suggest that moringa leaf extract prevents experimentally induced cataracts. This effect is attributed to the antioxidant activity of moringa (63725).
Thyroid effects: Moringa leaf extract may have anti-thyroid effects. A study in animal models reported reduced serum triiodothyronine (T3) levels and increased thyroxine (T4) levels, suggesting reduced peripheral conversion of T4 to T3 (16348).
Wound-healing effects: Preliminary data from animal research suggest that extracts from moringa leaf, pulp, and seed increase the rate of wound healing, increase strength of new skin, and decrease scar area. While the exact mechanism of action is unclear, it is thought that moringa may improve wound healing due to its antibacterial activity or its zinc content (63671).
There is insuf cient reliable information available about the pharmacokinetics of moringa.
Classi cations
Cytochrome P450 3A4 (CYP3A4) Inhibitors, Diuretics
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This monograph was last reviewed on 8/4/2017 and last updated on 12/8/2017. Monographs are reviewed at least once per year. If you have comments or suggestions on something that should be reviewed or included, please tell the editors. For details about our evidence-based approach, see our Editorial Principles and Process.
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 Subject : Re:Natural Medicines Comprehensive Database.. 01/02/2018 06:50:02 PM 
Lauren Angelo
Posts: 1
Here are some great resources for herbal products (some require a subscription, others do not):
National Center for Complementary and Alternative Medicine (
Office of Dietary Supplements (
Medline Plus Drugs and Supplement Directory (
Natural Medicines (
University of Maryland Complementary and Alternative Medicine Guide ( (

If you are a preceptor for Rosalind Franklin University, you can get access to our library system and all of our electronic resources, which includes Natural Medicines.
 Subject : Re:Natural Medicines Comprehensive Database.. 01/05/2018 12:02:41 AM 
Laura E Licari
Posts: 38
Thank you everyone for the quick responses! I have the information that I need. I love the teamwork provided on the Forum, it was fun to get some much insightful input! Feel free to send me any additional comments at [email protected].
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