Gentian

Before using gentian, talk to your healthcare provider. You may not be able to use gentian if you have certain medical conditions.

Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have:

• low blood pressure.

It is not known whether gentian will harm an unborn baby. Do not use this product without medical advice if you are pregnant.

It is not known whether gentian passes into breast milk or if it could harm a nursing baby. Do not use this product without medical advice if you are breast-feeding a baby.

Do not give any herbal/health supplement to a child without medical advice.

Follow your healthcare provider's instructions about any restrictions on food, beverages, or activity.

Avoid using gentian together with other herbal/health supplements that can lower blood pressure, such as andrographis, casein peptides, cat's claw, fish oil, L-arginine, lycium, stinging nettle, and others.

Avoid to confuse gentian with white hellebore (Veratrum album) which is highly toxic and can cause accidental poisoning when used in homemade preparations.

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Although not all side effects are known, gentian is thought to be likely safe for most people when taken by mouth in small amounts as part of a combination product.

Common side effects may include:

• stomach discomfort; and

• skin rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

No clinical trials support traditional use of gentian to stimulate appetite, improve digestion, or treat GI complaints. Gentian has also been used as an emmenagogue and to treat wounds, sore throat, arthritic inflammation, and jaundice.

Infusions, decoctions, and macerations of gentian roots and rhizomes have been used as a bitter digestive tonic in doses of 1 to 4 g/day. There are no clinical studies to substantiate this dosage recommendation.

Documented adverse effects. Avoid use.

Quality clinical trials evaluating the effect of gentian or its chemical constituents are lacking. 2

Analgesic/anti-inflammatory
Animal data

Gentianine and gentiopicroside have been shown to exert a measurable anti-inflammatory and analgesic effect in animals. Extracts of G. lutea were active in carageenan-induced rat paw edema, xylol-induced mouse ear edema, and cotton-pellet granulatoma models. In addition, the extracts were active in several wound-healing models. 13 , 14 , 15

Clinical data

Clinical trials are lacking.

Antimicrobial

Radix Gentianae Lutea and gentian extracts have been shown to exert antibacterial, antifungal, and antiprotozoal effects in vitro. 2

Methanolic extracts of the flowers and leaves of G. lutea demonstrated a wide range of activity against gram-positive and gram-negative bacteria and yeasts. Isolated chemical constituents mangiferin, isogentisin, and gentiopicrin also demonstrated activity. 16 , 17 Activity against Helicobacter pylori has been demonstrated in vitro. 18 , 19 Amarogentin and 2 other iridoids inhibited topoisomerase I of Leishmania . 20

Animal data

The roots of G. lutea have been used as an anthelmintic in ethnoveterinary medicine. 19

Clinical data

Clinical trials are lacking.

Hepatic effects
Animal data

In rats, intragastric and intraduodenal administration of gentian extracts stimulated bile production 2 , 21 and showed a protective effect on the liver against chemical insults. 21

Clinical data

In an uncontrolled study, stimulation of gall bladder secretions was increased by gentian. 2

GI tract

Bitter substances ingested before meals are reputed to improve the appetite and aid digestion by stimulating the flow of gastric juices and bile. However, because gentian is most often consumed in alcoholic beverages, it is difficult to distinguish the effects of gentian from those of alcohol.

Animal data

Ethanol extracts of the roots and rhizomes of G. lutea have increased gastric secretions in rats and sheep. 2

Clinical data

In 2 uncontrolled clinical studies, stimulation of gastric secretions was increased and GI symptoms (eg, abdominal pain, constipation, dyspepsia, heartburn) were reduced. 2

Other uses

Gentian extracts have hydroxy radical scavenging activity 22 , 23 and exert a protective effect against ketoconazole-induced testicular damage in rats, assumed to be due to antioxidant effects. 24 Gentiopicroside and the essential oil of G. lutea relax smooth muscle in isolated animal trachea and ileum. 2 , 25 Gentian extracts prolong swimming endurance in mice. 26

1. Gentiana lutea L. USDA, NRCS. 2010. The PLANTS Database ( http://plants.usda.gov , July 2010). National Plant Data Center, Baton Rouge, LA 70874-4490 USA.
2. Radix Gentianae Luteae . In: WHO Monographs on Selected Medicinal Plants . Vol 13. Geneva, Switzerland: World Health Organization; 1999.
3. Meyer JE. The Herbalist . Hammond, IN: Hammond Book Co; 1934.
4. Leung AY. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics . 2nd ed. New York, NY: J Wiley; 1996.
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6. Bricout J. Identification and determination of the bitter constituents of Gentiana lutea roots [in French]. Phytochemistry . 1974;13(12):2819-2823.
7. Glatz Z, Pospisilova J, Musil P. Determination of gentiopicroside in extracts of Centaurium erythreae and Gentiana lutea by micellar electrokinetic capillary chromatography. J Liq Chromatogr Relat Technol . 2000;23(12):1831-1839.
8. Szucs Z, Danos B, Nyiredy S. Comparative analysis of the underground parts of Gentiana species by HPLC with diode-array and mass spectrometric detection. Chromatographia . 2002;56(1):S19-S23.
9. Hayashi T, Yamagishi T. Two xanthone glycosides from Gentiana lutea . Phytochemistry . 1988;27(11):3696-3699.
10. Toriumi Y, Kakuda R, Kikuchi M, Yaoita Y, Kikuchi M. New triterpenoids from Gentiana lutea . Chem Pharm Bull (Tokyo) . 2003;51(1):89-91.
11. Kakuda R, Machida K, Yaoita Y, Kikuchi M, Kikuchi M. Studies on the constituents of Gentiana species. II. A new triterpenoid, and (S)-(+)- and (R)-(−)-gentiolactones from Gentiana lutea . Chem Pharm Bull (Tokyo) . 2003;51(7):885-887.
12. Menkovic N, Savikin-Fodulovic, Savin K. Chemical composition and seasonal variations in the amount of secondary compounds in Gentiana lutea leaves and flowers. Planta Med . 2000;66(2):178-180.
13. Mathew A, Taranalli AD, Torgal SS. Evaluation of anti-inflammatory and wound healing activity of Gentiana lutea rhizome extract in animals. Pharm Biol . 2004;42(1):8-12.
14. Ozturk N, Korkmaz S, Ozturk Y, Baser KH. Effects of gentiopicroside, sweroside and swertiamarine, secoiridoids from gentian ( Gentiana lutea ssp. symphyandra), on cultured chicken embryonic fibroblasts. Planta Med . 2006;72(4):289-294.
15. Chen L, Liu JC, Zhang XN, et al. Down-regulation of NR2B receptors partially contributes to analgesic effects of Gentiopicroside in persistent inflammatory pain. Neuropharmacology . 2008;54(8):1175-1181.
16. Savikin K, Menkovic N, Zdunic G, Stevic T, Radanovic D, Jankovic T. Antimicrobial activity of Gentiana lutea L. extracts. Z Naturforsch C . 2009;64(5-6):339-342.
17. Weckesser S, Engel K, Simon-Haarhaus B, Wittmer A, Pelz K, Schempp CM. Screening of plant extracts for antimicrobial activity against bacteria and yeasts with dermatological relevance. Phytomedicine . 2007;14(7-8):508-516.
18. Mahady GB, Pendland SL, Stoia A, et al. In vitro susceptibility of Helicobacter pylori to botanical extracts used traditionally for the treatment of gastrointestinal disorders. Phytother Res . 2005;19(11):988-991.
19. Lans C, Turner N, Khan T, Brauer G. Ethnoveterinary medicines used to treat endoparasites and stomach problems in pigs and pets in British Columbia, Canada. Vet Parasitol . 2007;148(3-4):325-340.
20. Ray S, Majumder HK, Chakravarty AK, Mukhopadhyay S, Gil RR, Cordell GA. Amarogentin, a naturally occurring secoiridoid glycoside and a newly recognized inhibitor of topoisomerase I from Leishmania donovani . J Nat Prod . 1996;59(1):27-29.
21. Liu ZW, Chen C, Jin R, Shi G, Song C, Hu Z. Studies on liver-protecting and bile secretion-promoting effects of gentiopicroside. Zhong Cao Yao . 2002;33:47-50.
22. Calliste CA, Trouillas P, Allais DP, Simon A, Duroux JL. Free radical scavenging activities measured by electron spin resonance spectroscopy and B16 cell antiproliferative behaviors of seven plants. J Agric Food Chem . 2001;49(7):3321-3327.
23. Kusar A, Zupancic A, Sentjurc M, Baricevic D. Free radical scavenging activities of yellow gentian ( Gentiana lutea L.) measured by electron spin resonance. Hum Exp Toxicol . 2006;25(10):599-604.
24. Amin A. Ketoconazole-induced testicular damage in rats reduced by Gentiana extract. Exp Toxicol Pathol . 2008;59(6):377-384.
25. Rojas A, Bah M, Rojas JI, Gutiérrez DM. Smooth muscle relaxing activity of gentiopicroside isolated from Gentiana spathacea . Planta Med . 2000;66(8):765-767.
26. Öztürk N, Baser KH, Aydin S, Öztürk Y, Calis I. Effects of Gentiana lutea ssp. symphyandra on the central nervous system in mice. Phytother Res . 2002;16(7):627-631.
27. Wang CH, Wang ZT, Bligh SW, White KN, White CJ. Pharmacokinetics and tissue distribution of gentiopicroside following oral and intravenous administration in mice. Eur J Drug Metab Pharmacokinet . 2004;29(3):199-203.
28. Wang CH, Cheng XM, He YQ, et al. Pharmacokinetic behavior of gentiopicroside from decoction of Radix Gentianae, Gentiana macrophylla after oral administration in rats: a pharmacokinetic comparison with gentiopicroside after oral and intravenous administration alone. Arch Pharm Res . 2007;30(9):1149-1154.
29. Bakuridze AD, Nikolaev SM, Tsagarenshvili NT, Kurdiani NG, Mikaia GA. Influence of Gentiana lutea L extract on blood coagulation [in Russian]. Georgian Med News . 2009;(172-173):89-91.
30. Suzuki O, Katsumata Y, Oya M. Inhibition of monoamine oxidase by isogentisin and its 3-O-glucoside. Biochem Pharmacol . 1978;27(16):2075-2078.
31. Haraguchi H, Tanaka Y, Kabbash A, Fujioka T, Ishizu T, Yagi A. Monoamine oxidase inhibitors from Gentiana lutea . Phytochemistry . 2004;65(15):2255-2260.
32. Garnier R, Carlier P, Hoffelt J, Savidan A. Acute dietary poisoning by white hellebore ( Veratrum album L.). Clinical and analytical data. A propos of 5 cases [in French]. Ann Med Interne (Paris) . 1985;136(2):125-128.
33. Rauber-Lüthy C, Halbsguth U, Kupferschmidt H, et al. Low-dose exposure to Veratrum album in children causes mild effectsa case series. Clin Toxicol (Phila). 2010;48(3):234-237.

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