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Periwinkle

Scientific Name(s): Catharanthus roseus G. Don. Family: Apocyanaceae (dogbanes)

Common Name(s): Periwinkle , red periwinkle , Madagascar or Cape periwinkle , old maid , church-flower , ram-goat rose , “ myrtle ,” magdalena 1

Uses

Periwinkle alkaloids have been used in the treatment of leukemia, Hodgkin's disease, malignant lymphomas, neuroblastoma, Wilms tumor, Kaposi's sarcoma, mycosis fungoides, to improve cerebral blood flow, and treat high blood pressure.

Dosing

There is no recent clinical evidence to support specific doses of periwinkle herb. The pure alkaloids vincristine and vinblastine are used in cancer therapy at single weekly IV doses of 0.05 to 0.15 mg/kg and 0.1 to 0.2 mg/kg respectively.

Contraindications

Contraindications have not yet been identified.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking. Avoid use.

Interactions

None well documented.

Adverse Reactions

Do not self-administer the plant periwinkle. Physicians will inform patients using pharmaceutical forms of periwinkle of possible adverse reactions.

Toxicology

Periwinkle is potentially toxic and has been known to cause acute dyspnea.

Botany

Although the plant is said to be native to the West Indies, it was first described in Madagascar. 1 The periwinkle is a perennial herb that grows to about 2 feet. 2 It is highly branched and develops a woody base. The flowers can bloom throughout the year, depending on the climate. These are often bred for their unique colors ranging from white to green-yellow and lavender. The seed pod dries, splits and releases numerous tiny seeds, of which there are about 350,000/lb. 1 Also referred to as Lochnera rosea Reichb., Vinca rosea L., and Ammocallis rosea Small. The related plant Vinca minor (common periwinkle, Myrtle) is used as a ground cover.

History

The plant was introduced in Europe during the mid-1700s during which time it was cultivated as an ornamental. Today it grows throughout much of the world and plantations have been established on most continents in the warmer climates. The plant has been widely used in tropical folk medicine. Decoctions of the plant have been used for maladies ranging from ocular inflammation, diabetes and hemorrhage to treating insect stings and cancers.

Chemistry

All parts of the plant contain alkaloids. By 1977, 73 unique alkaloids had been isolated and named, and today the number exceeds 100. The concentration of alkaloids varies with the part of the plant and the region of harvest. Roots collected in India have yielded up to 1.22% total alkaloids. The hypotensive alkaloids reserpine and alstonine have been isolated from the root in concentrations less than 0.03%. 1 The alkaloid designated ajmalicine, raubasine, 3 vinceine or vincaine appears to be structurally similar to yohimbine. The most well known of the “vinca” alkaloids derived from C. roseus are vinblastine (vincaleukoblastine, Velban ) 4 and vincristine (leurocristine, Oncovin ), 4 which are now widely used antineoplastic agents.

The leaves also contain a complex volatile oil. 1

Uses and Pharmacology

A number of pharmacologic activities have been ascribed to the periwinkle plant.

Cancer

Investigations by the Lilly company into the antidiabetic activity of the plant found no effect on blood sugar levels but uncovered the antineoplastic effects of plant extracts. Vincristine and vinblastine bind to tubulin in cellular microtubules, thus preventing polymerization, arresting cellular division and killing the cell. These drugs may also exert immunosuppressant activity and may interfere with other components of the cell cycle to induce cellular death. These drugs are used for the treatment of leukemia, Hodgkin's disease, malignant lymphomas, neuroblastoma, Wilms tumor, Kaposi's sarcoma and mycosis fungoides, among others. An extensive body of literature exists on the clinical uses of the various purified alkaloids of Catharanthus .

Miscellaneous uses

Catharanthine has demonstrated diuretic properties. 3 Ajmalicine may improve cerebral blood flow and has been used to treat high blood pressure when given in combination with rauwolfia alkaloids. 3

Injection of a concentrated aqueous extract was shown to lower blood sugar levels in cats and tended to moderate blood sugar levels in humans according to a treatise on African plant uses. 1

Dosage

There is no recent clinical evidence to support specific doses of periwinkle. The pure alkaloids vincristine and vinblastine are used in cancer therapy at single weekly IV doses of 0.05 to 0.15 mg/kg and 0.1 to 0.2 mg/kg respectively.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking. Avoid use.

Interactions

None well documented.

Adverse Reactions

There has been at least one report of persons attempting to smoke periwinkle leaves as an hallucinogenic substitute for marijuana, but this appears to have not become common because of a lack of any significant pharmacologic effect. 1

Toxicology

The periwinkle plant has been reported to have caused poisonings in grazing animals. 1 Severe systemic adverse events are associated with the prolonged use of vincristine and vinblastine, and fatalities have been associated with the use of these alkaloids. Acute dyspnea has been reported following antineoplastic treatment with the related alkaloids vindesine ( Eldisine ) 4 and vinorelbine ( Navelbine ). 4 , 5

The related Vinca minor has been declared “unsafe” for human consumption by the FDA. 2

Bibliography

1. Morton JF. Major Medicinal Plants . Springfield, IL: Charles C. Thomas, 1977.
2. Dobelis IN. Magic and Medicine of Plants . Pleasantville, NY: Reader's Digest Association, 1986.
3. Duke JA. Handbook of Medicinal Herbs . Boca Raton, FL: CRC Press, 1985.
4. Olin BR, Hebel SK, eds. Drug Facts and Comparisons . St. Louis, MO: Facts and Comparisons, 1994.
5. Thomas P, et al. Rev Mal Respir . 1993;10:268.

Copyright © 2009 Wolters Kluwer Health

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