Dragon's Blood

Scientific Name(s): Croton lechleri Muell. Arg.
Common Name(s): Blood of the dragon, Crofelemer, Drago, Dragon's blood, Sangre de drago, Sangre de grado, SP-303

Medically reviewed by Drugs.com. Last updated on Jul 24, 2023.

Clinical Overview

Use

Crofelemer, a single constituent of the C. lechleri tree, is approved by the US Food and Drug Administration (FDA) (brand name, Mytesi) for symptomatic relief of noninfectious diarrhea in patients with HIV/AIDS who are receiving antiretroviral therapy. A variety of traditional uses are associated with dragon's blood resin or sap, such as bleeding control, wound healing, and treatment of GI problems; however, evidence from clinical trials is insufficient to support these uses.

Dosing

Clinical data are lacking to provide dosing recommendations for C. lechleri.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

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

Interactions

None well documented.

Adverse Reactions

No major toxic effects from consumption of C. lechleri extract have been reported. Systemic absorption of crofelemer is minimal, and studies report low levels of GI-related adverse effects (eg, abdominal pain, flatulence, dyspepsia).

Toxicology

Weak to no mutagenicity has been reported for the sap or essential oil of C. lechleri; however, the chemical constituent taspine is considered cytotoxic.

Scientific Family

• Euphorbiaceae (spurge)

Botany

The genus Croton comprises approximately 750 species of trees and shrubs commonly found in tropical and subtropical regions. C. lechleri is a medium-sized tree that grows approximately 15 m in height, and the trunk is covered with smooth, mottled bark. When the bark is cut or damaged, it oozes a red, sap-like resin, which makes the tree appear to be bleeding. The plant has heart-shaped, alternate leaves 15 to 30 cm in width and length, as well as 3-celled fruits from small flowers borne on tall, thin spikes.(De Marino 2008, Gupta 2008, Jones 2003)

"Dragon's blood" is a name applied to many red resins described in medical literature. A number of alternative sources of "dragon's blood" are documented, including the genera Dracaena, Daemonorops, and Pterocarpus, as well as mercury sulfide.(Gupta 2008) Synonyms include Oxydectes lechleri and Croton draco.

History

Dragon's blood is mentioned in early Greek, Roman, and Arabic records; however, sources of preparations vary. Recorded use of "sangre de grado" (blood of the dragon) is extensive among Latin American countries, dating to the 1600s; both the bark and resin have been used internally and externally to stop bleeding, heal wounds, and treat GI problems (including piles and hemorrhoids).(Cobb 2014, Gupta 2008) The sap has also been used in vaginal baths before childbirth and as a remedy for cancer, as well as a pigment for artistic uses.(Alonso-Castro 2012, Duke 2002, Gonzales 2006, Gupta 2008)

Chemistry

Reviews of the chemical constituents of C. lechleri have been published.(Cobb 2014, Jones 2003)

Among other alkaloids, taspine has been isolated from C. lechleri sap, and sinoacutine has been isolated from the leaves.(De Marino 2008, Fayad 2009, Jones 2003) Proanthocyanidins (or oligomers) and flavonols are the major phenolic constituents of the sap of C. lechleri, including galloepicatechin, gallocatechin, epicatecin, and catechin.(Cai 1993a, Cai 1993b, Cai 1991, Cottreau 2012, Gonzales 2006) Diterpenes and steroidal compounds have also been described.(Jones 2003) The bark essential oil consists primarily of sequiterpenes and monoterpenes.(Rossi 2003) Crofelemer, a single constituent of the tree, has been approved by the FDA (brand name, Mytesi).

Uses and Pharmacology

Crofelemer is an antisecretory antidiarrheal proanthocyanidin oligomer extracted from the C. lechleri tree and is approved by the FDA for symptomatic relief of noninfectious diarrhea in patients with HIV/AIDS receiving antiretroviral therapy. Data in this monograph is mostly focused on use of the natural product C. lechleri (eg, sap, resin, plant extracts), primarily in animal and in vitro studies.(Frampton 2013, Hornby 2015)

Antibacterial/Antiviral effects

In vitro data

In in vitro studies, several phenolic compounds and diterpenes, as well as the essential oil from the plant, have demonstrated antibacterial activity.(Cai 1993a, Chen 1994, Rossi 2003)

The constituent taspine inhibited RNA-directed DNA polymerase activity from certain tumor virus types, including leukemia and sarcoma virus.(Gupta 2008, Sethi 1977)

Antioxidant activity

Antioxidant properties have been described for C. lechleri sap.(Gupta 2008, Lopes 2004, Rossi 2003)

C. lechleri sap has an exceptionally high and stable antioxidant content (at least 93% inhibition percentage of 2,2-diphenyl-1-picrylhydrazyl [DPPH]), suggesting a potential role as an antioxidant agent or ingredient for consumer product formulations (eg, food, pharmaceuticals, nutraceuticals or cosmetics, paint or paper products).(Escobar 2018)

Avulsed teeth replantation

A 10% C. lechlerisap was found to be an effective medium to preserve viability of teeth for replantation.(Martins 2016)

Cancer

Animal and in vitro data

C. lechleri extracts increased apoptosis in Helen Lake tumor cell and other human cancer cell lines, and have inhibited tumor growth in mice.(Alonso-Castro 2012, Gonzales 2006, Gupta 2008, Montopoli 2012) Thaspine (taspine), a topoisomerase inhibitor, alone induced apoptosis in mouse models of colon cancer.(Fayad 2009) An inhibitory effect against mutagens has been demonstrated in vitro.(Gonzales 2006)

Conversely, leukemic cells from children were exposed to C. lechleri extracts and showed resistance to the extract and increased survival times.(Styczynski 2006)

Diarrhea

Animal data

Experiments in mice have shown that C. lechleri sap has activity on gastric smooth muscle cells.(Froldi 2009)

GI effects

Animal data

Reductions in the size of induced gastric ulcers in rats were achieved when sap from C. lechleri and Croton palanostigma was added to the rats' drinking water for 7 days. A decrease in bacterial counts of ulcers in the sap-drinking rats versus controls was also reported.(Jones 2003)

Immunomodulatory activity

In vitro data

An in vitro study demonstrated immunomodulatory activity of sangre de drago, with potent inhibitory activity on classical and alternative pathways of the complement system and inhibition of proliferation of activated T cells.(Gupta 2008)

Wound-healing effects

Animal and in vitro data

Anti-inflammatory properties have been described for C. lechleri sap. Anti-inflammatory actions of the taspine alkaloid from dragon's blood were first documented in 1979.(Perdue 1979) Later studies confirmed these actions, leading to further studies regarding wound healing. In one study, taspine was found to be the active cicatrizant principle by an in vivo test in mice; increased migration of human fibroblasts was suggested as the probable mechanism in this acceleration of the wound-healing process.(Vaisberg 1989) Another report evaluating taspine's wound-healing properties demonstrated positive results (with higher dosing, results were seen earlier rather than later) using such parameters as wound tensile strength and histology; taspine also stimulated chemotaxis for fibroblasts. Data from the report suggest that taspine promotes early phases of wound healing in a dose-dependent manner.(Porras-Reyes 1993) Another chemical constituent, a dihydrobenzofuran lignan also involved in wound healing actions, was isolated in 1993.(Pieters 1993) Additionally, an in vitro study evaluating the effect of C. lechleri sap demonstrated inhibition of cutaneous neurogenic inflammation.(Pereira 2010)

Clinical data

Clinical data regarding the use of C. lechleri sap for wound healing are lacking. C. lechleri offers limited use in dermatology and further investigations are necessary to gain additional insight into its potential clinical usefulness.(Pona 2019)

Dosing