Scientific Name(s): Eurycoma longifolia Jack
Common Name(s): Cay Ba Binh, Eurycoma, Malaysian ginseng, Pasak bumi, Tongkat Ali
The Simaroubaceae family consists of 30 genera and 200 species. E. longifolia is a tall, slender, shrubby tree that grows in sandy soil. The plant is indigenous to Southeast Asia countries, including Myanmar, Thailand, Laos, Cambodia, and Malaysia.1, 2, 3
A decoction of the roots, root bark, or bark of E. longifolia has been consumed orally to treat many conditions, including diarrhea, fever, glandular swelling, bleeding, edema, persistent cough, hypertension, bone pain, and tertian malaria. The bark has also been used topically to treat wounds, ulcers, syphilitic sores, and headache. The plant has traditionally been used as an aphrodisiac, with recent increases in demand for E. longifolia products due to its aphrodisiac properties.1, 2, 3
Numerous reviews and studies of the phytochemical components of E. longifolia have been conducted.1, 2, 3 The plant's pharmacological activity is attributed to various quassinoids and quassinoid diterpenoids, squalene derivatives, biphenylneolignans, tirucallane-type triterpenes, canthine-6-1, and beta-carboline alkaloids.4, 5 Other identified constituents include eurycomaoside,eurycolactone, laurycolactone, and eurycomalactone.
Quassinoids, including eurycomanol, eurycomanol-2-O-beta-D-glycopyranoside, 13beta,18-dihydroeurycomanol, 14,15p-dihydroxyklaineanone, and 6-alpha-hydroxyeurycomalactone, have been isolated from the roots. Pasakbumins A-D (also known as eurycomanones) have also been isolated.4, 6, 7, 8, 9
Biphenylneolignans include the following: 2 isomeric 2,2-dimethoxy-4-(3-hydroxy-1-propenyl)-4-(1,2,3-trihydroxypropyl) diphenyl ethers and 2 biphenyls, 2-hydroxy-3,2,6-trimethoxy-4-(2,3-epoxy-1-hydroxypropyl)-5-(3-hydroxy-1-propenyl)-biphenyl, and 2-hydroxy-3,2-dimethoxy-4-(2,3-epoxy-1-hydroxypropyl)-5-(3-hydroxy-1-propenyl)-biphenyl.12
Uses and Pharmacology
Blood glucose levels decreased in streptozotocin-induced hyperglycemic adult rats after treatment with aqueous extracts of E. longifolia 150 mg/kg body weight. Blood glucose levels decreased 38% (P<0.05) and 47% (P<0.001) with 2 different extracts.15
Animal and in vitro data
In one study, eurycomalactone, at a concentration of 2.5 mg/kg, exhibited antimalarial activity and prolonged survival time in mice infected with Plasmodium berghei. However, this concentration also caused early death in some of the infected mice. Additional experiments using a 34% alcoholic extract, water extract, n-hexane fraction, chloroform fraction, and 95% ethanolic fraction were also toxic to the test animals.16 In vitro, antimalarial activity against P. berghei was observed at an inhibitory concentration of 4.5 × 107 g/mL.1, 2, 3, 16
In vitro data
In a bioassay study, 2 quassinoids, pasakbumin A (also known as eurycomanone) and pasakbumin B, exhibited antiulcer activity.9
The anti-anxiety effects of various fractions of E. longifolia were investigated in mice using various behavioral tests, including the open-field (emotional state), elevated plus-maze (anxiolytic and anxiogenic drug effects), and fighting tests. The plant's anxiolytic effect was similar to the diazepam positive control.17, 18
A study in adults (N=63) with moderate stress reported improvements in stress hormone profiles and some mood indices with administration of an E. longifolia hot water extract over 4 weeks.2
In vitro data
The quassinoid 14,15beta-dihydroxyklaineanone inhibited tumor promoter–induced Epstein-Barr virus activation at an in vitro 50% inhibitory concentration (IC50) of 5 mcM.19
In a clinical study of middle-aged Japanese subjects (N=84), an immunomodulating effect was reported (ie, increased total T cells, CD4+ T cells, and naive T cell numbers) following administration of an E. longifolia 200 mg preparation taken daily for 4 weeks.20
Testosterone deficiency/Androgen-deficient osteoporosis
Reviews have reported improvements in androgen-related osteoporosis and ergogenic/muscle mass with E. longifolia, possibly related to increased testosterone levels and antioxidant effects associated with its use.2, 3, 21
In vitro data
In osteoblast cell lines, treatment with E. longifolia aqueous root extracts demonstrated greater cell proliferation and calcium deposition than testosterone-treated cells.22
Testosterone deficiency/Sexual performance
In a study evaluating the effects of E. longifolia extract on the initiation of sexual performance in rats, doses of 200, 400, and 800 mg/kg body weight were administered orally twice daily for 10 days and continued throughout the 1-month testing period. Testosterone 15 mg/kg was used as a positive control. E. longifolia promoted the growth of both ventral prostate and seminal vesicles compared with control, but was associated with lower sexual performance than the testosterone-treated group.23 Other studies have demonstrated similar results.24, 25
A systematic review of randomized controlled trials (published through October 2014) investigating the use of E. longifolia extract (tongkat ali) compared with placebo for improvement in erectile dysfunction identified 2 trials (N=139) that met inclusion criteria. One trial used a combination product of E. longifolia 200 mg plus Polygonium minus 100 mg, whereas the second trial used E. longifolia as a single constituent at 300 mg/day (two 75 mg capsules twice daily); both were 12-week trials. The trials were prone to a high risk of bias, did not specify that a diagnosis of erectile dysfunction was needed, and had differences in baseline erectile dysfunction index scores. At week 12, pooled weighted mean difference in change of erectile function index score was 0.91 (95% confidence interval [CI], –1.5 to 3.33; P=0.002), with high heterogeneity (I2=89.5%); subgroup analysis revealed the improvement was specific to subjects with a lower baseline index score (ie, at or below 15.77 in the study using the combination product) and did not apply to those with a higher baseline index score (ie, 21.3 or above in the E. longifolia monotherapy study). No significant differences were observed between treatment and placebo groups.21, 26, 27
Dosing recommendations are largely based on historical practice or manufacturer recommendations, as clinical studies are lacking.
Doses ranging from 100 to 800 mg daily have been reported.3
200 mg of a water-soluble extract of E. longifolia root taken twice daily for up to 3 months has been suggested.2
Pregnancy / Lactation
Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking. Antiestrogenic effects have been demonstrated in rodents.2
Case reports are lacking; however, in a study of healthy volunteers, the bioavailability of a single dose of propranolol was decreased when coadministered with an E. longifolia aqueous extract.28
Limited information is available. Extracts of E. longifolia should not be used in prostate cancer due to observed increased levels of testosterone in rodent studies.2
Data collected from the Drug-Induced Liver Injury Network between 2004 and 2013 among 8 US centers revealed 15.5% (130) of hepatotoxicity cases were caused by herbals and dietary supplements. Of the 217 supplement products implicated in liver injury, E. longifolia was among the 22% (116) labeled as single-ingredient products.29
Limited clinical information is available regarding toxicity of E. longifolia. E. longifolia is not considered to be generally recognized as safe (GRAS) by the US Food and Drug Administration.3
In one study, the median lethal dose for an oral E. longifolia alcoholic extract in mice was determined to be 2.6 g/kg; symptoms of acute toxicity included depression, shallow respiration, and convulsion. In this study, 95% of mice died at a dose of 0.43 g/kg, and increased weight of the liver, kidneys, spleen, and testes was observed.16
One product, M-Tongkat Ali, harvested and prepared in Malaysia, was found to have higher than normal traces of lead (10.64 ± 0.37 ppm).30
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