Scientific Name(s): Rhodiola roanensis Britton, Rhodiola rosea L., Sedum rosea
Common Name(s): Arctic root, Golden root, Rhodaxon, Roseroot, SHR-5
R. rosea is a perennial plant with a thick rhizome and yellow, fragrant flowers. It grows in sandy soil at high altitudes in the arctic areas of Europe and Asia, including eastern Siberia. The plant reaches a height of 30 to 76 cm. Unique chemical constituents distinguish R. rosea from other Rhodiola species.1, 2
The Greek physician Dioscorides (AD 40-90) first recorded this plant in De Materia Medica, renaming it from Rodia riza to R. rosea, which refers to the roselike aroma of the freshly cut root. The Swedish naturalist Carl Linnaeus (1707-1778) documented use of R. rosea as an astringent to treat hernia, leucorrhea, hysteria, and headache. For centuries, the plant has been used in the Russia Federation and Scandinavia, where the majority of the research has been conducted.2, 3, 4 The plant has also been used as a hemostatic agent in Tibetan folk medicine.5 Extract of R. rosea is registered in the Russian Federation as a medicinal product for human use.4 Due to increased demand for the plant, R. rosea is listed as threatened or endangered in many areas of the world, including parts of the United States.1
Three cinnamyl alcohol vicianosides (rosavin, rosin, rosarin) are specific to R. rosea.4, 6 These 3 substances, along with rosiridin and salidroside, are the 5 marker compounds that must be present to reliably identify R. rosea.4, 7 R. rosea extract used in most clinical trials was standardized to a minimum of rosavins 3% and salidroside 0.8% to 1%, the naturally occurring ratio in the plant.2 The phenylethanol derivatives salidroside (rhodioloside) and tyrosol have been found in the underground part of the plants.3, 8 Flavonoids in R. rosea include rhodiolin, rodinin, rodiosin, acetylrodalgin, and tricin, as well as other catechins and proanthocyanidins.2, 9 Monoterpenes include rosiridol and rosaridin, and triterpenes include daucosterol and beta-sitosterol.2, 5 Terpenes and volatile compounds have been isolated from R. rosea and include the essential oil components of monoterpene hydrocarbons, monoterpene alcohols and straight-chain aliphatic alcohols, N-decanol, geraniol (responsible for the rose-like odor), linalool, nonanal, decanal, nerol, and cinnamyl alcohol.10 Phenolic acids, including chlorogenic, hydroxycinnamic, and gallic acids, are also present.2, 9, 11, 12
Uses and Pharmacology
Plant adaptogens, such as those from R. rosea, improved mental and physical performance through stimulatory effects on various physiological systems.9, 12 R. rosea's use in traditional Ayurvedic medicine for adaptogenic properties has been examined.13
R. rosea increased the survival of freshwater snail eggs against induced stressors, including heat shock and oxidative and heavy metal stress.14 When administered to rats, injections of the plant extract prevented stress-induced elevations of beta-endorphins, adrenocorticotropic hormone, cortisol, insulin, thyroxin, and triiodothyronine.15 R. rosea given to rats increased swimming time up to 159%, with improvement continuing throughout the supplementation period.16
Clinical trials evaluating R. rosea for mental and physical fatigue have reported conflicting results. Positive findings were reported in a clinical trial conducted among 56 physicians experiencing fatigue during night duty17 and among students during stressful examination periods.18, 19 Improved sleep patterns and overall quality of sleep have been described with the use of R. rosea.17, 18, 19, 20 A small (N = 15), randomized, placebo-controlled, crossover study evaluated the effects of a single dose of 3 mg/kg administered 1 hour prior to an exercise bicycle session that began with a 10-minute warm-up followed by a 6-mile time trial. Results were lower with R. rosea compared with placebo for the time required to complete 6 miles, heart rate during the warm-up period but not the time trial, and patients’ rating of exertion level.21 A systematic review evaluating the efficacy of R. rosea for physical and mental fatigue reported conflicting clinical trial results for both conditions.22 Meta-analysis could not be conducted because the studies used different instruments to measure fatigue. In addition, studies had either a high risk of bias or reporting flaws that may have compromised their validity. A placebo-controlled clinical trial evaluated the effect of R. rosea on fatigue for 42 days in 48 nursing students doing shift work.23 In this study, both a visual analog scale for fatigue and the RAND-36 Vitality subscale indicated that R. rosea increased fatigue.
Other trials evaluating the effect of R. rosea on physical performance suggested a positive effect; however, most recent trials have reported no effect on time to exhaustion,24, 25, 26, 27 cardiovascular outcomes,27, 28 tissue hypoxia,26, 27, 28 exercise-induced muscle damage, delayed onset of muscle soreness, plasma cytokines,29 or rate of adenosine triphosphate turnover for R. rosea extracts.25
In vitro and animal data
The usefulness of R. rosea as an antioxidant and anticarcinogenic agent has been suggested based on findings from in vitro studies.11, 30, 31, 32, 33 Several antioxidant compounds have been identified in the plant, including p-tyrosol, organic acids, and flavonoids. A mechanism of action has been described that includes induction of apoptosis and necrosis.34
The same researchers described experiments in animals with induced cancers. R. rosea potentiated antitumor and antimetastatic effects in mice with lung carcinoma,35 inhibited tumor dissemination,36 inhibited growth rate of Ehrlich tumors and Pliss lymphosarcoma,37 and protected tissues from cyclophosphamide toxicity.38, 39 Another in vitro experiment showed efficacy against prostate cancer cells in rats.3
R. rosea extract administration improved certain parameters in superficial bladder carcinoma in a small (N = 12) study.40
CNS activity of R. rosea has been reported.12 Earlier studies found that low to medium doses of the plant had stimulatory effects, while larger doses had sedative effects.2 In lower doses, R. rosea stimulated norepinephrine, dopamine, serotonin, and nicotinic cholinergic systems in the CNS. R. rosea also increased the permeability of the blood-brain barrier to precursors of dopamine and serotonin41, 42, 43 and improved cerebral circulation.44 In an in vitro study, R. rosea root extract inhibited monoamine oxidases A and B.45
A systematic review of 4 clinical trials of R. rosea in psychiatric disorders found sufficient positive results to warrant further research, suggesting that a stimulating adaptogenic effect is responsible for antidepressant activity.46
Clinical trials evaluating R. rosea for mild to moderate depression have reported conflicting results. A double-blind, randomized clinical trial of R. rosea (SHR-5) conducted for 6 weeks in 89 patients reported antidepressant effects as compared with use of placebo, as measured on the Hamilton Depression Rating Scale (HAM-D) as well as the Beck Depression Inventory (BDI).47 A second placebo-controlled clinical trial compared the efficacy of sertraline and R. rosea (SHR-5) in 57 patients for12 weeks.48 There was no difference between treatments for the study’s primary outcome, the change in HAM-D 17. There were also no differences between treatments for BDI or Clinical Global Impression Change scores. The odds of improvement were greater with sertraline than with R. rosea (odds ratio 1.9 vs 1.4), but R. rosea was tolerated. Earlier trials of varying methodology also produced conflicting results.49, 50
The Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder (MDD) in adults (2016) do not recommend R. rosea in the management of MDD based on insufficient evidence.51
A study using the fruit fly Drosophila demonstrated increased longevity with R. rosea administration and suggested the effects were not caused by metabolic rate or male mating success.52
Clinical trials are lacking. Several older experiments by a small pool of researchers investigated the antiarrhythmic and inotropic effects of R. rosea extract in animal models.53, 54, 55, 56, 57, 58, 59
Clinical doses are commonly 200 to 600 mg/day.2 Doses of 340 to 680 mg/day of R. rosea extract (as SHR-5) in depression have been evaluated for up to 12 weeks, but with conflicting results.47, 60 A daily dose of 170 mg/day for 4 weeks was evaluated in a study examining athletic performance and antioxidant effects.
Pregnancy / Lactation
Information regarding safety and effectiveness in pregnancy and lactation is lacking.9
None well documented. In vitro studies have suggested that R. rosea may be a potent inhibitor of cytochrome P450 (CYP) 2C19, CYP 2D6, CYP 3A4, and P-glycoprotein.61, 62, 63 In a rat study, R. rosea did not affect the pharmacokinetics of theophylline or warfarin, or alter the prothrombin time with warfarin.64 In a rabbit study, R. rosea substantially increased exposure to losartan, but not losartan’s active metabolite.65 In a case report, a young woman developed supraventricular tachycardia 3 days after adding R. rosea to long-term administration of escitalopram.66 A 2-phase, randomized crossover experimental study in 13 nonsmoking healthy volunteers (20 to 26 years of age) documented a modest but statistically significant 21% reduction in CYP2C9 activity when pretreated with 2 weeks of R. rosea (equivalent to 290 mg/day R. rosea extract or 1,000 mg/day dried R. rosea). Clinical significance is unknown but may become clinically relevant when administering agents with a narrow therapeutic index, such as warfarin or phenytoin. No significant effects were observed on CYP1A2, CYP2C19, CYP2D6, or CYP3A4. Poor metabolizers with genotypes CYP2D6 *4/*4 and CYP2C9 *2/*2 were excluded from the study.68
R. rosea has a very low level of toxicity in rats. The median lethal dose was calculated to be approximately 3.4 g/kg (equal to 235 g in a 70 kg person).67 R. rosea was reported to be safe in toxicity studies.13
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