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Aloe (Aloe vera)



Interactions

Aloe/Drug Interactions:
  • AntidiabeticsAntidiabetics: Concomitant use of glucose-lowering agents with oral forms of aloe may increase hypoglycemic effects. Hypoglycemic properties of aloe have been reported in two methodologically weak human trials, with purported equivalence to an oral hypoglycemic sulfonylurea agent (glibenclamide) (41; 40). Laboratory studies have documented beta-cell stimulation and subsequent drops in blood glucose in mice (75; 81). In contrast, a small randomized trial, published as a conference abstract, found no evidence of hypoglycemia in 16 type 2 diabetics given aloe juice (15mL twice daily) (48).
  • AntifungalsAntifungals: According to in vitro data, an extract of fresh Aloe vera leaves inhibited the mycelial growth of Botrytis gladiolorum, Fusarium oxysporum f.sp. gladioli, Heterosporium pruneti, and Penicillium gladioli (2).
  • Anti-inflammatoriesAnti-inflammatories: In vivo, Aloe vera gel (97.5%) significantly reduced UV-induced erythema after 48 hours, superior to 1% hydrocortisone in placebo gel. In contrast, 1% hydrocortisone in cream was more efficient than Aloe vera gel (57).
  • AntineoplasticsAntineoplastics: There is preliminary evidence from a small case-control study that aloe consumption may reduce the risk of developing lung cancer (82). Numerous laboratory studies suggest that aloe-emodin (an anthraquinone glycoside) and aloe extracts may have cytotoxic or anticancer effects (83; 84; 85; 86).
  • AntiviralsAntivirals: Acemannan, the major carbohydrate fraction in aloe gel, has been shown in vitro to possess immunostimulant and antiretroviral activities (49; 50; 51; 50; 51).
  • Cardiac glycosidesCardiac glycosides: In theory, low levels of serum potassium (due to aloe latex laxative overuse) could interfere with cardiac glycosides or other antiarrhythmic agents.
  • Cardiovascular agentsCardiovascular agents: In theory, use of oral aloe with herbs that affect heart rhythm may increase the risk of dehydration, potassium depletion, and electrolyte imbalance.
  • ContraceptivesContraceptives: Aqueous extracts of Aloe barbadensis Mill. Syn. have been investigated for their antifertility activity in animal research, but the authors did not observe any anti-implantation activity (87). In in vitro research, lyophilized Aloe barbadensis proved to be spermicidal due to the multiple microelements (boron, barium, calcium, chromium, copper, iron, potassium, magnesium, manganese, phosphorus, and zinc) that were toxic to the sperm tail, causing instant immobilization (26). Aloe's fertility effects in humans are unclear.
  • Dermatologic agentsDermatologic agents: In humans, Aloe barbadensis Miller extracts increased the water content of the stratum corneum of the arms, although transepidermal water loss was not altered (88).
  • DiureticsDiuretics: In theory, use of oral aloe with other diuretics may increase the risk of dehydration, potassium depletion, and electrolyte imbalance.
  • Gastrointestinal agentsGastrointestinal agents: According to anecdotal reports, occasional abdominal cramping and diarrhea with oral aloe use may occur.
  • Hormonal agentsHormonal agents: The methanolic extracts from Aloe species contain hydroxyanthraquinones, such as emodin, which are phytoestrogens with an affinity to human estrogen receptors (89).
  • Hydrophilic agentsHydrophilic agents: Limited evidence suggests that 0.5% extract from Aloe vera in a hydrophilic cream is an effective treatment for genital herpes and psoriasis vulgaris (53).
  • Insulin preparationsInsulin preparations: Based on the laxative properties of oral aloe latex, prolonged use may cause potassium depletion and act additively with insulin to reduce serum potassium levels. Concomitant use of insulin with oral forms of aloe may increase hypoglycemic effects, according to preliminary human data (41; 40). One animal study suggests that stimulation of beta-cells is responsible for this effect of aloe, thus the interaction might not apply to type 1 diabetics, in whom beta-cells have been destroyed.
  • LaxativesLaxatives: Theoretically, concomitant use of oral aloe latex and other laxatives may exacerbate hypokalemia, dehydration, metabolic alkalosis, or other electrolyte abnormalities.
  • Non-potassium-sparing diuretics (loop diuretics, thiazide diuretics)Non-potassium-sparing diuretics (loop diuretics, thiazide diuretics): Based on the laxative properties of oral aloe latex, prolonged use may cause potassium depletion. Hypokalemia may be exacerbated by simultaneous applications of thiazide diuretics.
  • Oral corticosteroids, oral hydrocortisoneOral corticosteroids, oral hydrocortisone: Based on the laxative properties of oral aloe latex, prolonged use may cause potassium depletion. Hypokalemia may be exacerbated by simultaneous application of steroids.
  • Radioprotective drugsRadioprotective drugs: According to laboratory evidence, aloe polysaccharides may have a radioprotective effect on nonmalignant cells via modulation of the cell cycle (90; 91).
  • SevofluraneSevoflurane: There is a poorly described single case report of excess bleeding in a surgical patient receiving the anesthetic agent sevoflurane and oral aloe (78).
  • SteroidsSteroids: In theory, use of oral aloe with steroids may increase the risk of dehydration, potassium depletion, and electrolyte imbalance.
  • SunscreenSunscreen: According to human and animal study, incorporation of sunscreen microspheres into Aloe vera gel may increase the sunscreen formulation's efficacy more than four times (92).
  • Thyroid hormonesThyroid hormones: Aloe has been linked to thyroid dysfunction, according to one case report (76).
  • Topical hydrocortisoneTopical hydrocortisone: Concomitant topical use of aloe may enhance absorption of hydrocortisone, although there is limited evidence in this area (93).
  • Zidovudine (AZT)Zidovudine (AZT): Preliminary reports suggest that AZT levels may be boosted by aloe ingestion, although data remain scant in this area (94).

Aloe/Herb/Supplement Interactions:
  • AntifungalsAntifungals: According to in vitro data, an extract of fresh Aloe vera leaves inhibited the mycelial growth of Botrytis gladiolorum, Fusarium oxysporum f.sp. gladioli, Heterosporium pruneti, and Penicillium gladioli (2).
  • Anti-inflammatoriesAnti-inflammatories: In vivo, Aloe vera gel (97.5%) significantly reduced UV-induced erythema after 48 hours, being superior to 1% hydrocortisone in placebo gel. In contrast, 1% hydrocortisone in cream was more efficient than Aloe vera gel (57).
  • AntineoplasticsAntineoplastics: There is preliminary evidence from a small case-control study that aloe consumption may reduce the risk of developing lung cancer (82). Numerous laboratory studies suggest that aloe-emodin (an anthraquinone glycoside) and aloe extracts may have cytotoxic or anticancer effects (83; 84; 85; 86).
  • AntioxidantsAntioxidants: Antioxidant properties have been attributed to aloesin derived from Aloe vera (3; 4; 5). In vitro, a polysaccharide from Aloe vera var. chinensis also showed free radical-scavenging and other antioxidant properties (95).
  • AntiviralsAntivirals: Acemannan, the major carbohydrate fraction in aloe gel, has been shown in vitro to possess immunostimulant and antiretroviral activities (49; 50; 51; 50; 51).
  • Cardiovascular agentsCardiovascular agents: In theory, use of oral aloe with herbs that affect heart rhythm may increase the risk of dehydration, potassium depletion, and electrolyte imbalance.
  • ContraceptivesContraceptives: Aqueous extracts of Aloe barbadensis Mill. have been investigated for their antifertility activity in animal research, but authors did not observe any anti-implantation activity (87). In in vitro research, lyophilized Aloe barbadensis proved to be spermicidal due to the multiple microelements (boron, barium, calcium, chromium, copper, iron, potassium, magnesium, manganese, phosphorus, and zinc) that were toxic to the sperm tail, causing instant immobilization (26). Aloe's fertility effects in humans are unclear.
  • Dermatologic agentsDermatologic agents: In humans, Aloe barbadensis Miller extracts increased the water content of the stratum corneum of the arms, although transepidermal water loss was not altered (88).
  • DiureticsDiuretics: In theory, use of oral aloe with other diuretics may increase the risk of dehydration, potassium depletion, and electrolyte imbalance.
  • Gastrointestinal agentsGastrointestinal agents: According to anecdotal reports, occasional abdominal cramping and diarrhea with oral aloe use may occur.
  • Hormonal agentsHormonal agents: The methanolic extracts from Aloe species contain hydroxyanthraquinones, such as emodin, which are phytoestrogens with an affinity for human estrogen receptors (89).
  • HypoglycemicsHypoglycemics: Concomitant use of glucose-lowering agents with oral forms of aloe may increase hypoglycemic effects, according to preliminary human data (41; 40).
  • HydrophilicsHydrophilics: Limited evidence suggests that 0.5% extract from Aloe vera in a hydrophilic cream is an effective treatment of genital herpes and psoriasis vulgaris (53). Theoretically, Aloe vera may also interact with other hydrophilic agents and change their effectiveness.
  • LaxativesLaxatives: Theoretically, concomitant use of oral aloe latex and other laxatives may exacerbate hypokalemia, dehydration, metabolic alkalosis, or other electrolyte abnormalities.
  • Licorice root (Glycyrrhiza glabra L.)Licorice root (Glycyrrhiza glabra L.): Based on the laxative properties of oral aloe latex, prolonged use may result in potassium depletion. Hypokalemia may be exacerbated by simultaneous applications of licorice root.
  • Radioprotective agentsRadioprotective agents: According to laboratory evidence, aloe polysaccharides may have a radioprotective effect on nonmalignant cells via modulation of the cell cycle (90; 91).
  • SteroidsSteroids: In theory, use of oral aloe with steroids, or phytosterols, may increase the risk of dehydration, potassium depletion, and electrolyte imbalance.
  • SunscreenSunscreen: According to human and animal research, incorporation of sunscreen microspheres into Aloe vera gel may increase the sunscreen formulation's efficacy more than four times (92).
  • Thyroid agentsThyroid agents: Aloe has been linked to thyroid dysfunction, based on one case report (76).
  • Vitamins (C, E)Vitamins (C, E): Aloe may slow the absorption of vitamins C and E (96).

Aloe/Food Interactions:
  • AbsorptionAbsorption: The high mucilage content in aloe taken orally may interfere with absorption of foods and orally administered drugs. Malabsorption may occur after prolonged oral use of aloe.

Aloe/Lab Interactions:
  • Serum glucose levelsSerum glucose levels: Preliminary evidence from two poorly conducted human trials and animal data suggest that oral forms of aloe may lower blood sugar (41; 40; 75).
  • Serum potassium levelsSerum potassium levels: Based on the laxative properties of oral aloe latex, prolonged use may cause potassium depletion, metabolic alkalosis, and dehydration.
  • Thyroid panelThyroid panel: Aloe has been linked to thyroid dysfunction, according to one case report (76).
  • Zidovudine levelsZidovudine levels: Preliminary reports suggest that AZT levels may be boosted by aloe ingestion, although data remain scant in this area (94).

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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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