Cinchona sp.

 

Cinchona sp.

Synonyms

No documentation.

Vernacular Name

Quinine bark, China bark, cinchona bark, yellow cinchona, red cinchona, Peruvian bark, Jesuit's bark, fever tree

Description

Cinchona sp. species are identified as small evergreen trees or shrubs with a course, rough bark with a thin-walled cork.  The leaves are smooth on the surface and oval in shape.  The plant produces small fragrant flowers. 

Origin / Habitat

Cinchona sp. tree is native to South America, most commonly found in Ecuador, but also found in Bolivia, Costa Rica, Peru and Venezuela.  It is now cultivated throughout Southeast Asia. The tree can grow in several types of terrain but requires very nutrient-rich soil in order to thrive.  The roots of this plant need to be exposed to the air so rocky areas are well suited for the growth of this plant.

Chemical Constituents

Cinchona sp. contains alkaloids, mainly quinine but also including quinidine cinchonine, tannins, bitter triterpenic glycosides (quinovin), and quinic acid [1].Typical Cinchona sp. contains about 16% of quinoline alkaloids consisting mainly of quinine, quinidine, cinchonine, and cinchonidine [2].

Plant Part Used

Bark, wood, stems [3].

Traditional Use

The name ‘Peruvian bark’ refers to several species that cross-breed creating hybrids that are difficult to specifically classify.  The plant has great importance in that some of the alkaloids have been invaluable in creating medicines.  Quinine used for treating malaria is an example of this.  After its discovery in the early 1600’s, it became a registered product in the British Pharmacopoeia for use in treating malaria. Cinchona sp. has also been used to treat fevers, cancer, mouth and throat diseases, indigestion, anemia and in some areas to treat parasites [3] [4].

Pharmacology

Pre-clinical

Cinchona sp. contains the alkaloid quinine, which has been used as an antimalarial drug and has been used clinically in malaria caused by Plasmodium falciparum [5]. Quinine is also antispasmodic and used for leg cramps and as a bitter agent in tonic waters and beverages. The alkaloids quinine and quinidine also exert antiarrhythmic effects on cardiovascular system [6].

 

Clinical

Various crossover, randomised trials, and two meta-analyses have confirmed that quinine is effective in the prevention of nocturnal leg cramps, with the mechanism including neuro-muscular junction blocking activity [7].

Interaction and Depletions

Interaction with other Herbs

No documentation.

Interaction with Drugs

Isolated constituents from Cinchona sp are reported in laboratory studies to have platelet aggregation inhibiting properties [10]. Use with caution in those individuals with bleeding disorders or on anticoagulant medications.

Quinine can interact with many drugs including but not limited to blood-thinners, muscle relaxers, heart medications, seizure medications and antivirals.  Do not use Cinchona sp.  if taking any prescription medication.

Precautions and Contraindications

Side effects

Cinchona sp. has been used in traditional medicines and reported safe in recommended doses. However, isolated constituents found in Cinchona sp., including quinine and quinidine, have reported side effects, contraindications and drug interaction potentials.

 

Discontinue if allergy occurs.

Quinine use can lead to cinchonism, a cluster of symptoms including headache, visual disturbances, nausea/vomiting, increased sweating, tinnitus, and more severe symptoms including diarrhea, abdominal pain, anemia, disturbances in cardiac rhythm and blindness [11]. A lethal dose of quinine has not been clearly defined, but fatalities have been reported after the ingestion of 2 to 8 gm in adults [12].

Quinidine is reported to delay ventricular depolarization slightly (class 1c effect), resulting in widening of the QRS complex and leading to orthostatic hypotension [13].

 

Pregnancy

Quinine, the major alkaloid in Cinchona sp , has been reported to have abortifacient effects in laboratory studies [8] [9]. Do not use Cinchona sp during pregnancy.

Age limitation

No documentation.

Adverse reaction

No documentation.

Read More

  1) Western Herb

References

  1. Karle JM, Karle IL, Gerena L, Milhous WK. Stereochemical evaluation of the relative activities of the cinchona alkaloids against Plasmodium falciparum. Antimicrob Agents Chemother. Jul1992;36(7):1538-1544.
  2. Robins RJ, Webb AJ, Rhodes MJ, Payne J, Morgan MR. Radioimmunoassay for the quantitative determination of quinine in cultured plant tissues. Planta Med. Jun1984;50(3):235-238.
  3. Taylor L. The Healing Power of Rainforest Herbs:  A Guide to Understanding and Using Herbal Medicinals  New York: Square One Publishers;402.
  4. Duke JA. Medicinal Plants of Latin America. New York:Taylor and Francis;2009.212.
  5. Knauer A, Sirichaisinthop J, Reinthaler FF, et al. In-vitro response of Plasmodium falciparum to the main alkaloids of Cinchona in northwestern Thailand. Wien Klin Wochenschr. 2003;115(3):39-44.
  6. Yang F, Hanon S, Lam P, Schweitzer P. Quinidine revisited. Am J Med. 2009;122(4):317-321.
  7. Pinn G. Quinine for cramps. Aust Fam Physician. Oct1998;27(10):922-923.
  8. Barnes K, Durrheim D, Blumberg L. Quinine as unofficial contraceptive--concerns about safety and efficacy. S Afr Med J. 1998;88(10):1280-1282.
  9. Nosten F, McGready R, d'Alessandro U, Bonell A, Verhoeff F, Menendez C, Mutabingwa T, Brabin B. Antimalarial drugs in pregnancy: a review. Curr Drug Saf. Jan2006;1(1):1-15.
  10. Shah BH, Nawaz Z, Virani SS, Ali IQ, Saeed SA, Gilani AH. The inhibitory effect of cinchonine on human platelet aggregation due to blockade of calcium influx. Biochem Pharmacol. 1998 Oct 15;56(8):955-960.
  11. Bateman DN, Dyson EH. Quinine toxicity. Adverse Drug React Acute Poisoning Rev. Winter1986;5(4):215-233.
  12. Krishna S, White NJ. Pharmacokinetics of quinine, chloroquine and amodiaquine. Clinical implications. Clin Pharmacokinet.1996;30:263-269.
  13. Watt G, Na-Nakorn A, Bateman DN, et al. Amplification of quinine cardiac effects by the resistance-reversing agent prochlorperazine in falciparum malaria. Am J Trop Med Hyg. 1993;49(5):645-649.