Cinchona sp.

Cinchona sp.

Synonyms

No documentation

Vernacular Name

Cinchona , quinine bark, china bark, cinchona bark, yellow cinchona, red cinchona, peruvian bark, jesuit's bark, fever tree.

Description

The name ‘Cinchona’ refers to several species that cross-breed creating hybrids that are difficult to specifically classify. Cinchona sp. has great importance in that some of the alkaloids have been invaluable in creating medicines. Cinchona sp. used for treating malaria is an example of this. Alkaloids from this plant are also used in beverages and as general tonics.

Cinchona sp. is 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 and cinchonamine; 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

Medicinal Uses

General         

Antimalarial
Digestive tonic
Nocturnal leg cramps
Intestinal parasites
Cardiac regulation 

Most Frequently Reported Uses

Antimalarial
Digestive tonic
Nocturnal leg cramps

Other Reported Uses

Intestinal parasites
Cardiac regulation

Dosage

Dosage Range

Cinchona sp. powdered bark: Use 1.5-2.5gm in 240mL (1 cup) hot water. Steep for 5-10 minutes and drink 1-3 times daily.

The isolated alkaloid quinine has been widely studied as an antimalarial, and has been used at doses of 325mg-1gm daily as the sulfate salt. 

Most Common Dosage

2.5g powdered bark infused in hot water, twice per day.

Standardization Dosage

No documentation

Pharmacology

Pre-clinical

The alkaloids quinine and quinidine also exert antiarrhythmic effects on cardiovascular system.[3]

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.[4] Quinine is also antispasmodic and used for leg cramps and as a bitter agent in tonic waters and beverages.

Various crossover, randomized trials, and 2 meta-analyses have confirmed that quinine is effective in the prevention of nocturnal leg cramps, with the mechanism including neuro-muscular junction blocking activity.[5]

Interaction and Depletions

Interaction with other Herbs

No documentation

Interaction with Drugs

Based on pharmacology, use with caution in individuals with bleeding disorders or those taking blood-thinning medications such as aspirin or warfarin (Coumadin). 

Based on pharmacology, use with caution in individuals taking antiarrhythmic medications, such as verapamil (Calan) or disopyramide (Norpace). 

Based on case reports, quinine may increase levels of the anticonvulsant drugs Phenobarbital and carbamazepine (Tegretol). Use Cinchona sp. with caution in individuals taking anticonvulsant medications. 

Based on a case report, use of quinine in individuals taking the antiviral drug amantadine (Symmetrel) may lead to increased levels of the drug. Use with caution in those taking amantidine. 

Based on pharmacology, use with caution when using non-depolarizing muscle relaxants on patients.

Precautions and Contraindications

Side effects

Quinidine is reported to delay ventricular depolarization slightly (class 1c effect), resulting in widening of the QRS complex and leading to orthostatic hypotension.[6] Discontinue if allergy occurs.

Isolated constituents from Cinchona sp. are reported in laboratory studies to have platelet aggregation inhibiting properties.[11] Use with caution in those individuals with bleeding disorders or on anticoagulant medications.

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.

Pregnancy

Quinine, the major alkaloid in Cinchona sp., has been reported to have abortifacient effects in laboratory studies.[7],[8] Do not use Cinchona sp. during pregnancy.

Age limitation

A lethal dose of quinine has not been clearly defined, but fatalities have been reported after the ingestion of 2 to 8 grams in adults.[9].

Adverse reaction

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.[10]

Read More

  1) South Central America Herbs

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. Jul 1992;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. Jun 1984;50(3):235-238. 
  3. Yang F, Hanon S, Lam P, Schweitzer P. Quinidine revisited. Am J Med. 2009;122(4):317-321. 
  4. 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.
  5. Pinn G. Quinine for cramps. Aust Fam Physician. Oct 1998;27(10):922-923. 
  6. 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.  
  7. Barnes K, Durrheim D, Blumberg L. Quinine as unofficial contraceptive--concerns about safety and efficacy. S Afr Med J. 1998;88(10):1280-1282.  
  8. Nosten F, McGready R, d'Alessandro U, Bonell A, Verhoeff F, Menendez C, Mutabingwa T, Brabin B. Anti-malarial drugs in pregnancy: a review. Curr Drug Saf. Jan 2006;1(1):1-15.  
  9. Krishna S, White NJ. Pharmacokinetics of quinine, chloroquine and amodiaquine. Clinical implications. Clin Pharmacokinet.1996;30:263-269. 
  10. Bateman DN, Dyson EH. Quinine toxicity. Adverse Drug React Acute Poisoning Rev. Winter 1986;5(4):215-233. 
  11. 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. 15 Oct 1998;56(8):955-960.