Policosanol

Overview

Policosanol is a natural mixture of higher aliphatic primary alcohols isolated from sugar cane wax with other sources obtaining policosanol from the wax of honeybees. Pioneering research in Cuba indicates that policosanol is a natural agent that lowers elevated cholesterol levels without side effects, and it also apparently acts as a mild blood thinner. The cholesterol-lowering effects have been demonstrated in experimental models and in patients with type II hyperlipoproteinemia. (1) , (2) , (3) , (4) A new proprietary product has been developed that is made from beeswax, and is reported to be a more stable form than other products.

Dosage Info

Dosage Range

5-20mg daily.

Most Common Dosage

5mg, 2 times a day.

Dosage Forms

Tablets and capsules.

Adult RDI

None established

Adult ODA

None established

Active Forms

Aliphatic primary alcohols, including 1-tetracosanol, 1-hexacosanol, 1-heptacosanol, 1-octacosanol, 1-nonacosanol, 1-triacontanol, 1-dotriacontanol and 1-tetratriacontanol. (5) , (6)

Absorption

Not available.

Toxicities & Precautions

General

Policosanol is reported safe in recommended dosages. (7) , (8)

Functions in the Body

Cholesterol Levels

Numerous studies have demonstrated decreased total and LDL cholesterol levels and increased HDL levels. (9) , (10) , (11) , (12) , (13) , (14) A long term study was done to determine efficacy and tolerability of policosanol. The results were that policosanol had long-term effectiveness in lowering LDL levels and raising HDL levels, and was also safe and well tolerated in patients with Type 2 diabetes. (15) It is believed that these beneficial effects are due to inhibition of hepatic cholesterol synthesis at a point prior to generation of mevalonate. Policosanol has also demonstrated some down regulation of HMG-CoA reductase, but not inhibition of the enzyme like the "statin" medications. (16) , (17)

Platelet Aggregation

Policosanol has been reported to decrease platelet aggregation in human subjects in a dose-dependent manner. (18) , (19) However, it does not seem to alter coagulation times. A study reported that policosanol administered with warfarin did not significantly alter the kinetics of the anticoagulant medication. (20) A randomized, double-blind, placebo-controlled evaluation compared policosanol with aspirin in inhibiting platelet aggregation. It demonstrated similar results for aspirin and for policosanol and even a possible advantage for combined therapy. (21)

Acetylcholine (ACh) Release

An animal study demonstrated that policosanol may interact with the modulation of the acetylcholine (ACh) release at the neuromuscular junction, causing an increase in the release of ACh. (22)

Clinical Applications

Intermittent Claudication

The results of two double-blind, placebo-controlled trials indicate that policosanol is an effective treatment for individuals with intermittent claudication. In one study, patients taking 10 mg of policosanol twice daily for 6 months increased treadmill walking distance before the onset of pain from 132.5 meters (baseline) to 205.7 meters after therapy. These patients also increased their maximum walking distance from 229.5 meters to 365.4 meters, while placebo controls did not register any gains. (23) A 2-year trial produced similar results, except that taking policosanol for longer periods of time resulted in greater improvements. Final values at the end of two years were as follows: initial claudication distance increased from 125.9 to 333.5 meters and maximum claudication distance increased from 219.5 to 648.9 meters. (24) Another study, also, had similar results and policosanol was found to be well tolerated and did not impair safety indicators. (25)

Elevated Cholesterol

Numerous studies report that policosanol is a product that can effectively correct abnormal cholesterol levels. (26) , (27) These studies routinely report reductions in LDL-cholesterol and total cholesterol, while producing increases in HDL-cholesterol. For example, in one study, patients with type II hypercholesterolemia who took 10 mg of policosanol daily exhibited 24.4% reductions in LDL-cholesterol, 16.2% reduction in total cholesterol, and 29.1% increase in the “good" HDL-cholesterol. (28) In a direct comparison with “statin" drugs, policosanol performed better than both lovastatin and simvastatin. Policosanol at 10 mg/day resulted in a 24% reduction in LDL, whereas lovastatin at 20 mg/day reduced LDL-cholesterol 22%, and simvastatin at 10 mg/day reduced LDL-cholesterol 15%. In this same study, policosanol caused a significant increase in patients’ HDL-cholesterol, while HDL-cholesterol levels did not change in the patients taking the “statin" drugs. (29)

Symptoms and Causes of Deficiency

Policosanol is not made in the human body and there is no deficiency condition associated with a lack of this substance in the diet.

Dietary Sources

Though isolated from sugar cane wax and the wax of honeybees, policosanol does not occur to any appreciable degree in the diet.

References

  1. View Abstract: Menendez R, et al. Oral administration of policosanol inhibits in vitro copper ion-induced rat lipoprotein peroxidation. Physiol Behav. Aug1999;67(1):1-7.
  2. View Abstract: Alcocer L, et al. A comparative study of policosanol Versus acipimox in patients with type II hypercholesterolemia. Int J Tissue React. 1999;21(3):85-92.
  3. View Abstract: Batista J, et al. Effect of policosanol on hyperlipidemia and coronary heart disease in middle-aged patients. A 14-month pilot study. Int J Clin Pharmacol Ther. Mar1996;34(3):134-7.
  4. View Abstract: Canetti M, et al. A two-year study on the efficacy and tolerability of policosanol in patients with type II hyperlipoproteinaemia. Int J Clin Pharmacol Res. 1995;15(4):159-65.
  5. View Abstract: Gonzalez Canavaciolo VL, et al. Validation of a gas chromatographic method for determining fatty alcohols that compose policosanol in five-milligram film-coated tablets. J AOAC Int. Jul1999;82(4):834-9.
  6. View Abstract: Cabrera L, Uribarri E, Laguna A, Sierra R, Mederos D, Gonzalez M, et al. Study of the interaction between policosanol and excipients. Boll Chim Farm. Mar 2002;141(2):138-42.
  7. View Abstract: Aleman CL, et al. Carcinogenicity of policosanol in mice: an 18-month study. Food Chem Toxicol. Jul1995;33(7):573-8.
  8. View Abstract: Mesa AR, et al. Toxicity of policosanol in beagle dogs: one-year study. Toxicol Lett. Aug1994;73(2):81-90.
  9. View Abstract: Prat H, et al. Comparative effects of policosanol and two HMG-CoA reductase inhibitors on type II hypercholesterolemia. Rev Med Chil. Mar1999;127(3):286-94.
  10. View Abstract: Mas R, et al. Effects of policosanol in patients with type II hypercholesterolemia and additional coronary risk factors. Clin Pharmacol Ther. Apr1999;65(4):439-47.
  11. View Abstract: Torres O, et al. Treatment of hypercholesterolemia in NIDDM with policosanol. Diabetes Care. Mar1995;18(3):393-7.
  12. View Abstract: Castano G, Mas R, Fernandez L, et al. Effects of policosanol on postmenopausal women with type II hypercholesterolemia. Gynecol Endocrinol. Jun2000;14(3):187-95.
  13. View Abstract: Pons P, Rodriguez M, Robaina C, et al. Effects of successive dose increases of policosanol on the lipid profile of patients with type II hypercholesterolaemia and tolerability to treatment. Int J Clin Pharmacol Res. 1994;14(1):27-33.
  14. View Abstract: Castano G, Mas R, Fernandez JC, et al. Effects of policosanol in older patients with type II hypercholesterolemia and high coronary risk. J Gerontol A Biol Sci Med Sci. Mar 2001;56(3):M186-92.
  15. View Abstract: Mas R, Castano G, Fernandez J, et al. Long- term effects of policosanol on older patients with Type 2 diabetes. Asia Pac J Clin Nutr. 2004;13(Suppl):S101.
  16. View Abstract: McCarty M. Policosanol safely down-regulates HMG-CoA reductase - potential as a component of the Esselstyn regimen. Med Hypotheses. Sep 2002;59(3):268.
  17. View Abstract: Gouni-Berthold I, Berthold HK. Policosanol: clinical pharmacology and therapeutic significance of a new lipid-lowering agent. Am Heart J. Feb 2002;143(2):356-65.
  18. View Abstract: Carbajal D, et al. Effect of policosanol on platelet aggregation and serum levels of arachidonic acid metabolites in healthy volunteers. Prostaglandins Leukot Essent Fatty Acids. Jan1998;58(1):61-4.
  19. View Abstract: Arruzazabala ML, et al. Effect of policosanol successive dose increases on platelet aggregation in healthy volunteers. Pharmacol Res. Nov1996;34(5-6):181-5.
  20. View Abstract: Carbajal D, et al. Interaction policosanol-warfarin on bleeding time and thrombosis in rats. Pharmacol Res. Aug1998;38(2):89-91.
  21. View Abstract: Arruzazabala ML, et al. Comparative study of policosanol, aspirin and the combination therapy policosanol-aspirin on platelet aggregation in healthy volunteers. Pharmacol Res. Oct1997;36(4):293-7.
  22. View Abstract: Re L, et al. Effects of some natural extracts on the acetylcholine release at the mouse neuromuscular junction. Pharmacol Res. Mar1999;39(3)239-45.
  23. View Abstract: Castano G, et al. A double-blind, placebo-controlled study of the effects of policosanol in patients with intermittent claudication. Angiology. Feb1999;50(2):123-30.
  24. View Abstract: Castano G, Mas Ferreiro R, Fernandez L, et al. A long-term study of policosanol in the treatment of intermittent claudication. Angiology. Feb2001;52(2):115-25.
  25. View Abstract: Castano G, Mas R, Gamez R, Fernandez L, Illnait J. Effects of policosanol and ticlopidine in patients with intermittent claudication: a double-blinded pilot comparative study. Angiology. Jul2004;55(4):361-71.
  26. View Abstract: Castano G, Mas R, Fernandez L, et al. Effects of policosanol on postmenopausal women with type II hypercholesterolemia. Gynecol Endocrinol. Jun2000;14(3):187-95.
  27. View Abstract: Pons P, Rodriguez M, Robaina C, et al. Effects of successive dose increases of policosanol on the lipid profile of patients with type II hypercholesterolaemia and tolerability to treatment. Int J Clin Pharmacol Res. 1994;14(1):27-33.
  28. View Abstract: Castano G, Mas R, Fernandez JC, et al. Effects of policosanol in older patients with type II hypercholesterolemia and high coronary risk. J Gerontol A Biol Sci Med Sci. Mar 2001;56(3):M186-92.
  29. View Abstract: Prat H, et al. Comparative effects of policosanol and two HMG-CoA reductase inhibitors on type II hypercholesterolemia. Rev Med Chil. Mar1999;127(3):286-94.