Clinical trials supporting therapeutic claims are of limited quality and quantity. Clinical trials evaluating R. rosea for mental or physical fatigue and mild to moderate depression have reported conflicting results. Results from trials evaluating adaptogenic properties and physical endurance are equivocal.
Dosing
Clinical doses are commonly 200 to 600 mg/day. For depression, doses of 340 to 680 mg/day of R. rosea extract (as SHR-5) have been evaluated for up to 12 weeks.
Contraindications
Contraindications have not been identified.
Pregnancy/Lactation
Information regarding safety and effectiveness in pregnancy and lactation is lacking.
Interactions
See Drug Interactions section.
Adverse Reactions
Information is limited.
Toxicology
R. rosea was reported to be safe in toxicity studies.
Scientific Family
Crassulaceae (stonecrop)
Botany
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
History
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
Chemistry
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
A systematic review of randomized controlled trials of Rhodiola used alone (not as a combination product), and published in English and Chinese only, found inadequate reporting and an unclear risk of bias in most included studies.(72)
Adaptogenic effects/Performance enhancement
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)
Animal data
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 data
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 duty(17) 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. Open label studies report positive results with R. rosea supplementation in chronic fatigue and stress-related syndromes (N=100, 400 mg/day for 8 weeks(71); and N=118, 400 mg/day for 12 weeks(76)). Due to the methodology, conclusions other than apparent safety and acceptable tolerability cannot be drawn (see Depression section below).
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) rate of adenosine triphosphate turnover for R. rosea extracts,(25) or heat acclimation.(77) Small studies evaluating short-term (3 days) supplementation of R. rosea extract on performance reported equivocal results,(69, 78) while a systematic review that included 10 clinical trials reported overall positive findings on athletic performance with no clinically relevant adverse effects.(74)
Antiaging
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)
Cancer
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)
Clinical data
R. rosea extract administration improved certain parameters in superficial bladder carcinoma in a small (N = 12) study.(40)
Cardiovascular effects
Animal data
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)
A systematic review of preclinical studies reported potential mechanisms of action for R. rosea's potential role in ischemic stroke. Antioxidant and anti-inflammatory mechanisms, among other attributes, have been described.(73)
Clinical data
Clinical trials of R. rosea are lacking; however, clinical trials evaluating the related species Rhodiola wallichiana may have potential in reducing the frequency of episodes of angina due to effects on blood viscosity and other cardiovascular indices.(75)
Depression
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 serotonin(41, 42, 43) and improved cerebral circulation.(44) In an in vitro study, R. rosea root extract inhibited monoamine oxidases A and B.(45)
Clinical data
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 (see Adaptogenic section above)(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. Antidepressant effects of R. rosea as add-on therapy to sertraline was demonstrated in a clinical trial (N=100) as measured using Hamilton Depression Rating (HAM-D), Beck Depression Inventory (BDI), and Clinical Global Impression Change (CGI/C) scores. The higher dose of R. rosea (0.6 g/day) was suggested to be more effective than 0.3 g/day, although both groups showed statistically significant results over placebo at 12 weeks.(70) Earlier trials of varying methodology 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)
Other uses
Dosing
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
Interactions
A small clinical study (N=13 healthy volunteers) evaluated the effect of R. rosea on substrates of the CYP450 enzymes, reporting reduced CYP2C9 metabolic activity only. No effect on enzymes CYP1A2, CYP2C19, CYP2D6, and CYP3A4 were noted.(68)
Escitalopram: Rhodiola rosea may enhance the adverse/toxic effect of escitalopram. No action needed.(61, 62, 66, 68)
Losartan: Rhodiola rosea may increase the serum concentration of losartan. No action needed.(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
Index Terms
Rhodiola wallichiana
References
Disclaimer
This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.
This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.
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Effects of short-term golden root extract (Rhodiola rosea) supplementation on resistance exercise performance. Int J Environ Res Public Health. 2021;29;18(13):6953. doi:10.3390/ijerph1813695334209617
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