Eurycoma Longifolia

Scientific Name(s): Eurycoma longifolia Jack
Common Name(s): Cay Ba Binh, Eurycoma, Malaysian ginseng, Pasak bumi, Tongkat Ali

Medically reviewed by Drugs.com. Last updated on Jul 22, 2024.

Clinical Overview

Use

Animal and in vitro trials have evaluated E. longifolia for its antimalarial, anxiolytic, and antihyperglycemic activity; however, clinical evidence is lacking to support these uses. Limited clinical trial data suggest potential benefit for erectile dysfunction, but trials were of poor quality.

Dosing

Dosing recommendations are largely based on historical practice or manufacturer recommendations, as clinical studies are lacking.

Doses ranging from 100 to 800 mg daily have been reported.

Contraindications

Contraindications have not been clearly defined. Extracts of E. longifolia should not be used in patients with prostate cancer.

Pregnancy/Lactation

Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Limited information is available.

Toxicology

No data.

Scientific Family

• Simaroubaceae

Botany

The Simaroubaceae family consists of 30 genera and 200 species. E. longifolia is a tall, slender, shrubby tree that grows in sandy soil. The plant is indigenous to Southeast Asia countries, including Myanmar, Thailand, Laos, Cambodia, and Malaysia.Bhat 2010, Rehman 2016, Ulbricht 2013

History

A decoction of the roots, root bark, or bark of E. longifolia has been consumed orally to treat many conditions, including diarrhea, fever, glandular swelling, bleeding, edema, persistent cough, hypertension, bone pain, and tertian malaria. The bark has also been used topically to treat wounds, ulcers, syphilitic sores, and headache. The plant has traditionally been used as an aphrodisiac, with recent increases in demand for E. longifolia products due to its aphrodisiac properties.Bhat 2010, Rehman 2016, Ulbricht 2013

Chemistry

Numerous reviews and studies of the phytochemical components of E. longifolia have been conducted.Bhat 2010, Rehman 2016, Ulbricht 2013 The plant's pharmacological activity is attributed to various quassinoids and quassinoid diterpenoids, squalene derivatives, biphenylneolignans, tirucallane-type triterpenes, canthine-6-1, and beta-carboline alkaloids.Chan 1992, Le-Van-Thoi 1970 Other identified constituents include eurycomaoside,eurycolactone, laurycolactone, and eurycomalactone.

Quassinoids, including eurycomanol, eurycomanol-2-O-beta-D-glycopyranoside, 13beta,18-dihydroeurycomanol, 14,15p-dihydroxyklaineanone, and 6-alpha-hydroxyeurycomalactone, have been isolated from the roots. Pasakbumins A-D (also known as eurycomanones) have also been isolated.Chan 1992, Chan 1989, Chan 1991, Darise 1982, Tada 1991

Squalene derivatives include eurylene, 14-deacetyl eurylene, longilene peroxide, and teurilene.Itokawa 1991, Morita 1993

Biphenylneolignans include the following: 2 isomeric 2,2-dimethoxy-4-(3-hydroxy-1-propenyl)-4-(1,2,3-trihydroxypropyl) diphenyl ethers and 2 biphenyls, 2-hydroxy-3,2,6-trimethoxy-4-(2,3-epoxy-1-hydroxypropyl)-5-(3-hydroxy-1-propenyl)-biphenyl, and 2-hydroxy-3,2-dimethoxy-4-(2,3-epoxy-1-hydroxypropyl)-5-(3-hydroxy-1-propenyl)-biphenyl.Morita 1992

Alkaloids include 9,10-dimethoxycanthin-6-one, 10-hydroxy-9-methoxycanthin-6-one, 11-hydroxy-10-methoxycanthin-6-one, 5,9-dimethoxycanthin-6-one, and 9-methoxy-3-methylcanthin-5,6-dione.Choo 2002, Mitsunaga 1994

Uses and Pharmacology

Antihyperglycemic activity

Animal data

Blood glucose levels decreased in streptozotocin-induced hyperglycemic adult rats after treatment with aqueous extracts of E. longifolia 150 mg/kg body weight. Blood glucose levels decreased 38% (P<0.05) and 47% (P<0.001) with 2 different extracts.Husen 2004

Antimalarial activity

Animal and in vitro data

In one study, eurycomalactone, at a concentration of 2.5 mg/kg, exhibited antimalarial activity and prolonged survival time in mice infected with Plasmodium berghei. However, this concentration also caused early death in some of the infected mice. Additional experiments using a 34% alcoholic extract, water extract, n-hexane fraction, chloroform fraction, and 95% ethanolic fraction were also toxic to the test animals.16 In vitro, antimalarial activity against P. berghei was observed at an inhibitory concentration of 4.5 × 10⁷ g/mL.Bhat 2010, Rehman 2016, Satayavivad 1998, Ulbricht 2013

Antiulcer activity

In vitro data

In a bioassay study, 2 quassinoids, pasakbumin A (also known as eurycomanone) and pasakbumin B, exhibited antiulcer activity.Tada 1991

Anxiolytic activity

Animal data

The anti-anxiety effects of various fractions of E. longifolia were investigated in mice using various behavioral tests, including the open-field (emotional state), elevated plus-maze (anxiolytic and anxiogenic drug effects), and fighting tests. The plant's anxiolytic effect was similar to the diazepam positive control.Ang 1999, Sarris 2013

Clinical data

A study in adults (N=63) with moderate stress reported improvements in stress hormone profiles and some mood indices with administration of an E. longifolia hot water extract over 4 weeks.Rehman 2016

Epstein-Barr virus

In vitro data

The quassinoid 14,15beta-dihydroxyklaineanone inhibited tumor promoter–induced Epstein-Barr virus activation at an in vitro 50% inhibitory concentration (IC₅₀) of 5 mcM.Jiwajinda 2002

Immunomodulatory effects

Clinical data

In a clinical study of middle-aged Japanese subjects (N=84), an immunomodulating effect was reported (ie, increased total T cells, CD4+ T cells, and naive T cell numbers) following administration of an E. longifolia 200 mg preparation taken daily for 4 weeks.George 2016

Testosterone deficiency/Androgen-deficient osteoporosis

Reviews have reported improvements in androgen-related osteoporosis and ergogenic/muscle mass with E. longifolia, possibly related to increased testosterone levels and antioxidant effects associated with its use.George 2014, Rehman 2016, Ulbricht 2013

In vitro data

In osteoblast cell lines, treatment with E. longifolia aqueous root extracts demonstrated greater cell proliferation and calcium deposition than testosterone-treated cells.Thu 2017

Testosterone deficiency/Sexual performance

Animal data

In a study evaluating the effects of E. longifolia extract on the initiation of sexual performance in rats, doses of 200, 400, and 800 mg/kg body weight were administered orally twice daily for 10 days and continued throughout the 1-month testing period. Testosterone 15 mg/kg was used as a positive control. E. longifolia promoted the growth of both ventral prostate and seminal vesicles compared with control, but was associated with lower sexual performance than the testosterone-treated group.Ang 2000 Other studies have demonstrated similar results.Ang 2001, Ang 2003

Clinical data

A systematic review of randomized controlled trials (published through October 2014) investigating the use of E. longifolia extract (tongkat ali) compared with placebo for improvement in erectile dysfunction identified 2 trials (N=139) that met inclusion criteria. One trial used a combination product of E. longifolia 200 mg plus Polygonium minus 100 mg, whereas the second trial used E. longifolia as a single constituent at 300 mg/day (two 75 mg capsules twice daily); both were 12-week trials. The trials were prone to a high risk of bias, did not specify that a diagnosis of erectile dysfunction was needed, and had differences in baseline erectile dysfunction index scores. At week 12, pooled weighted mean difference in change of erectile function index score was 0.91 (95% confidence interval [CI], –1.5 to 3.33; P=0.002), with high heterogeneity (I²=89.5%); subgroup analysis revealed the improvement was specific to subjects with a lower baseline index score (ie, at or below 15.77 in the study using the combination product) and did not apply to those with a higher baseline index score (ie, 21.3 or above in the E. longifolia monotherapy study). No significant differences were observed between treatment and placebo groups.George 2014, Kotirum 2015, Malviya 2011

Dosing

Dosing recommendations are largely based on historical practice or manufacturer recommendations, as clinical studies are lacking.

Doses ranging from 100 to 800 mg daily have been reported.Ulbricht 2013

Male infertility

200 mg of a water-soluble extract of E. longifolia root taken twice daily for up to 3 months has been suggested.Rehman 2016

Pregnancy / Lactation

Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking. Antiestrogenic effects have been demonstrated in rodents.Rehman 2016

Interactions

Propranolol: Eurycoma longifolia may decrease the serum concentration of propranolol. No action needed.(Salman 2010)

Adverse Reactions

Limited information is available. Extracts of E. longifolia should not be used in prostate cancer due to observed increased levels of testosterone in rodent studies.Rehman 2016

Data collected between 2004 and 2013 from 8 US centers in the Drug-induced Liver Injury Network revealed that 15.5% (130) of hepatotoxicity cases were caused by herbals and dietary supplements, whereas 85% (709) of cases were related to prescription medications. Of the 130 cases of liver injury related to supplements, 65% were from non-bodybuilding supplements and occurred most often in Hispanics/Latinos compared with non-Hispanic whites and non-Hispanic blacks. Liver transplant was also more frequent with toxicity from non-bodybuilding supplements (13%) than with conventional medications (3%) (P<0.001). Overall, the proportion of severe liver injury cases was significantly higher for supplements than for conventional medications (P=0.02). Of the 217 supplement products implicated in liver injury, 175 had identifiable ingredients, of which E. longifolia was among the 32 (18%) single-ingredient products.Navarro 2014

Toxicology

Limited clinical information is available regarding toxicity of E. longifolia. E. longifolia is not considered to be generally recognized as safe (GRAS) by the US Food and Drug Administration.Ulbricht 2013

In one study, the median lethal dose for an oral E. longifolia alcoholic extract in mice was determined to be 2.6 g/kg; symptoms of acute toxicity included depression, shallow respiration, and convulsion. In this study, 95% of mice died at a dose of 0.43 g/kg, and increased weight of the liver, kidneys, spleen, and testes was observed.Satayavivad 1998

One product, M-Tongkat Ali, harvested and prepared in Malaysia, was found to have higher than normal traces of lead (10.64 ± 0.37 ppm).Ang 2003

References

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