Black Catechu Drug Information - Precautions to be kept in mind while using Black Catechu

Taxonomic Class

Fabaceae

Common Trade Names

Multi-ingredient preparations: Diarcalm, Elixir Bonjean, Enterodyne, Hemo eleen, Katha, Shanti Bori (used in rural Bangladesh as a component of oral contraceptives), Spanish Tummy Mixture (may contain pale catechu or black catechu as replacement product)

Common Forms

Available as a dry powder, in a dried extract or liquid for oral use (0.3 to 2 g), as a local injection for hemorrhoids, and as a tincture.

Source

The crude drug is prepared as a dried extract from the heartwood of Acacia catechu, a leguminous tree that is native to Burma and eastern India and naturalized in Jamaica. The extract is prepared by boiling heartwood pieces in water, evaporating this mixture to a syrup, and then cooling to molds. The dried molds are then broken into pieces.

Chemical Components

A. catechu contains 20% to 35% catechutannic acid, 2% to 10% acacatechin, catechu-red (a flavonoid), quercetin, and gum.

Actions

No pharmacokinetic studies are known. Most animal studies, both in vivo and in vitro, suggest possible physiologic activities, but these activities are poorly described. Studies have suggested that the herb exerts hypoglycemic effects and hypotensive effects and may have antileukemic and contraceptive activity .

Reported Uses

A. catechu is claimed to be useful as a topical agent for sore gums and mouth ulcers. It is a powerful astringent and indicated in numerous countries (not including the United States) for treating diarrhea and other GI problems. This agent has been commonly used in India as an ointment for indolent ulcers and has been used in rural Bangladesh as a component of an antifertility pill . Other claims include arresting nosebleeds, assisting healing in nipple fissures, and acting as a contraceptive. In the late 1800s, chronic gonorrhea was treated with an infusion of catechu.

Dosage

Dried extract can be given in doses of 0.3 to 2 g P.O. or by infusion (tea). The tincture is given in doses of 2.5 to 5 ml of a 1:5 dilution in 45% alcohoL

Adverse Reactions

• CV: hypotension.

• GI: constipation.

Interactions

• Anticholinergics, opioid analgesics: Increases risk of constipation. Avoid administration with black catechu.

• Antihypertensives: Increases risk of hypotension. Avoid administration with black catechu.

• Captopril: Additive hypotensive effect of catechu . Avoid administration with black catechu.

• Immunosuppressants: Increases risk of fungal infection. Avoid administration with black catechu.

• Iron-containing products: May bind iron products and gelatin, creating an insoluble complex. Do not administer together.

Contraindications And Precautions

Avoid using black catechu in pregnant or breast-feeding patients. Products of the catechu family are contraindicated in patients undergoing immunosuppressive therapy. This herb is also known as a dietary carcinogen.

Special considerations

• Long-term effects of chronic use of black catechu are unknown.

• Alert Inform the patient that unstandardized products may contain high amounts of inactive ash and fungal contaminants such as aflatoxin, a toxic metabolite of Aspergillus that is associated with certain cancers.

• Monitor blood pressure.

• Black catechu is incompatible with iron or zinc sulfate preparations.

• Caution the patient taking anticholinergics, opioid analgesics, or other drugs known to cause significant constipation about the additive effects with catechu.

• Caution the patient about the risk of hypoglycemia, especially if he has diabetes.

• Inform the patient that catechu is not a clinically proven antifertility drug and thus should not replace conventional oral contraceptive therapy.

• Advise women to avoid using black catechu during pregnancy or when breast-feeding.

• Points of Interest

• Although A. catechu and pale catechu have the name catechu in common, pale catechu is a different plant-Uncaria gambir, a member of the Rubiaceae family-and used primarily in the dye industry and as a veterinary astringent.

Commentary

Black catechu products were popular both in the United States and abroad during the mid-1800s and early 1900s. The drug is used as an antidiarrheal and antifertility drug in some parts of the world. Human clinical trials are lacking, and few animal studies have been conducted. Clinical efficacy in chronic diarrhea has not been proved. Acute and chronic toxic effects are also unknown. Although this agent has been used in women with cracked nipples, it is unknown whether these patients were breast-feeding at the time. Although pharmacologically interesting, black catechu cannot be recommended for any ailment until more is known about its risks and benefits.