Xysmalobium undulatum (uzara) – review of an antidiarrhoeal traditional medicine

Ethnopharmacological relevanceXysmalobium undulatum, commonly known as uzara, is traditionally used as an antidiarrhoeal and to treat stomach cramps, dysmenorrhoea and afterbirth cramps. In addition, it was reportedly used to treat anxiety and other conditions relating to mental health.Aim of the reviewTo unite the botanical aspects, ethnopharmacology, phytochemistry, biological activity, pharmacokinetic and pharmacodynamic data, toxicity and commercial aspects of the scientific literature available on uzara.MethodAn extensive review of the literature covering 1917–2014 was carried out. Electronic databases including Scopus®, Pubmed®, Google Scholar® and Google® were used to assemble the data. All abstracts, full-text articles and books written in English and German were examined and included.ResultsThe phytochemistry of uzara has been comprehensively investigated and at least 18 compounds have been isolated and characterised. Uzara contains mainly cardenolide glycosides such as uzarin and xysmalorin and cardenolide aglycones such as uzarigenin and xysmalogenin. Limited scientific studies on the biological activity of uzara have been done. In vitro antisecretory antidiarrhoeal action was confirmed. Central nervous system activity was conflicting, in vitro and in vivo (animals) studies were inconclusive and no clinical studies have been performed. No antimutagenic effects have been reported and no toxicity up to date has been associated with uzara consumption. Significant cross-reactivity of uzara compounds with commercial digoxin and digitoxin assays may interfere with therapeutic drug monitoring.ConclusionsThe key traditional uses associated with uzara have been investigated in vitro and in vivo (animal), but clinical trial data is lacking.

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