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Noni (Morinda citrifolia)
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Noni/Drug Interactions:- GeneralGeneral: Based on animal studies, noni may decrease gastric transit time (12). There lies the potential for an interaction with oral agents, although clinical significance is unclear.
- ACE inhibitorsACE inhibitors: Noni contains 56mEq/L of potassium (2; 3). ACE inhibitors may also increase potassium. Theoretically, concomitant use of noni and ACE inhibitors may increase the risk of hyperkalemia.
- AnalgesicsAnalgesics: Based on animal study, Morinda citrifolia and Tahitian Noni® juice may have dose-related, central analgesic effects (20), which are 75% as strong as morphine, yet non-addictive and side effect-free (32).
- Angiotensin II receptor antagonist (A2R blockers)Angiotensin II receptor antagonist (A2R blockers): Noni contains 56mEq/L of potassium (2; 3). Angiotensin receptor blockers may also increase potassium. Theoretically, concomitant use of noni and angiotensin receptor blockers may increase the risk of hyperkalemia
- AnthelminthicsAnthelminthics: A proposed mechanism of action for noni's antihelminthic effects is the ability of the ethanol extract to induce paralysis and death of parasites, as was observed with the human parasitic nematode worm Ascaris lumbricoides within 24 hours (33). There lies the potential for an interaction with antihelminthic agents, although clinical significance is unclear.
- Antiangiogenic drugsAntiangiogenic drugs: Based on laboratory studies, noni may have antiangiogenic properties (34).
- AntibioticsAntibiotics: Based on laboratory and in vitro evidence, specific compounds from various parts of the noni plant may have antibacterial effects (35; 36; 37; 38; 39; 40).
- AnticoagulantsAnticoagulants: Coumadin resistance was reported in a 41 year-old female consuming noni juice concomitantly with warfarin (19). The patient presented with decreased INRs. She was taking 7mg of warfarin on Monday and Wednesday and 6mg on other days, while also consuming one to two small glasses of a noni juice called "Noni Juice 4 Everything." This product contained more than 115 components, one of which was vitamin K.
- Antidiabetic agentsAntidiabetic agents: Some noni juice products contain high amounts of sugar, which may raise blood sugar. Theoretically, these juice products may interfere with agents used to control blood sugar.
- AntihypertensivesAntihypertensives: Based on animal studies, the total extract of the noni roots and various noni root extracts may have a hypotensive effect (13; 14; 15; 16; 17; 18).
- Anti inflammatory agentsAnti inflammatory agents: In various animal and in vitro studies, noni has shown anti-inflammatory properties (41; 42; 43; 44).
- Antilipemic agentsAntilipemic agents: A proposed mechanism of action for noni's antiatherosclerotic effects is the ability of the MeOH extract and CHCl3-, EtOAc-, n-BuOH-, and H2O-soluble phases derived from the fruits of Morinda citrifolia to inhibit copper-induced LDL oxidation (45). There lies the potential for an interaction with antiatherosclerotic agents, although clinical significance is unclear.
- Antineoplastic agentsAntineoplastic agents: Various extracts and constituents from all parts of the noni plant have been tested for their effect on animal cancer models and cell lines. In several studies, the noni extract suppressed tumor growth through activation of the host immune system (46; 47; 48; 49; 50), which is supported by another noni study showing general immunostimulation effects (20). Noni has also shown general cytotoxicity effects (51), which may be dose-dependent (20). However, these effects are not universal across all cancer lines (51). Noni extracts have exhibited specific inhibitory effects on Ras oncogene function (52), cell transformation induced by 12-O-tetradecanoylphorbol-13-acetate (TPA) or epidermal growth factor (EGF) (53; 54), the tumor-promoting effect of tumor necrosis factor-a (TNF-a) (55), and activator protein-1 transactivation (56). When administered before the induction of a cancer, noni extract has shown preventative effects (43; 57; 58; 59). Specifically, the anthraquinone 2-methoxy-1,3,6-trihydroxyanthraquinone may be a potent quinine reducatase inducer that is nearly 40 times more potent than the positive control l-sulforaphane (5). On a side note, the pasteurization of noni juice seems to have no effect on its chemistry and performance in NF-kappa B activity (60). There lies the potential for an interaction with antineoplastic agents, although clinical significance is unclear.
- AntiviralsAntivirals: A proposed mechanism of action for noni's antiviral effects is the ability of one specific compound isolated from noni roots, 1-methoxy2-formyl-3-hydroxy anthraquinone, to suppress cytopathic effect of HIV-infected MT-4 cells in vitro, without inhibiting cell growth (61); however, other studies have shown no effect (62). There lies the potential for an interaction with antivirals, although clinical significance is unclear.
- Diuretics, potassium sparingDiuretics, potassium sparing: Noni contains 56mEq/L of potassium (2; 3). Potassium-sparing diuretics may also increase potassium. Theoretically, concomitant use of noni and potassium-sparing diuretics may increase the risk of hyperkalemia
- Gastrointestinal agentsGastrointestinal agents: A proposed mechanism of action for noni's gastrointestinal effects is inhibition of gastric emptying via a mechanism involving stimulation of cholecystokinin secretion and cholecystokinin 1 receptor activation (12). There lies the potential for an interaction with gastrointestinal agents, although clinical significance is unclear.
- Hepatotoxic agentsHepatotoxic agents: Based on case reports and the hepatotoxic anthraquinones in noni fruit, noni may be hepatotoxic (6; 4; 5; 11) (7; 8). There lies the potential for an interaction with hepatotoxic agents, although clinical significance is unclear.
- ImmunosuppressantsImmunosuppressants: Based on animal studies, noni may stimulate the immune system (20). There lies the potential for an interaction with immunosuppressive agents, although clinical significance is unclear.
- Metabolic enzymesMetabolic enzymes: Noni fruit contains a natural precursor for xeronine, called proxeronine, which is hypothetically converted in the body to the alkaloid xeronine. It has been hypothesized that xeronine is able to modify the molecular structure of proteins and is a critical normal metabolic co-regulator (63; 64). There lies the potential for an interaction with metabolic agents, although clinical significance is unclear.
- Potassium saltsPotassium salts: Noni contains 56mEq/L of potassium (2; 3).
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Noni/Herb/Supplement Interactions:- GeneralGeneral: Based on animal studies, noni may decrease gastric transit time (12).
- Antiangiogenic herbsAntiangiogenic herbs: Based on laboratory studies, noni may have antiangiogenic properties (34). There lies the potential for an interaction with angiogenic/antiangiogenic herbs, although clinical significance is unclear.
- AntibacterialsAntibacterials: Based on laboratory and in vitro evidence, specific compounds from various parts of the noni plant may have antibacterial effects (35; 36; 37; 38; 39; 40).
- Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Coumadin resistance was reported in a 41-year old female consuming noni juice concomitantly with warfarin (19). The patient presented with decreased INRs. She was taking 7mg of warfarin on Monday and Wednesday and 6mg on other days, while also consuming one to two small glasses of a noni juice called "Noni Juice 4 Everything." This product contained more than 115 components, one of which was vitamin K.
- AntihelminthicsAntihelminthics: A proposed mechanism of action for noni's antihelminthic effects is the ability of the ethanol extract to induce paralysis and death of parasites, as was observed with the human parasitic nematode worm Ascaris lumbricoides within 24 hours (33).
- Anti inflammatory herbsAnti inflammatory herbs: In various animal and in vitro studies, noni has shown anti-inflammatory properties (41; 42; 43; 44). There lies the potential for an interaction with anti-inflammatory herbs, although clinical significance is unclear.
- AntilipemicsAntilipemics: A proposed mechanism of action for noni's antihelminthic effects is the ability of the MeOH extract and CHCl3-, EtOAc-, n-BuOH-, and H2O-soluble phases derived from the fruits of Morinda citrifolia to inhibit copper-induced LDL oxidation (45). There lies the potential for an interaction with antiatherosclerotic herbs, although clinical significance is unclear.
- AntineoplasticsAntineoplastics: Various extracts and constituents from all parts of the noni plant have been tested for their effect on animal cancer models and cell lines. In several studies, the noni extract suppressed tumor growth through activation of the host immune system (46; 47; 48; 49; 50), which is supported by another noni study showing general immunostimulation effects (20). Noni has also shown general cytotoxicity effects (51), which may be dose-dependent (20). However, these effects are not universal across all cancer lines (51). Noni extracts have exhibited specific inhibitory effects on Ras oncogene function (52), cell transformation induced by 12-O-tetradecanoylphorbol-13-acetate (TPA) or epidermal growth factor (EGF) (53; 54), the tumor-promoting effect of tumor necrosis factor-a (TNF-a) (55), and activator protein-1 transactivation (56). When administered before the induction of a cancer, noni extract has shown preventative effects (43; 57; 58; 59). Specifically, the anthraquinone 2-methoxy-1,3,6-trihydroxyanthraquinone may be a potent quinine reducatase inducer that is nearly 40 times more potent than the positive control l-sulforaphane (5). On a side note, the pasteurization of noni juice seems to have no effect on its chemistry and performance in NF-kappa B activity (60). There lies the potential for an interaction with antineoplastics, although clinical significance is unclear.
- AntioxidantsAntioxidants: A proposed mechanism of action for noni's antioxidant effects is the inhibition of both lipid peroxides and superoxide anion radicals (65; 66; 67). Yang et al. report the total antioxidant capacity (TAC) in fresh noni juice to be equivalent to 127mg ascorbic acid per 100mL in a scavenger assay of 1,1-diphenyl-2-picrylhydrazyl (DPPH) (68). After two months of traditional fermentation, TAC decreased by 70%. Storage of fresh noni juice at 24ºC for two months decreased TAC by 80%, while storage at -18ºC exhibited no significant change in TAC. Hot air and freeze-dried noni powders exhibited reduction in TAC by 45% and 20%, respectively. The pasteurization of noni juice seems to have no effect on its chemistry and performance in oxygen radical absorbance capacity (ORAC) assays, but enzyme treatment seems to have a negative effect on antioxidant capacity (60). There lies the potential for an interaction with antioxidants, although clinical significance is unclear.
- AntiviralsAntivirals: A proposed mechanism of action for noni's antiviral effects is the ability of one specific compound isolated from noni roots, 1-methoxy2-formyl-3-hydroxy anthraquinone, to suppress cytopathic effect of HIV-infected MT-4 cells in vitro, without inhibiting cell growth (61); however, other studies have shown no effect (62). There lies the potential for an interaction with antivirals, although clinical significance is unclear.
- DiureticsDiuretics: Noni contains 56mEq/L of potassium (2; 3). Some herbal diuretics may also increase potassium. Theoretically, concomitant use may increase the risk of hyperkalemia
- Gastrointestinal herbs and supplementsGastrointestinal herbs and supplements: A proposed mechanism of action for noni's gastrointestinal effects is inhibition of gastric emptying via a mechanism involving stimulation of cholecystokinin secretion and cholecystokinin 1 receptor activation (12). There lies the potential for an interaction with gastrointestinal herbs and supplements, although clinical significance is unclear.
- Hepatotoxic herbs and supplementsHepatotoxic herbs and supplements: Based on case reports and the hepatotoxic anthraquinones in noni fruit, noni may be hepatotoxic (6; 4; 5; 11; 7; 8).
- HypoglycemicsHypoglycemics: Some noni juice products contain high amounts of sugar, which may raise blood sugar. Theoretically, these juice products may interfere with agents used to control blood sugar.
- HypotensivesHypotensives: Based on animal studies, the total extract of the noni roots and various noni root extracts may have a hypotensive effect, although the mechanism for this effect is not clear (13; 14; 15; 16; 17; 18).
- ImmunostimulantsImmunostimulants: Based on animal studies, noni may stimulate the immune system (20).
- Metabolic herbsMetabolic herbs: Noni fruit contains a natural precursor for xeronine, called proxeronine, which is hypothetically converted in the body to the alkaloid xeronine. It has been hypothesized that xeronine is able to modify the molecular structure of proteins and is a critical normal metabolic co-regulator (63; 64).
- PotassiumPotassium: Noni contains 56mEq/L of potassium (2; 3).
- Vitamin KVitamin K: Based on a case report, a vitamin K-fortified juice product containing noni and >115 components from several other plants may have caused acquired coumarin resistance (19). Noni juice and/or fruit itself is not a source for vitamin K.
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Noni/Food Interactions:- GeneralGeneral: Based on animal studies, noni may decrease gastric transit time (12).
- Potassium-containing foodsPotassium-containing foods: Noni contains 56mEq/L of potassium (2; 3).
- Vitamin K-containing foodsVitamin K-containing foods: Based on a case report, a vitamin K-fortified juice product containing noni and >115 components from several other plants may have caused acquired coumarin resistance (19). Noni juice and/or fruit itself is not a source for vitamin K.
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Noni/Lab Interactions:- Blood glucoseBlood glucose: Some noni juice products contain high amounts of sugar, which may raise blood sugar.
- Blood pressureBlood pressure: Based on animal studies, the total extract of the noni roots and various noni root extracts may lower blood pressure, although the mechanism for this effect is not clear (13; 14; 15; 16; 17; 18)
- Coagulation panelCoagulation panel: Coumadin resistance was reported in a 41-year old female consuming noni juice concomitantly with warfarin (19). The patient presented with decreased INRs. She was taking 7mg of warfarin on Monday and Wednesday and 6mg on other days, while also consuming one to two small glasses of a noni juice called "Noni Juice 4 Everything." This product contained more than 115 components, one of which was vitamin K.
- C-Reactive Protein (CRP)C-Reactive Protein (CRP): In various animal and in vitro studies, noni has shown anti-inflammatory properties (41; 42; 43; 44).
- Lactate dehydrogenase levelsLactate dehydrogenase levels: Based a case report, noni may be elevate lactate dehydrogenase levels (11).
- Liver enzyme levelsLiver enzyme levels: Based on case reports and the hepatotoxic anthraquinones in noni fruit, noni may be hepatotoxic (6; 4; 5) and may elevate transaminase levels (11) (7; 8).
- PotassiumPotassium: Noni contains 56mEq/L of potassium (2; 3)
- Virus titersVirus titers: Based on in vitro studies, noni may have either no effect (62) or suppressive effects on HIV (61).
- White blood cell countWhite blood cell count: Based on animal studies, noni may stimulate the immune system and enlarge the thymus (20).
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Copyright © 2011 Natural Standard (www.naturalstandard.com)
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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
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