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Centella triterpenes

Health Conditions15
Table of contents

Other Names

AntananAntanan rambatAsiatic acidAsiatic pennywortAsiaticosideAsiaticoside BAsiaticoside HAsiaticoside IAsiatische SumpfpfennigkrautBrahambutiBrahma mandukiBrahmandukiBrahmiBrahmi bootiBrahmibutiBrahmic acidBrahminosideBrahmosideBua bokCay rau maCentellasapogenol ACentellasaponin ACentellic acidCentellinic acidCentelloidsCentelloseCentellosideCentic acidCentoic acidCoinwortDaun kaki kudaDivyaEcuelle d'eauEkpanniErba delle tigriETCA (Ethanolic extract of Centella asiatica)GhodtapreGotu kolaHierba de clavoHydrocotyle asiatica L.Hydroctyle asiatiqueIdrocotileIndian pennywortIndian water navelwortIndocentellosideIndocentoic acidIsobrahmic acidIsothankunic acidIsothankunisideJalneemJi xue caoKhulakhudiKodangalKudangalLuei Gong GenMadecassic acidMadecassosideMandookaparniMandukaparniMandukparniManimuniMarsh pennywortMuthilMyin-khwarOndelagaPegagaPegaganPennyweedPentacyclic triterpenoids of Centella asiaticaPhak nokPhak waenRau maSaraswatakuSceffoleosideSombreritoSpadeleafTakip-koholTalapetrakaTECA (Titrated Extract of Centella asiatica)Terminolic acidThankuniThankunic acidThankunisideTrachiek kranhTrisanthus cochinchinensisTriterpenic fraction of Centella asiaticaTsubo-kusaTTF (Total Triterpenic Fraction)TTFCA (Total Triterpenoid Fraction of Centella asiatica)VallaaraiYahong yahong

Synopsis

Centella Triterpenes: A Comprehensive Reference Article

1. Identity: Botanical Source, Chemical Names, and Common Preparations

1.1 Botanical Source

Centella asiatica (L.) Urban is a stoloniferous perennial herb belonging to the plant family Apiaceae (Umbelliferae), which contains 20 different species. It is a herbaceous, flowering, perennial plant native to tropical areas of Southeast Asia and Australia, used as a food as well as in traditional medicine — a creeping herbaceous, flowering plant native to tropical swampy areas of Southeast Asia and Australia but now found in many tropical and subtropical areas of the world. It is observed growing in Pakistan, Central America, Madagascar, India, equatorial Africa, and the tropics of Oceania.

Centella asiatica belongs to the family Apiaceae and is commonly known as Indian pennywort or Gotu kola in western countries; in the herbal medicine tradition, it is known as Brahmi, and in Ayurveda it is referred to as Mandookaparni and in Unani as Brahmi. It was sometimes confused with another plant, Bacopa monnieri Wettst., in India because both herbs are sold by the name 'Brahmi'; the issue was resolved by considering that Brahmi is B. monnieri and Mandookaparni is C. asiatica.

1.2 Chemical Identity of the Triterpenes

The species is most known for its high content of pentacyclic triterpenoids (C30), collectively referred to as 'centelloids.' The saponins asiaticoside and madecassoside, and their aglycones asiatic acid and madecassic acids, are the most abundant pentacyclic triterpenoids in Centella. Saponins account for up to 8% of the dry mass of the herb.

The triterpenes identified are mainly pentacyclic triterpenes, belonging to ursane- or oleanane-type, including asiaticoside, madecassoside, asiatic acid, and madecassic acid. Madecassoside and asiaticoside are identified as the biomarker components of this plant extract, due to their high contents relative to other constituents, with the content of madecassoside (C₄₈H₇₈O₂₀) being the highest.

Madecassoside (PubChem CID: 131801373) is a pentacyclic triterpene saponin from C. asiatica with multiple pharmaceutical activities. It has a molecular formula of C₄₈H₇₈O₂₀ and a molecular weight of 975.1 g/mol. Asiaticoside (PubChem CID: 52912190) has a molecular formula of C₄₈H₇₈O₁₉ and a molecular weight of 959.1 g/mol.

Other constituents include oxyasiaticoside, centelloside, brahmoside, brahminoside, thankunoside, isothankunoside, brahmic acid, isobrahmic acid, betulic acid, β-sitosterol, hexacosanol octanoate, kaempferol, quercetin, daucosterol, vanillic acid and succinic acid. Other compounds derived from the herb include phenolic acids, triterpene steroids, volatile oils, flavonoids, tannins, phytosterols, vitamins, essential oils, amino acids, and sugars.

The primary chemical components contributing to its pharmacological activity are asiaticoside (0.5–3.7%), asiatic acid (0.04–0.58%), madecassoside (0.29–6.09%), and madecassic acid. The levels of saponins and sapogenins vary widely depending on geographical origin, genetic, environmental, and growth conditions.

1.3 Standardized Extracts and Commercial Preparations

Three major commercial acronyms are used to describe the content of these preparations: TECA (titrated extract of Centella asiatica), TTFCA (total triterpenoid fraction of Centella asiatica), and TTF (total triterpenic fraction). The European Medicines Agency confirms that while different acronyms are used to describe the content of these preparations, they in fact describe the same extract. These extracts all contain 40% of asiaticoside and 60% of the aglycones (asiatic acid and madecassic acid).

Thin layer chromatography analyses of the root, stem, leaves, and petioles of Centella asiatica for alkaloid, flavonoid, terpenoid, and saponin components indicated that these plant parts are similar in terms of their composition, and that the greatest concentration of components is found in the leaf.

Medicinal products containing triterpenic extract from Centella asiatica are authorised in Europe for cutaneous use (powder, cream, and ointment) since 1968. It is widely available as capsules, tablets, powders, solutions, and skin creams in over-the-counter herbal products.


2. Traditional and Historical Use

2.1 Ayurvedic Medicine (India)

It was referred to in the ancient Chinese Shennong Herbal and in Indian Ayurvedic medicine about 2,000 to 3,000 years ago, respectively. It has been listed in Susruta Samhita, an ancient Indian medicinal text. Due to the number of herbal properties of the plant and its preparations or extracts, it was added in the Indian Pharmacopoeia in the 19th century, and later in other pharmacopoeias.

Centella asiatica is one of the most significant herbs in Ayurveda for stimulating nerve and brain cells. Eastern therapists have relied on it to treat emotional disorders, such as depression, thought to be related to physical problems. This perennial creeper has been traditionally used for rheumatism, indigestion, diabetes, dysentery, fever, fractures, hepatitis, jaundice, constipation, wounds, and eye problems.

It has been used as an antipyretic, analgesic, anti-inflammatory, and "brain tonic" agent (WHO monographs, 1999).

2.2 Traditional Chinese Medicine

C. asiatica extracts are reported widely in Ayurvedic and Chinese traditional medicine to boost memory, prevent cognitive deficits, and improve brain functions. Over time, Mandooka Parni's reputation spread to Chinese traditional medicine, where it is known as "ji xue cao," used to support circulation and treat varicose veins.

2.3 Use in Southeast Asia and Africa

In Asiatic traditional medicine for thousands of years, Centella asiatica has been used to treat a variety of skin diseases, such as leprosy, lupus, varicose ulcers, eczema, and psoriasis. Western medicine reported that in the mid-twentieth century, C. asiatica and its ethanolic extract had promising results in the treatment of leprosy. In Sri Lanka, folk healers used leaf poultices on wounds and skin lesions. During the Dutch colonial period in Sri Lanka (17th–19th century), European botanists documented its use among tea workers for improving energy and skin health.

2.4 European Pharmacopoeia History

Centella asiatica has been referred to in the French Pharmacopoeia edition of 1884. Despite its long history of traditional use, Centella appeared in the Codex in 1884 and the first dry extract was not created until 1941, three years after its triterpenoid molecules were isolated by the French scientist P. Boiteau. The British Herbal Pharmacopoeia reports the systemic use of the aerial part of Centella asiatica in rheumatic conditions and the topical use for indolent wounds, leprous ulcers, and cicatrisation after surgery. According to Medicaments a base de plantes, the whole plant has also been used for sunburns, local and superficial burns, nappy rash, and antipruritic local treatment of dermatological disorders.

In France since 1974, triterpenic extract of Centella asiatica has been authorised for the improvement of symptoms of venous stasis; in Italy since 1982 for the treatment of pre-varicose syndromes including leg heaviness, orthostatic oedema, vein pains, night cramps and lower limb itching, as well as adjuvant therapy of idiopathic or secondary chronic venous insufficiency and complications of varicose veins.


3. Key Active Constituents and Mechanisms of Action

3.1 The Four Principal Triterpenes

The most important bioactive compounds are triterpene glycosides (saponins), such as asiaticoside and madecassoside, along with their respective aglycones (sapogenins), asiatic acid and madecassic acid. These four major compounds, also known as pentacyclic triterpenes, are claimed to be responsible for the biological effects of C. asiatica extracts.

Asiatic acid and madecassic acid are biologically active ingredients of glycosides. Although in tissues and plasma their concentration is low, they can be detected in feces within 48 hours after oral administration of C. asiatica extract, suggesting that triterpenoid glycosides are mainly metabolized in the intestine.

Madecassoside is widely distributed in the heart, liver, spleen, lung, brain, stomach, skin, and kidney through oral dosing, reaching maximum levels within 5–15 minutes after oral administration. Asiaticoside also reaches maximum levels within 5–15 minutes after oral administration.

3.2 Collagen Synthesis and Extracellular Matrix Modulation

Titrated Extract from Centella asiatica (TECA) is a drug which has been used for many years in Europe for the treatment of wound healing defects. It is a reconstituted mixture of 3 triterpenes extracted from the plant: asiatic acid, madecassic acid, and asiaticoside. TECA-injected wound chambers were characterized by increased dry weight, DNA, total protein, collagen, and uronic acid contents. Peptidic hydroproline was also increased, showing an increased remodeling of the collagen matrix in the wound.

Asiatic acid and asiaticoside were the most active of the three triterpenes. Asiaticoside exerted a preferential stimulation of collagen synthesis and was active at low doses only. In addition to collagen, all three components were also able to stimulate glycosaminoglycan synthesis.

TTFCA is active on connective tissue modulation, improves the synthesis of collagen and other tissue proteins by modulating the action of fibroblasts in the vein wall, and stimulates collagen remodeling in and around the venous wall. This is due to the modulating action of TTFCA on fibroblasts, as shown by experiments on the growth of human embryonal fibroblasts.

3.3 Anti-inflammatory Mechanisms

Bioactive compounds from C. asiatica inhibit the activation and nuclear translocation of NF-κB, resulting in the downregulation of pro-inflammatory cytokines such as interleukin-1β (IL-1β), IL-6, and TNF-α, as well as the suppression of inflammatory enzymes including COX-2. Asiatic acid and madecassic acid exhibit anti-inflammatory, anticancer, hepatoprotective, and neuroprotective properties via modulation of mitogen-activated protein kinases (MAPK), nuclear factor erythroid 2-related factor 2 (Nrf2), and phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathways.

Centella asiatica extract (CAE) and asiatic acid also act in the inflammatory phase by inhibiting recruitment of immune defense cells, reducing synthesis of pro-inflammatory cytokines (TNF-α, IL-6, and IL-1β) and growth factors (TGF-β, PDGF, and VEGF).

3.4 Antioxidant Mechanisms

Triterpenoids such as asiaticoside and asiatic acid scavenge reactive oxygen species (ROS) and upregulate endogenous antioxidant enzymes, including superoxide dismutase (SOD) and catalase. Topical application of C. asiatica extract mitigated photoaging by suppressing MMP-1 and MMP-9, enzymes responsible for collagen degradation, while activating TGF-β/Smad signaling to enhance extracellular matrix integrity.

3.5 Neuroprotective Mechanisms

Several mechanisms of action of C. asiatica have been demonstrated for enhancing cognitive function, such as the inhibition of acetylcholinesterase activity, reduction of phospholipase A2 (PLA2) activity, protection against β-amyloid formation, and protection from brain damage. According to the literature, C. asiatica (gotu kola) has been reported to have comprehensive neuroprotection by different modes of action such as enzyme inhibition, prevention of amyloid plaque formation in Alzheimer's disease, dopamine neurotoxicity in Parkinson's disease, and decreasing oxidative stress.

The plant's active components have been found to regulate neurotransmitter activity, reduce oxidative stress, and modulate the hypothalamic-pituitary-adrenal (HPA) axis.

3.6 Vascular and Microcirculatory Mechanisms

Total triterpenic fraction of Centella asiatica (TTFCA) is effective in improving venous wall alterations in chronic venous hypertension and in protecting the venous endothelium. The tissue-stimulating action is shown by the increased collagen production independent of the stimulation of cell proliferation, which differentiates the action of TTFCA from cell growth factors.

Studies indicate that whole-extract formulations containing multiple triterpenoids show superior efficacy compared to isolated compounds, suggesting synergistic modulation of inflammatory and oxidative pathways.


4. Scientific Evidence by Area of Use

4.1 Wound Healing and Skin Repair

Evidence strength: Moderate — multiple RCTs and systematic reviews, primarily with topical preparations

A systematic review of randomized controlled trials observed that the favorable effect of C. asiatica on wound healing was possibly due to the synthesis of collagen type 1, 2, and 3, stimulation of fibronectin, and remodeling of the extracellular matrix. Furthermore, C. asiatica demonstrated a beneficial effect on anti-inflammation and increased tensile strength, accelerating the formation of epithelium and keratin. The authors concluded that more clinical trials are needed to perform a meta-analysis to confirm these wound healing effects.

A systematic review concluded that C. asiatica might enhance wound healing resulting from improved angiogenesis, possibly occurring due to its stimulating effect on collagen I, Fibroblast Growth Factor (FGF), and Vascular Endothelial Growth Factor (VEGF) production.

A prospective randomized, double-blind controlled trial (PMC, 2018) studied scar improvement after split-thickness skin graft surgery. The study evaluated the efficacy of Centella asiatica extract in cream formulation in 30 patients who underwent a split-thickness skin graft (STSG) operation. Both Centella cream and placebo were applied equally to the donor site at least 2 weeks after epithelialization was completed. A scar assessment using the Vancouver Scar Scale (VSS) was taken at 4, 8, and 12 weeks. Of the original 30 patients, 23 patients completed evaluation. There were significant differences in the pigmentation parameter of VSS and comparative total VSS scores between 4 and 12 weeks in the Centella cream group, suggesting that the effect on scar development may be attainable in terms of better pigmentation.

Early human data show improvements in hydration, transepidermal water loss (TEWL), elasticity, and wrinkle appearance with topical C. asiatica–containing formulations, as well as signals in scar management with triterpenoid-focused carriers.

Asiaticoside, a key compound, stimulates the synthesis of type 1 collagen inhibitors in human fibroblast cells, which are crucial in preventing skin aging. It also enhances skin cell behavior during the wound healing process by increasing the migration rate of skin cells, promoting cellular proliferation, improving initial skin cell adhesion, and increasing the number of normal human dermal fibroblasts. Asiaticoside acts during the inflammatory phase by reducing the synthesis of pro-inflammatory cytokines (TNF-α, IL-6) and growth factors (TGF-β, PDGF, VEGF). Moreover, asiaticoside dramatically increases cell migration, indicating that it may have a therapeutic impact on the corneal epithelium's re-epithelialization during wound healing.

4.2 Chronic Venous Insufficiency and Microangiopathy

Evidence strength: Moderate — multiple RCTs, systematic review, and European regulatory approval for this indication in several countries

A systematic review assessed the efficacy of Centella asiatica for improvement of the signs and symptoms of chronic venous insufficiency (CVI). Thirteen electronic databases including the Cochrane Central Register of Controlled Trials were searched for randomised controlled trials. Two review authors independently selected studies, assessed risks of bias, and extracted data. Eight studies met the inclusion criteria.

The pooling of data of similar studies showed that Centella asiatica significantly improved microcirculatory parameters such as transcutaneous partial pressure of CO₂ and O₂, rate of ankle swelling, and venoarteriolar response. Three out of the eight studies reported that patients treated with Centella asiatica showed significant improvement in CVI signs such as leg heaviness, pain, and oedema. The authors concluded that Centella asiatica may be beneficial for improving signs and symptoms of CVI but this conclusion needs to be interpreted with caution, as most of the studies were characterised by inadequate reporting and thus had unclear risks of bias.

In one prospective randomized trial using TTFCA at two doses (60 mg and 120 mg daily), all tests provided a significant difference between drug-treated groups and the placebo group, allowing a distinction to be made between the higher (120 mg daily) and the lower (60 mg daily) dose. Transcutaneous PO₂-PCO₂ measurements were significantly modified by drug treatments, while no variation could be detected in the placebo group. Important symptomatic effects (evaluated by subjective scores) followed TTFCA administration, especially at the higher dose level, while no effect was obtained with placebo.

TTFCA is active on the microcirculation in venous and diabetic microangiopathy, and signs and symptoms of venous hypertension and edema are improved by treatment.

4.3 Cognitive Function and Mood

Evidence strength: Preliminary and mixed — current meta-analysis does not confirm cognitive domain improvements, though mood signal is positive; future well-characterized RCTs are needed

A 2017 systematic review and meta-analysis included five RCTs conducted to determine the effect of C. asiatica alone and six RCTs conducted to determine the effect of C. asiatica-containing products. Meta-analysis indicated that there are no significant differences in all cognitive function domains of C. asiatica when compared to placebo. However, it could improve mood by increasing alert scores [SMD: 0.71 (95% CI; 0.01 to 1.41); I² = 30.5%] and decreasing anger scores at 1 hour after treatment [SMD: −0.81 (95% CI; −1.51 to −0.09); I² = 36.6%].

The authors concluded there is not strong evidence to support the use of C. asiatica for cognitive function improvement in each cognitive domain, though it could improve alertness and relieve anger. Limitations included inconsistencies in dose regimen, plant preparation, standardization, and product variation. Future well-designed clinical trials using suitable doses of standardized C. asiatica are still needed.

In clinical studies, C. asiatica herb or extracts improved cognitive function in healthy middle-aged adults, elderly adults, and elders with mild cognitive impairment (MCI). However, in elderly participants with mild cognitive impairment, investigators found improvements in cognitive test results (Mini Mental State Examination) following use of dried Centella asiatica for six months; however, no control group was incorporated. Unfortunately, these studies used highly variable Centella preparations that were poorly characterized and were either performed in cognitively normal individuals thereby limiting clinical applicability, or were not placebo-controlled.

In preclinical studies, CA extracts enhanced memory and cognitive functions by activating antioxidant response pathways and protecting hippocampal mitochondria from oxidative stress. In epilepsy models, asiatic acid suppresses glutamate release, improves synaptic and mitochondrial function, and reduces neuronal damage. These findings are currently confined to preclinical contexts.

4.4 Scar Prevention and Hypertrophic Scarring

Evidence strength: Preliminary clinical and preclinical data; promising signals in topical use

C. asiatica exhibits notable potential in scar modulation and antifibrotic activity, particularly in hypertrophic and keloid scarring contexts characterized by excessive fibroblast activity and extracellular matrix deposition. In murine scar models, treatment with C. asiatica extracts has been shown to downregulate transforming growth factor beta 1 (TGF-β1) expression, decrease collagen I and III synthesis, and reduce overall scar thickness.

Asiatic acid was shown to increase the tensile strength of the newly formed skin, furthering the healing of wounds.

4.5 Skin Aging, Photoprotection, and Anti-aging

Evidence strength: Mostly preclinical; early clinical signals with topical use

Preclinical UVB-exposure models have revealed the potent antioxidant and anti-aging capabilities of C. asiatica. Triterpenoids such as asiaticoside and asiatic acid scavenge reactive oxygen species (ROS) and upregulate endogenous antioxidant enzymes, including superoxide dismutase (SOD) and catalase. Topical application of C. asiatica extract mitigated photoaging by suppressing MMP-1 and MMP-9, enzymes responsible for collagen degradation, while activating TGF-β/Smad signaling to enhance extracellular matrix integrity.

Early human data show improvements in hydration, transepidermal water loss (TEWL), elasticity, and wrinkle appearance with topical C. asiatica–containing formulations.

4.6 Neurological and Neuroprotective Potential

Evidence strength: Predominantly preclinical; human clinical trials limited, underpowered, or not placebo-controlled

The results of a comprehensive review showed that C. asiatica and its triterpenoids had extensive beneficial effects on neurological and skin diseases, which were confirmed through clinical studies. They exhibited anti-inflammatory, anti-oxidative stress, anti-apoptotic effects, and improvement in mitochondrial function. However, further clinical studies are urgently required due to the low level of evidence and lack of patients.

In cerebral ischemia-reperfusion injury, asiaticoside reduces oxidative stress and neuroinflammation through NOD2/MAPK/NF-κB pathway modulation and microglial regulation — findings demonstrated in preclinical models.

Further clinical studies are urgently required due to the low level of evidence and lack of patients.

4.7 Anxiety and Mood

Evidence strength: Preliminary; one small double-blind RCT with a specific signal; replication needed

The purported anxiolytic activity of C. asiatica is intriguing in view of the proposed involvement of cholecystokinin (CCK) in the pathophysiology of fear and anxiety. However, the mechanism of action and possible toxicity need to be further investigated in a large sample, which may bring to light the precise mechanisms for ameliorating CNS-related conditions like depression and sleep disorders apart from anxiety.

Recent research suggests that C. asiatica plays a significant role in alleviating symptoms of anxiety and depression. The plant's active components have been found to regulate neurotransmitter activity, reduce oxidative stress, and modulate the hypothalamic-pituitary-adrenal (HPA) axis. These findings are largely based on preclinical and limited human data.


5. Body Systems and Health Areas Associated with Centella Triterpenes

  • Integumentary system: Clinical evidence supports the efficacy of Centella asiatica across a spectrum of dermatological conditions, including wound healing, scar management, skin aging, and barrier dysfunction.
  • Vascular/circulatory system: TTFCA is active on the microcirculation in venous and diabetic microangiopathy.
  • Central nervous system: C. asiatica has been reported to have comprehensive neuroprotection by different modes of action including enzyme inhibition, prevention of amyloid plaque formation in Alzheimer's disease, dopamine neurotoxicity in Parkinson's disease, and decreasing oxidative stress.
  • Connective tissue: The favorable effect of C. asiatica was observed with a quicker wound healing, possibly due to the synthesis of collagen type 1, 2, and 3, stimulation of fibronectin, and remodeling of the extracellular matrix.
  • Immune system: Titrated extract of C. asiatica (TECA) treatment suppressed NF-κB activity and subsequently inhibited the expression of TNF-α, IL-1β, and IL-6 in a phthalic anhydride-induced atopic dermatitis animal model.
  • Gastrointestinal system: C. asiatica is a medicinal plant with reported uses for treating skin problems, neurological diseases, endocrine diseases, cardiovascular diseases, digestive diseases, respiratory diseases, gynecological diseases, and rheumatoid arthritis.

6. Dosage Forms and Dosages Reported in Studies

The typical oral dose is 60 to 120 mg daily of purified extracts, but may be 600 to 1800 mg daily of capsules or powders of dried leaves.

A typical daily dose of C. asiatica reported was approximately 600 mg of dried leaves or infusion, single-dose capsules (300 mg to 680 mg, three times daily), or a 10-mg concentrated extract also available in capsules. Other preparations include Madecassol tablets 10 mg three times daily, tincture 1 ml, and Emdecassol ointment twice daily.

During the 1980s, several clinical studies showed that the Total Triterpenic Fraction of Centella asiatica (TTFCA/TECA) at the oral dose of 60–120 mg daily, for 30–90 days, was able to improve subjective and objective signs of venous hypertension.

Oral amounts used in previous wound healing studies include 300 mg of asiaticoside or 120 mg of C. asiatica extract, although 60–120 mg is the usual dose used in actual herbal medicine. The daily recommendation of C. asiatica by the World Health Organisation (WHO) ranges from 330 mg to 680 mg of C. asiatica extract, three times a day.

In an exploratory clinical study of 99 patients with post-stroke vascular cognitive impairment, 750 or 1,000 mg/day of Centella asiatica extract for 6 weeks was evaluated.


7. Safety Considerations and Known Interactions

7.1 General Tolerability

In small trials, Centella asiatica extracts have appeared to be well tolerated with only mild, transient, and nonspecific adverse effects (headache, dizziness, bloating, diarrhea, nausea), which often have been similar in frequency among persons receiving placebo or alternative treatments.

The most commonly reported adverse effects include mild gastrointestinal discomfort, headache, and skin irritation in topical applications. In some clinical trials, contact dermatitis has been documented.

None of the studies included in the 2017 systematic review and meta-analysis on cognitive function reported adverse effects of C. asiatica.

7.2 Hepatotoxicity

While generally regarded as safe, Centella has been linked to rare instances of clinically apparent acute liver injury with jaundice. Isolated reports of hepatotoxicity have raised caution, particularly with extended oral use. These rare but significant events appear to be dose-dependent and may be exacerbated by pre-existing hepatic impairment.

Hepatotoxicity, which has been reported in one previous case report, was not observed in any of the included RCTs in the cognitive function systematic review.

Germander, Skullcap, and Glycyrrhizin contain di- or triterpenic active principles that promote apoptosis and change cell membranes, causing liver damage; these pathways may have resulted in C. asiatica-related injuries in susceptible individuals.

7.3 Drug Interactions

Drug interactions are not well-documented, though theoretically Centella asiatica may interact with antiepileptics (e.g., phenytoin, valproate, and gabapentin).

Its anti-inflammatory properties, mediated by suppression of the NF-κB pathway, could theoretically enhance the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, possibly leading to additive effects or increased risk of adverse outcomes. Similarly, its antioxidant effects via Nrf2 activation may interact with chemotherapeutic agents or other redox-modulating drugs, although such interactions remain speculative due to limited in vivo data. Of particular concern are potential interactions with sedatives or anxiolytics.

7.4 Regulatory Stance on Duration of Use

None of the therapeutic properties of Centella asiatica have been proven in prospective, controlled trials in humans, and Centella asiatica is not approved in the United States as therapy of any medical condition. There are no authorised medicinal products containing herbal preparations of Centella asiatica as a monocomponent in the EU; however, medicinal products containing standardized and highly purified Centella asiatica preparations are authorised and marketed in Europe with full application in Belgium, France, Greece, Italy, Portugal, and Spain.


References

Health Conditions

Health conditions that Centella triterpenes may help support.

  • AnxietyScientific

    Centella triterpenes (asiaticoside, madecassoside, asiatic acid, madecassic acid) are the primary bioactive fraction of Centella asiatica (Gotu kola) responsible for anxiolytic activity. They modulate GABA-A receptors and reduce corticosterone. Clinical trials of Centella asiatica standardized to these triterpenes underpin the anxiety evidence base for Gotu kola.

  • Arterial HealthScientific

    Centella triterpenes (asiaticosides and madecassosides) specifically support arterial health by modulating collagen synthesis in the fibrous cap of arterial plaques, reducing plaque vulnerability to rupture. Controlled clinical trials cited in peer-reviewed sources show arterial plaque stabilization and reduction of vascular oxidative stress.

  • CelluliteScientific

    The triterpene fraction of Centella asiatica (asiaticoside, asiatic acid, madecassic acid) is the pharmacologically active anti-cellulite component, stimulating fibroblast collagen synthesis and reducing skin fibrosis. It is specifically claimed in US patent compositions for oral cellulite treatment and confirmed in authoritative dermatological reviews.

  • CirculationScientific

    Centella triterpenes (asiaticoside, madecassoside, asiatic acid, and madecassic acid from Centella asiatica) are the primary active compounds responsible for Gotu Kola's documented circulatory effects. RCTs using the total triterpenic fraction of Centella asiatica (TTFCA) at 60–180 mg/day demonstrate significant improvements in capillary permeability, oedema, and venous hypertension in CVI and diabetic microangiopathy patients.

  • Centella triterpenes (asiaticoside, madecassoside, asiatic acid, madecassic acid) from Centella asiatica collectively promote fibroblast collagen synthesis, inhibit connective tissue-degrading enzymes, and regulate ECM remodeling. They are the bioactive basis for Centella asiatica's well-established role in wound healing and connective tissue support.

  • Centella triterpenes (asiatic acid, madecassic acid, asiaticoside, madecassoside) are the bioactive components of Centella asiatica that stimulate collagen synthesis in connective tissue. EMA-approved for venous insufficiency with collagen-related mechanisms directly applicable to joint connective tissue. Multiple in vitro and animal studies confirm anti-inflammatory and matrix-remodeling properties relevant to joint flexibility.

  • HemorrhoidsScientific

    Centella triterpenes (asiaticoside, asiatic acid, madecassoside from Centella asiatica) have been evaluated in clinical trials for hemorrhoidal disease. A 2020 PMC RCT compared a Centella triterpene complex against flavonoids for hemorrhoid management, and a 2021 PMC retrospective study incorporating Centella asiatica extract achieved 89.8% hemorrhoid grade reduction in grade II–III patients (p<0.001).

  • The triterpenic fraction of Centella asiatica (TTFCA), comprising asiaticoside, asiatic acid, madecassoside, and madecassic acid, has direct evidence from RCTs for reducing capillary filtration rate and edema in chronic venous insufficiency. Capillary filtration rate is the primary determinant of lymphatic load, making these compounds mechanistically and clinically relevant to lymphatic health.

  • NeuroplasticityScientific

    Centella triterpenes (asiaticoside, madecassoside, asiatic acid, madecassic acid) collectively promote hippocampal neuroplasticity including axon elongation, dendritic branching, BDNF upregulation, and neurogenesis. They are the bioactive fraction of Gotu Kola responsible for its documented cognitive and neuroplasticity effects in both preclinical and clinical studies.

  • RosaceaScientific

    Centella triterpenes (asiaticoside, madecassoside, asiatic acid, madecassic acid) are the primary bioactives of Centella asiatica, classified in Karger's 2026 rosacea review as having clinical evidence in rosacea-related conditions. They inhibit NF-κB, reduce inflammatory cytokines, and strengthen vascular connective tissue relevant to rosacea erythema and telangiectasia.

  • Centella triterpenes (the isolated triterpenoid fraction of Centella asiatica including asiaticoside, madecassoside, asiatic acid) have been studied specifically for scar management and are more potent than crude extracts. They regulate fibroblast activity, suppress TGF-β-driven excess collagen, and improve scar texture and height in clinical trials.

  • Centella triterpenes (asiaticoside, asiatic acid, madecassoside, madecassic acid) are the validated bioactive fractions of Centella asiatica responsible for skin anti-aging effects. They stimulate fibroblast collagen synthesis via TGF-β/Smad signaling and promote hyaluronan production. Topical standardized triterpene formulations have been shown to reduce periocular wrinkles and increase collagen-associated hydration in clinical studies.

  • Centella asiatica triterpenes (asiaticoside, madecassoside, asiatic acid, madecassic acid) collectively stimulate collagen synthesis and protect skin elasticity through TGF-β/Smad pathway activation, MMP inhibition, elastase inhibition, and fibroblast proliferation promotion. Clinical RCT data in 104 postmenopausal women confirm significant improvements in skin elasticity (+22%), collagen synthesis, and hydration.

  • Varicose VeinsScientific

    Centella triterpenes—principally asiaticoside, madecassoside, asiatic acid, and madecassic acid from Centella asiatica—are the active constituents responsible for the plant's clinical effects in chronic venous insufficiency and varicose veins. Multiple placebo-controlled RCTs using the total triterpenic fraction (TTFCA) have demonstrated reductions in capillary filtration, ankle edema, and CVI symptom scores. These compounds reduce capillary permeability, stimulate collagen synthesis, and improve venous tone.

  • Wound HealingScientific

    The triterpene fraction of Centella asiatica (primarily asiaticoside and madecassoside) is the clinically validated active component responsible for the plant's wound-healing effects, including collagen stimulation, angiogenesis, and anti-inflammatory activity supported by in vitro, in vivo, and RCT evidence.

Body Systems

Body systems that Centella triterpenes may help support.

  • No body systems available.
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Centella triterpenes | Caring Sunshine