Indian ipecac

Other Names

Aadumuttada gidaAnantamulAnantamulaAntamulAntamulaAntomulAntomulaAntrapachakAntrapachanArkaparniAsclepias asthmaticaAsclepias vomitoriaBedakiCountry ipecacuanhaCynanchum indicumCynanchum vomitoriumDam belDama belDama butiDamnivelDamvelDum velEmetic swallow-wortIndian ipecacuanhaJangli pikvamJanglipikvamKakapalaKhadaki rasnaKirumanjiKukkapalaKurinjanKynbat kylianLataksiriMehendiMendiMoolarasnaMooliniMuliniNaayihaaleNacharuppanNaippalaiNancaruppanNangilaippirattiNay PalaiNayppalaiNipaladaberuPanacea twinerPitamariPitta valliPitvelSvasaghniSwasagniSwasamariTellayadalaTylophora asthmaticaTylophora indicaVallipalaVallippalaVeripalaVerripalaVincetoxicum indicumVomiting swallow-wort

Synopsis

Indian Ipecac (Tylophora indica)

Identity: Botanical Classification, Names, and Natural Source

Tylophora indica (Burm. f.) Merr. is a perennial, slender, twining or climbing medicinal plant belonging to the family Apocynaceae (formerly classified within Asclepiadaceae). It is commonly known in English as Indian-Ipecacuanha. The plant is also known by the synonyms Tylophora asthmatica and by the common English designations Emetic Swallow-wort and Country-Ipecacuanha. It is called Indian Ipecacuanha because its roots serve as an effective substitute for true Ipecac, which was used historically to induce vomiting after suspected poisoning.

The plant bears a large number of vernacular names across the Indian subcontinent: in Hindi, it is called Antmool or Jamgli; in Sanskrit, it is known as Lataksiri, Arkaparni, Swasagni, and Antrapachak; in Kannada as Nipaladaberu or Aadu muttada balli; in Bengali as Antomul; in Gujarati as Damvel or Mulini; in Tamil as Nangilai or Nacharuppan; and in Telugu as Kakapala or Veripala. In Ayurveda specifically, the plant is referred to as ananthamul and arkaparni.

Taxonomically, T. indica belongs to the kingdom Plantae, phylum Tracheophyta, class Magnoliopsida, order Gentianales, and family Apocynaceae. Accepted synonyms include Tylophora indica var. indica, Tylophora indica var. glabra (Decne.) H. Huber, and Tylophora indica var. intermedia M.A. Rahman & Wilcock. The genus name derives from the ancient Greek words tylos (knot) and phoros (bearing).

Morphology and Distribution

The plant is a climber or shrub with branches growing up to 1.5 meters in height. Its leaves are ovate-oblong to elliptic-oblong, 3–10 cm in length and 1.5–7 cm in width. Plant roots are long, fleshy, and fissured along their length, with a light brown, corky bark. The plant bears small flowers, 1–1.5 cm across, arranged in 2–3 flowered fascicles in axillary umbellate cymes.

T. indica is a twining perennial woody plant widely distributed in Africa, Asia, Australia, and Oceanic islands. It is distributed widely throughout the southern, eastern, and western parts of India, growing abundantly in plains, hilly slopes, and forests, and is commonly found in regions such as Uttar Pradesh, Bengal, Assam, Odisha, Maharashtra, Gujarat, and the sub-Himalayan tracts up to 1,260 meters in elevation. The genus Tylophora (Apocynaceae) consists of 63 accepted species widely distributed in Sri Lanka, Burma, Singapore, Nepal, Laos, St. Vincent, Barbados, the Grenadines, Vietnam, and Seychelles.

Common Preparations and Dosage Forms

T. indica has been prepared and consumed in India, Bangladesh, and Sri Lanka in the forms of powder, decoction, pulp, paste, and extract—both alone and in combination with other herbs. The active principle of the plant lies in its leaves and roots, which are known to exhibit emetic, cathartic, laxative, expectorant, diaphoretic, and purgative properties. The dried leaves of the plant are specifically used as an emetic and expectorant, and are indicated in overloaded states of the stomach and in other cases requiring the use of emetics. In modern supplement contexts, the plant is formulated as dried leaf powder in capsules, alcoholic (ethanolic) tinctures, aqueous decoctions, and as fresh whole leaves for direct consumption.

Traditional and Historical Use

Ancient Ayurvedic Records

According to historical accounts, T. indica was first chronicled in two classical texts of Ayurveda — the Charaka Samhita and the Sushruta Samhita — written around 1000 B.C., which highlight its therapeutic application in asthma. The Caraka Samhita mentions Tylophora leaves in formulations for respiratory disorders, specifically in so-called Svasa-Kaasahara (anti-asthmatic and anti-cough) therapies. The plant has been extensively used in both the Ayurveda and Siddha systems of medicine since ancient times, and is known in local communities by a wide variety of vernacular names.

Regional Folk Traditions

Traditionally, T. indica has been used in India, Bangladesh, and Sri Lanka against a wide range of ailments, including skin disorders, inflammation, cough, asthma, diarrhea, cancer, and microbial infections, in the form of various preparations. The plant has played a key role in ethnomedicine and has been in use for many years for the treatment of cough, bronchitis, diarrhea, dysentery, cancer, arthritis, microbial infections, and epilepsy by Asian populations.

Traditional applications also include the treatment of asthma, cough, inflammation, jaundice, and snakebite. In folk traditions across Kerala and Karnataka, village healers used a decoction of T. indica leaves mixed with honey to soothe whooping cough. Root or leaf powder has been used in diarrhea, dysentery, and intermittent malarial fever.

Pharmacopeial Recognition

The leaves of Tylophora indica were included in the Bengal Pharmacopoeia as early as 1884. The plant is documented in that pharmacopoeia as having laxative, expectorant, diaphoretic (sweat-inducing), and purgative (emetic) properties. The plant's leaves and roots have thus been included in pharmacopoeias since the late 19th century, valued for their purported laxative, expectorant, and diaphoretic properties.

Key Constituents and Active Compounds

Alkaloids: The Primary Bioactive Class

Phytochemical investigations have revealed the presence of a broad spectrum of bioactive compounds, including alkaloids (tylophorine, tylophorinidine, and tylophorinine), flavonoids, tannins, saponins, phenolic compounds, and steroids. The roots and leaves contain 0.2 to 0.46% of therapeutically important alkaloids tylophorine, tylophorinine, and tylophorinidine.

The roots and leaves of T. indica contain various active alkaloids such as tylophorine, tylophorinine, anti-cancerous tylophorinidine, and a number of other non-alkaloid components such as septidine, isotylocereberine, sterols, and flavonoids. The drug also contains major chemical constituents including α-amyrin, kaempferol, and quercetin, and other alkaloids like tylophorindine, desmethyltylophorine, desmethyltylophorinine, dehydrotylophorine, desmethyltylophoridine, and anhydrousdehydrotylophorinine. The alkaloid (+)-isotylocrebrine and (+)-septicine have been identified from the fresh leaf.

The major alkaloid tylophorine possesses immunosuppressive, anti-inflammatory, anti-tumor, anti-candidal, anti-amoebic, and anticancerous properties, while the alkaloid tylophorinidine has antileukemic properties. A group of minor alkaloids — tyloindicines F, G, H, and I — are also cytotoxic.

The phenanthroindolizidine alkaloid (−)-tylophorine has been reported for its significant anticancer activity through different biomechanistic pathways. A 2022 study aimed to evaluate the anticancer activity of phenanthroindolizidine alkaloids isolated from T. indica, isolating six such alkaloids (compounds 1–6), along with septicine, chlorogenic acid, and chlorogenic acid methyl ester, using vacuum liquid chromatography and preparative HPLC.

Non-Alkaloid Constituents

Flavonoids, notably quercetin and kaempferol, provide antioxidant support, while steroidal compounds (including β-sitosterol) contribute to immune regulation and mild antihistamine effects. These constituents collectively contribute to a broad spectrum of pharmacological activities, including anti-asthmatic, anti-inflammatory, immunomodulatory, anticancer, antioxidant, and antimicrobial effects.

Mechanisms of Action

Anti-Inflammatory and Immunomodulatory Activity

The major constituent in Tylophora is the alkaloid tylophorine. Laboratory research has shown this isolated plant extract exerts a strong anti-inflammatory action. Test-tube studies suggest that tylophorine is able to interfere with the action of mast cells, which are key components in the process of inflammation. At the molecular level, research suggests tylophorine may downregulate NF-κB signaling — a pathway central to inflammation. Phenanthroindolizidine-based tylophora alkaloids have been reported to have potential antitumor, anti-immuno, and anti-inflammatory activity. Structure–activity relationship studies of a series of tylophora alkaloids indicate that although these compounds are structural analogs, their potency of cytotoxicity, selectivity against the NF-κB signaling pathway, and their inhibitory effects against protein and nucleic acid synthesis differ.

Antiasthmatic and Bronchodilatory Activity

Ex vivo studies have demonstrated that active fractions of T. indica can significantly relax tracheal rings via targeting multiple signaling pathways, including noncompetitive antagonism of histamine and muscarinic receptors, β2-adrenergic stimulation, and activation of soluble guanylyl cyclase. In vivo studies further showed that active fractions ameliorated airway hyperresponsiveness and decreased bronchoalveolar lavage fluid (BALF) levels of inflammatory cytokines and immunoglobulin E (IgE). The major alkaloid tylophorine found in T. indica has been documented to possess immunosuppressive, antitumor, antifeedant, antibacterial, antifungal, antiamoebic, diuretic, and hepatoprotective activities, and has been reported to provide positive stimulation to the adrenal cortex.

Antiangiogenic and Anticancer Mechanisms

Tylophorine significantly inhibits a series of VEGF-induced angiogenesis processes including proliferation, migration, and tube formation of endothelial cells. It directly inhibits VEGFR2 tyrosine kinase activity and its downstream signaling pathways including Akt, Erk, and ROS in endothelial cells. Using human umbilical vein endothelial cells (HUVECs), researchers demonstrated that tylophorine inhibited VEGF-stimulated inflammatory responses including IL-6, IL-8, TNF-α, IFN-γ, MMP-2, and NO secretion. Tylophorine also significantly inhibited neovascularization in a sponge implant angiogenesis assay and inhibited tumor angiogenesis and tumor growth in vivo. Molecular docking simulation indicated that tylophorine could form hydrogen bonds and aromatic interactions within the ATP-binding region of the VEGFR2 kinase unit — suggesting tylophorine may be a viable drug candidate in anti-angiogenesis and anti-cancer therapies.

Anti-Neuroinflammatory Mechanisms

T. indica leaf extracts have been shown to effectively suppress lipopolysaccharide (LPS)-induced microglial activation, migration, and subsequent neuroinflammatory responses. This anti-neuroinflammatory potential has been attributed to the presence of therapeutically important alkaloids such as tylophorine, tylophorinine, and tylophorinidine.

Scientific Evidence by Area of Use

1. Bronchial Asthma and Allergic Rhinitis

A systematic review of herbal medicines for asthma published in PubMed identified 17 randomized clinical trials, of which eight described traditional Indian medicine and five specifically investigated Tylophora indica. Nine of the 17 trials overall reported clinically relevant improvement in lung function and/or symptom scores. The systematic review concluded that no definitive evidence for any of the herbal preparations emerged, and called for urgently designed, stringently controlled, clinically relevant randomized clinical trials.

One clinical trial with asthma sufferers found that tylophora leaf (150 mg of the leaf by weight) chewed and swallowed daily in the early morning for six days led to moderate to complete relief of asthma symptoms. In a follow-up trial with asthma patients, an alcoholic extract of crude tylophora leaves in 1 gram of glucose had comparable effects to that of chewing the crude leaf. Another trial found similar success in reducing asthma symptoms using a tylophora leaf powder of 350 mg per day. However, the tylophora was not as effective as a standard asthma drug combination. One double-blind trial failed to show any effect on asthma for tylophora.

A crossover double-blind trial published in the Journal of Allergy (1969) by Shivpuri et al. enrolled 110 asthmatic patients randomized to receive either one fresh Tylophora indica leaf or a spinach-leaf placebo daily for six days. The distribution of 110 asthmatic patients taking tylophora or placebo leaves was explicitly described; spinach leaves were used as the placebo, and both were cut into small pieces by non-medical staff and assigned code names by a statistician unknown to the physicians. Each patient was given one leaf daily for six days only. Results showed benefit in the treatment group relative to placebo, though the trial was subsequently criticized for methodological limitations including the difficulty of blinding a preparation with active emetic side-effects.

A more recent preclinical study concluded that results from ex vivo, in silico, and in vivo experiments confirm the traditional use of T. indica as an antiasthmatic agent.

Overall, studies from the 1970s suggesting benefits of tylophora for asthma were often criticized for poor design. Subsequent well-designed trials reported mixed results, indicating a need for further research. Despite its long-standing use in traditional medicine, modern scientific evidence remains inconclusive regarding its anti-inflammatory and antiallergic effects.

2. Anti-Cancer Activity

Tylophorine is known to possess anti-inflammatory and antitumor activity, but its roles in tumor angiogenesis — the key step involved in tumor growth and metastasis — and the involved molecular mechanisms have been an area of ongoing investigation. Using tylophorine and analyzing its inhibitory effects on human umbilical vein endothelial cells (HUVECs) in vitro and in an Ehrlich ascites carcinoma (EAC) tumor model in vivo, researchers demonstrated that tylophorine significantly inhibited a series of VEGF-induced angiogenesis processes including proliferation, migration, and tube formation of endothelial cells. It also directly inhibited VEGFR2 tyrosine kinase activity and downstream signaling pathways including Akt, Erk, and ROS.

Tylophorine exhibits strong anti-inflammatory activity, while tylophorinidine is a potent antitumor alkaloid of Tylophora. Evidence strength: Anticancer data are entirely preclinical (in vitro cell line studies and animal models). No human clinical trials investigating T. indica or its isolated alkaloids as cancer treatments have been reported in the literature reviewed.

3. Anti-Inflammatory and Immunomodulatory Effects

Test-tube studies suggest that tylophorine can interfere with the action of mast cells, which are key components in the process of inflammation; these actions are thought to support its traditional use as an antiasthmatic and antiallergic medication by Ayurvedic practitioners. Tylophora has been recognized for immunomodulatory, hypoglycaemic, antiallergic, and antimicrobial properties. Evidence for immunomodulatory activity in humans is limited; most data derive from animal models and in vitro experiments.

4. Antimicrobial Activity

Literature reports that different plant parts of T. indica, especially the leaves, possess a wide range of activities against different Gram-positive and Gram-negative bacteria. Experimental observations suggest that methanolic extracts are more effective than aqueous extracts. Further studies are needed to fully explore the potential of T. indica extracts on various microbial pathogens. Antibacterial activity was investigated by the well-diffusion method against bacterial pathogens associated with HIV; plant extracts showed better inhibitory activity against the tested organisms, with the methanolic leaf extract showing the highest inhibitory activity compared with all treatments. Evidence strength: In vitro only; no controlled human clinical trials on antimicrobial applications have been identified.

5. Diarrhea and Dysentery

Some of the plant's traditional potentials — including antiasthmatic and antidysenteric properties — have been supported by animal models and clinical trials; however, its conventional uses such as contraceptive and anti-venom applications need further scrutiny. In vitro and in vivo pharmacological studies on T. indica have revealed its potential as an antidiarrheal agent. Evidence for antidiarrheal effects in humans is largely anecdotal or restricted to animal studies.

6. Anti-Neuroinflammatory Activity

The medicinal potency of this herb is attributed to both alkaloid and non-alkaloid constituents. The roots and leaves contain the active alkaloids tylophorine, tylophorinine, and anticancerous tylophorinidine, as well as non-alkaloid components including septidine, isotylocereberine, sterols, and flavonoids. Research has shown that T. indica leaf extracts can effectively suppress LPS-induced microglial activation, migration, and subsequent neuroinflammatory responses, an effect attributed to the alkaloids tylophorine, tylophorinine, and tylophorinidine. Evidence strength: Preclinical only (cell culture and animal models); no human data.

7. Other Investigated Activities

Different parts of the plant are attributed with anti-asthmatic, antibacterial, anti-psoriatic, antimicrobial, antiulcer, antiallergic, antidiarrhoeal, hypolipidemic, and anxiolytic properties. Antidiabetic, hepatoprotective, antiangiogenic, anti-tumor, antioxidant, anticonvulsant, anti-rheumatic, and diuretic activities are also attributed to the plant owing to the presence of various active phytochemicals. All of these additional activities are based on preclinical (in vitro or animal) evidence only, with no published controlled human trials identified in the available literature for these specific indications.

Body Systems and Health Areas

Respiratory system: The leaves of the plant are used in Indian Ayurvedic medicine for the treatment of asthma and bronchitis.
Immune system: Tylophorine possesses immunosuppressive and antifeedant activities.
Gastrointestinal system: The herb has been used for treating cough, asthma, respiratory problems, bronchitis, flatulence, profuse perspiration, constipation, and diarrhea.
Oncology (preclinical): Tylophorine exerts anti-angiogenic effects via the VEGFR2 signaling pathway, suggesting it may be a viable drug candidate in anti-angiogenesis and anti-cancer therapies.
Musculoskeletal system: The plant is traditionally used as a folk remedy in the treatment of asthma, allergy, jaundice, rheumatism, and other respiratory problems.
Nervous system (preclinical): Cell-based studies indicate T. indica leaf extracts could effectively suppress LPS-induced microglial activation, migration, and subsequent neuroinflammatory responses.
Integumentary system: People apply tylophora to the skin for skin ulcers and wounds.

Dosage Forms and Dosages Reported in Studies

One clinical trial employed 150 mg of the fresh leaf by weight, chewed and swallowed daily in the early morning for six days. In a follow-up trial, an alcoholic extract of crude tylophora leaves in 1 gram of glucose was used, with comparable effects to chewing the crude leaf. Some clinical trial reports have used 350 milligrams of tylophora leaf placed in a capsule, given once daily for seven days. Some experts have used tylophora leaf taken in the amount of 200–400 milligrams of dried herb daily. Tylophora in powder form at about 400–500 milligrams given once daily to asthmatic patients for six days has also been reported. Traditionally, doses of 250 milligrams 1–3 times daily, standardized to 0.1% of tylophorine per dose, have been used. One clinical trial also reports the use of 40 mg of alcoholic extract of Tylophora indica daily for six days; this alcoholic extract in 1 gram of glucose had comparable effects to chewing crude leaves.

Tylophora leaf — 200 to 400 mg of the dried leaf per day or 1 to 2 ml of tincture per day — has been used in practice for treating asthma.

Safety Considerations

Gastrointestinal and Sensory Side Effects

Patients using tylophora may experience temporary nausea and vomiting, soreness of the mouth, and loss of taste for salt, particularly with the fresh leaf and tincture preparations. Across multiple studies, it appears these symptoms — nausea, vomiting, mouth soreness, and alterations in taste sensation — are more common among participants who chew whole leaves rather than those taking dried leaves or powdered extract in capsule form. However, the therapeutic benefits of the herb are also reported to be reduced as side effects decrease.

Toxicological Data

Toxicology studies have shown that T. indica is generally safe; however, it may cause significant toxicities at higher doses. A hydroalcoholic extract of T. indica was found to be safe up to doses of 2000 mg/kg when administered orally, producing no toxicity in Wistar rats. In animal studies, a single dose (12–100 mg/kg) of pure alkaloids suspended in peanut oil caused indolence, salivation, respiratory obstruction, and diarrhea in male rats. The LD50 value of the alkaloid was investigated to be 35.32 mg/kg (Dikshith et al., 1990). Preliminary studies on animals found tylophora extracts to be toxic only at extremely high doses; these extracts were apparently safe in the far smaller doses needed to produce a therapeutic effect.

Potential Dermatitis Risk

A study claimed that the alkaloids tylophorine and tylophorinine from the plant might cause dermatitis as a side effect, but no skin testing report is evident from the available literature.

Populations Requiring Caution

The herb's safety for use during pregnancy and breast-feeding has not been established. Because of its immunomodulatory properties, T. indica may modulate the immune system unpredictably in persons with autoimmune conditions; concurrent use with immunosuppressant drugs requires caution.

Conservation Status

Indiscriminate collection of the plant from its natural habitat, low seed germination potential, and difficulty in propagation through vegetative cuttings have resulted in the rapid depletion of natural stands of this plant, giving it an endangered status. Due to overharvesting and poor seed germination, T. indica is facing conservation threats in its natural habitats. Modern propagation techniques, such as micropropagation and somatic embryogenesis, have contributed to efforts toward conservation and sustainable utilization of the species.

Overall Evidence Assessment

Some of the plant's potentials — particularly antiasthmatic and antidysenteric — have been supported by animal models and clinical trials; however, conventional uses such as contraceptive and anti-venom applications still need further scrutiny. Information about various aspects of T. indica pertaining to phytochemistry, toxicology, and quality control are still unresolved. Further in-depth studies are required to discover key features including structure–activity relationships, mode of action, safety and toxicity, and therapeutic potentials in clinical settings.

Dosing protocols vary widely among studies, and long-term safety data are scarce. Some debate lingers about optimal extraction methods — alcoholic versus aqueous — affecting alkaloid bioavailability. The existing clinical trials for asthma, though several in number, are predominantly small, of older design (primarily from the 1960s–1980s), and have been consistently noted for methodological limitations. No current regulatory authority (WHO, EMA, U.S. FDA) has issued a formal approved indication for T. indica or any of its isolated alkaloids as medicinal agents.

References

Health Conditions

Health conditions that Indian ipecac may help support.

No conditions available.

Body Systems

Body systems that Indian ipecac may help support.

No body systems available.