Kalanchoe pinnatum

Other Names

Air plantBalangbanBaumgartenia soboliferaBrujaBryophyllum calcicolaBryophyllum calycinumBryophyllum germinansBryophyllum pinnatumBryophyllum pinnatum subsp. simplicifoliumBryophyllum pinnatum var. calcicolumCalanchoe pinnataCathedral bellsChou de faffeClapper bushCoeranaCoiramaCoirama-brancaCoirama-bravaCotyledon calycinaCotyledon calyculataCotyledon pinnataCotyledon rhizophyllaCrassula pinnataCrassuvia floripendiaCrassuvia floripendulaCrassuvia floripenulaCurtain plantDipartengaErva-da-costaFalatanantsifaonaFarine chaudeFloppersFlor de aireFolha-da-costaFolha-da-fortunaFolha-grossaGoethe plantGreen loveGros pourpier clochetteHerbe tortueHoja de aireKalabanaKalanchoe brevicalyxKalanchoe calcicolaKalanchoe calycinumKalanchoe floripendulaKalanchoé pennéKalanchoe pinnataKalanchoe pinnata var. brevicalyxKalanchoe pinnata var. calcicolaKalanchoe pinnata var. floripendulaKalanchoe pinnata var. genuinaKataka-takaKatakatakaLeaf-of-lifeLeeveltar RolaLife leafLife plantLive foreverMalainanaMangé-tortueManger tortueMeawaniMexican loveplantMiracle leafMotta pattiNever-deadOliwa ka kahakaiOliwa ku kahakaiPalpokPara-tudoPashipadehPatte de poulePatte de poule tortuePirarucuPotagojaRendadiakaSaiãoSaiaoSedum madagascarienseSiempre vivaSodifafanaSoudefafTsilafafaVerea pinnataVereia pinnataZeb maltet

Synopsis

Kalanchoe pinnata (Lam.) Pers.

1. Identity

Nomenclature and Taxonomy

Kalanchoe pinnata, commonly known as cathedral bells, air plant, life plant, miracle leaf, and love bush, is a succulent plant native to Madagascar. It is botanically classified with two main Latin names which refer to the same plant: Bryophyllum pinnatum and Kalanchoe pinnatum, as well as various synonyms of both. The accepted name is Bryophyllum pinnatum (Lam.) Pers., with B. calycinum and Kalanchoe pinnata recorded as its botanical synonyms.

The plant belongs to the family Crassulaceae. Throughout the world, it is popularly known as "saião" and "coirama" in Brazil, "folha-de-pirarucu" in Pará State, "fortuna" and "roda-da-fortuna" in Minas Gerais, "zakham-hayat" in Asia and Africa, "life-plant" in Mexico, and "love-plant," "Canterbury bells," and "cathedral bells" in the United States and Europe. In the Philippines it is known as katakataka or kataka-taka, which is also an adjective meaning "astonishing" or "remarkable."

Botanical Description and Distribution

Kalanchoe pinnata is a succulent perennial plant that grows 3–5 feet tall, with tall hollow stems, fleshy dark green leaves that are distinctively scalloped and trimmed in red, and bell-like pendulous flowers. The species is distinctive for the profusion of miniature plantlets that form on the margins of its leaves. The leaves of this species are thick, fleshy, elliptical in shape, curved, with a crenate or serrated margin, often reddish.

The plant has become naturalized in temperate regions of Asia, Australia, New Zealand, West Indies, Macaronesia, Mascarenes, Galápagos, Melanesia, Polynesia, and Hawaii. In many of these, such as Hawaii, it is regarded as an invasive species.

Common Preparations and Dosage Forms

Typically, all parts of the plant are used for medicinal purposes either as crude extract or juice. Preparations documented in the scientific and ethnobotanical literature include fresh leaf juice (press juice), aqueous decoctions, methanolic and hydroalcoholic extracts, poultices of crushed leaves, standardized dried leaf powder, and chewing tablets made from leaf press juice. The pharmaceutical characterization of the press juice of fresh (or fresh frozen) B. pinnatum leaves, which is the component of chewing tablets manufactured as blinded capsules (leaf press juice 50% on lactose), revealed the presence of flavonoids, cinnamic acid derivatives and bufadienolides.

2. Traditional and Historical Use

Africa and Madagascar

Species of the genus Kalanchoe have a long history of therapeutic use in ethnomedicine linked to their remarkable healing properties. The plant is widely used in folk medicine for treating burns, stopping bleeding, and alleviating inflammation. In West Africa, documented ethnobotanical records indicate local healers applied crushed leaves topically to boils and abscesses — a practice similar to that recorded in South Asian traditions.

South and Southeast Asia

In the Indian subcontinent, the plant has been incorporated into Ayurvedic and folk medicine practices. Conventionally, it is used for the treatment of fever, constipation, nourishment of the hair and treating grey hair, intestinal disorder, and leucorrhea. Traditional uses include treating fever, smallpox, otitis, cough, asthma, headache, convulsion, and general debility. The plant is also widely distributed in the Philippines, where it is known as katakataka.

South America, the Amazon, and the Caribbean

Throughout South America, Kalanchoe has had a long history of use. It is commonly called the "miracle leaf" and "life leaf" for its remarkable healing properties. In Brazil, the plant is considered a sedative, wound-healer, diuretic, anti-inflammatory and cough suppressant.

In Peru, indigenous tribes mix the leaf with aguardiente (sugar cane rum) and apply the mixture to the temples for headaches; they soak the leaves and stems overnight in cold water and then drink it for heartburn, urethritis, and fevers. The root is also prepared as an infusion and used for epilepsy. Other tribes in the Amazon squeeze the juice from fresh leaves and mix it with mother's milk for earaches. For the people of the Amazon, the Creoles use it roasted against inflammations and cancer and as an infusion as a popular remedy for fevers. The Palikur people of Brazil and French Guiana apply a preparation of the juice of Kalanchoe leaves mixed with coconut oil to their foreheads to treat headache.

Bryophyllum pinnatum has been recorded in Trinidad and Tobago as being used as a traditional treatment for hypertension.

Anthroposophic Medicine in Europe

In 1970, B. pinnatum was introduced in obstetrics at the anthroposophic Herdecke Community Hospital in Germany for the treatment of preterm labor. Bryophyllum pinnatum has since been introduced more broadly into anthroposophic medicine in Europe and is nowadays also widely used in conventional medicine in certain Swiss and German clinical settings.

General Preparation Methods in Traditional Contexts

Leaves have been used in the form of decoction, syrup, juice, poultice, and maceration. The extract of B. pinnatum leaves has been used for the treatment of severe disorders such as gastritis, ulcers, cough, bronchitis, various bacterial, viral and fungal infections, leishmaniasis, pain, and inflammation. There are, however, no reports in the scientific literature that describe specific amounts of plant or dosages for ethnomedicinal uses.

3. Key Constituents and Active Compounds

Overview of Phytochemical Classes

Altogether, 620 phytochemicals have been reported from K. pinnata, belonging to various classes such as bufadienolides, flavonoids, triterpenoids, volatile compounds, organic acids, and others. The various secondary metabolites identified from B. pinnatum include steroids, flavonoids, terpenoids, fatty acids, bufadienolides, proteins and peptides, vitamins, polysaccharides, and others.

Bufadienolides

Toad venom is regarded as the main source of bufadienolides; however, synthesis of these substances also takes place in a variety of other animal and plant organisms, including ethnomedicinal plants of the Kalanchoe genus. Chemically, bufadienolides are a group of polyhydroxy C-24 steroids and their glycosides, containing a six-membered lactone (α-pyrone) ring at the C-17β position. Bufadienolide compounds isolated from Bryophyllum pinnatum include bryophillin A, bersaldegenin-3-acetate, and bryophillin C; bryophillin C also showed insecticidal properties. From the pharmacological point of view, bufadienolides might be a promising group of steroid hormones with cardioactive properties and anticancer activity. Most of the literature indicates that the medicinal use of these compounds remains limited by their narrow therapeutic index and the risk of cardiotoxic effects.

Flavonoids

Among the constituents identified so far, flavonoids represent the class of secondary metabolites most commonly found, being the major component. For B. pinnatum, quercetin, kaempferol, and luteolin aglycones have been found. An aqueous extract of the leaves disclosed the presence of quercitrin, a kaempferol glycoside known as kampinnatoside, and kaempferol 3-O-α-L-arabinopyranosyl(1→2)-α-L-rhamnopyranoside, with some degree of anti-leishmanial activity. Flavonoids have been linked to pharmacological activities of the plant such as anticancer, antileishmanial, anti-inflammatory, and wound healing effects.

Triterpenoids, Organic Acids, and Other Compounds

Phytochemical studies of Kalanchoe pinnata have identified the presence of triterpenes, steroids, phenanthrene, flavonoids, flavones, chalcones, taraxasterol, aurones, phenolic acids, caffeic acid, syringic acid, malic, oxalic, and ferulic acids. Active compounds identified in K. pinnata extract include malic, p-hydroxybenzoic, syringic, and caffeic acids, each demonstrating 2.70 to 4.65 wt% inhibition in synthetic urine crystal growth experiments.

The medicinal plant contains ascorbic acid (26.42–44.03 mg/100 g), riboflavin (0.20–0.42 mg/100 g), thiamine (0.11–0.18 mg/100 g), and niacin (0.02–0.09 mg/100 g). These herbs are also noted as good sources of minerals such as Ca, P, K, Mg, Na, Fe, and Zn.

Established Mechanisms of Action

Smooth muscle relaxation (uterine and vesical): In vitro work with hTERT human myometrial cells showed that B. pinnatum leaf press juice inhibits the increase of intracellular free calcium concentration induced by oxytocin, a hormone known to play a role in labor. In the development of new tocolytic agents, a simultaneous inhibition of the immediate calcium-mediated canonical pathway and of the activation of MAPK-dependent pathways in the myometrium is nowadays seen as a required pharmacological profile. The present data show that B. pinnatum matches these requirements, which in turn further substantiates its use in the treatment of preterm labor.

Bufadienolide-mediated cardiac glycoside-like action: Bufadienolides inhibit Na-K adenosine triphosphatase (ATPase) activity in the myocardial cell membrane, increasing intracellular sodium and decreasing intracellular potassium, which results in reduction of the normal membrane resting potential. Normal electrical conduction is inhibited, and there is a decrease in the ability of the myocardium to act as a pacemaker, ultimately leading to potential loss of normal myocardial electrical function.

Anti-leishmanial via nitric oxide: Published research indicates the anti-leishmanial effect of Kalanchoe is mediated by nitric oxide intermediates (Da-Silva et al., 1999, cited in peer-reviewed literature).

Anti-inflammatory and antinociceptive: The different flavonoids, polyphenols, triterpenoids, and other chemical constituents of the herb are speculated to account for the observed antinociceptive, anti-inflammatory, and antidiabetic properties of the plant.

Antiurolithic (crystal inhibition): Calcium oxalate crystal nucleation, growth, and aggregation are inhibited by phytochemicals found in K. pinnata, such as flavonoids, saponins, and glycosides. This stops new stone formation and decreases the size of existing stones.

4. Scientific Evidence by Area of Use

4.1 Obstetrics — Preterm Labor (Tocolysis)

This is the area with the most substantial human clinical data for B. pinnatum.

Retrospective matched cohort: In a retrospective study, 67 pairs of pregnant women in preterm labor treated with intravenous B. pinnatum or beta-agonists were closely matched for maternal age, gestational age at tocolysis, CTG recorded contractions, cervical effacement, preterm premature rupture of the membranes, and history of preterm labor. Endpoints included prolongation of pregnancy, gestational age at delivery, and neonatal outcome. Pregnant women receiving B. pinnatum and beta-agonists were equal in prolongation of pregnancy (6.2 versus 5.4 days, not significant) and gestational age at delivery (38.0 versus 37.1 weeks, not significant), but had significantly fewer adverse effects. The conclusion was that B. pinnatum is no less effective than beta-agonists, but is significantly better tolerated.

Multicenter prospective observational study: Private practices and clinics for obstetrics and gynaecology in Switzerland were asked to document each prescription of B. pinnatum during 31 months using an online questionnaire. At the University Hospital Zurich, the Cantonal Hospital Winterthur, and two private practices, a total of 174 women and 208 prescriptions were recorded. Most patients were pregnant (87%). B. pinnatum was prescribed as a tocolytic agent to 83% of all patients and to 95% of all pregnant patients, and showed good or very good effectiveness.

Randomized controlled trials: Two randomized clinical trials on the use of Bryophyllum pinnatum in preterm labour were conducted; however, they reported results after early discontinuation (Complement Med Res, 2018). The clinical trial for preterm labor with Bryophyllum pinnatum was withdrawn early due to lack of patient enrollment. The absence of a fully completed large RCT limits the strength of this evidence to preliminary or moderate level.

Mechanism supporting tocolytic use: Experimental results support the use of B. pinnatum juice-based preparations in the treatment of preterm labor, where both oxytocin and vasopressin play important roles.

Evidence strength: Moderate — supported by a retrospective matched cohort, observational clinical data, and mechanistic in vitro studies; however, no completed large-scale RCT exists.

4.2 Urology — Overactive Bladder

Preclinical: In vitro experiments of Bryophyllum pinnatum on porcine bladder muscle have shown a muscle-relaxing effect. A study at the University Hospital Zurich investigated the inhibitory effects of leaf press juice on porcine bladder strips compared to oxybutynin (Schuler et al., 2012, Phytomedicine).

Randomized controlled trial (pilot): A prospective, double-blind randomized, placebo-controlled pilot study enrolled 20 patients (10 B. pinnatum, 10 placebo) and administered medication over 8 weeks at a dosage of 3 × 2 capsules B. pinnatum 50% (350 mg) per day or placebo (lactose). The primary aim was reduction of micturition frequency per 24 hours; secondary aims included change in quality of life and adverse events.

Additionally, a multicentre, non-randomised prospective trial examined Bryophyllum pinnatum and improvement of nocturia and sleep quality in women (Mirzayeva et al., 2023, Evidence-Based Complementary and Alternative Medicine).

Evidence strength: Preliminary — pilot RCT and observational data only; small sample sizes preclude definitive conclusions.

4.3 Urology — Kidney Stones (Urolithiasis)

Bryophyllum pinnatum leaves are commonly used in traditional and ethnomedical practice to treat urinary insufficiency and stone disorders. In traditional medicine, the juice of the leaves is also used for kidney stones; although there is ongoing research into and some scientific evidence for this use, further research is required.

In vitro studies: In vitro studies were conducted in supersaturated and artificial urine solutions to evaluate the antiurolithic properties of K. pinnata leaf extract on calcium oxalate monohydrate (COM) and surgically extracted kidney stones. Key organic acids present in the plant extract were also examined to investigate inhibition of kidney stone formation. Crystal growth in supersaturated solutions and artificial urine was inhibited by 41 and 15 wt% respectively, and COM and kidney stone mass decreased.

Preclinical animal studies: In ethylene glycol-induced urolithiatic rat models, treatment with K. pinnata resulted in marked reductions in serum urea, uric acid, and creatinine levels, along with notable improvements in renal histoarchitecture.

Evidence strength: Preliminary — in vitro and animal data only; no human clinical trials have been conducted on this specific indication.

4.4 Anti-inflammatory and Analgesic Effects

Animal studies: In order to scientifically appraise some of the ethnomedical uses of Bryophyllum pinnatum leaves, a study was undertaken to investigate the antinociceptive, anti-inflammatory and antidiabetic properties of the plant's leaf aqueous extract in experimental animal models. The antinociceptive effect was evaluated by the "hot-plate" and "acetic acid" test models of pain in mice. The anti-inflammatory effects were investigated in rats using fresh egg albumin-induced pedal (paw) oedema, with diclofenac (100 mg/kg) and chlorpropamide (250 mg/kg) used as reference drugs. Bryophyllum pinnatum leaf aqueous extract (BPE, 25–800 mg/kg i.p.) produced significant (P < 0.05–0.001) antinociceptive effects against thermally- and chemically-induced nociceptive pain stimuli in mice. The plant extract also significantly (P < 0.05–0.001) inhibited fresh egg albumin-induced acute inflammation. The results of this experimental animal study suggest that the aqueous extract possesses antinociceptive, anti-inflammatory, and hypoglycaemic properties.

Evidence strength: Preliminary — animal and in vitro data only; no human clinical trials have been completed for inflammation or pain indications.

4.5 Antidiabetic Effects

The plant has a major impact on diabetes, especially type II diabetes. Preclinical data have demonstrated hypoglycaemic effects in streptozotocin-induced diabetic rat models (Ojewole, 2005, Journal of Ethnopharmacology). Despite encouraging findings, clinical data remain scarce.

Evidence strength: Weak to preliminary — animal models only; no human clinical trials have established efficacy for diabetes.

4.6 Anti-leishmanial Activity

Kalanchoe pinnata (= Bryophyllum pinnatum) is a perennial medicinal herb popularly used in Brazil and other parts of the world to treat various inflammatory diseases; unusual flavonoids including kaempferol 3-O-α-L-arabinopyranosyl(1→2)α-L-rhamnopyranoside, quercetin 3-O-α-L-arabinopyranosyl(1→2)α-L-rhamnopyranoside and 4′,5-dihydroxy-3′,8-dimethoxyflavone 7-O-β-D-glucopyranoside have been identified from the plant and assessed for antileishmanial activity. The quercetin aglycone–type structure, as well as a rhamnosyl unit linked at C-3, seem to be important for antileishmanial activity. Quercitrin, identified in this plant, demonstrated some degree of anti-leishmanial activity.

Evidence strength: Preliminary — in vitro studies only; no controlled clinical trials on leishmaniasis have been conducted.

4.7 Antimicrobial Activity

Studies have evaluated cytotoxic and antimicrobial activities of Kalanchoe species extracts against different human cancer cell lines and bacteria and yeast strains including β-hemolytic Streptococcus, Staphylococcus aureus, Corynebacterium diphtheriae, Enterococcus hirae, Escherichia coli, and Candida albicans. Significant activity was observed for the ethanol extract of K. pinnata; however, this extract showed only significant microbiological effect, while the cytotoxic effect towards the cancer cell lines was weak.

Evidence strength: Preliminary — in vitro data only; no clinical antimicrobial trials exist for this plant.

4.8 Anticancer / Cytotoxic Activity

Bufadienolides isolated from leaves of K. pinnata and K. daigremontiana × tubiflora are able to inhibit the activation of Epstein-Barr virus early antigen (EBV-EA) in Raji cells, induced by 12-O-tetradecanoylphorbol-13-acetate. B. pinnatum exhibits noteworthy significance in oncological research by exhibiting its ability to modify numerous pathways, which may suggest a potential anticancer impact. However, all anticancer evidence is restricted to cell line and animal studies.

Evidence strength: Very preliminary — cell line (in vitro) and animal data only; no human oncology trials have been reported.

4.9 CNS Effects (Sedative / Anticonvulsant)

Radford et al. investigated that the CNS depressant activity of aqueous leaf extract could be due to the presence of bufadienolide and other water-soluble constituents in the extract. Kalanchoe has also shown sedative and central nervous system depressant actions in animal studies.

Evidence strength: Preliminary — animal studies only.

4.10 Dysmenorrhea and Related Gynecological Conditions

A systematic scoping review and case series examined the repurposing of Bryophyllum pinnatum for dysmenorrhea treatment (Zurfluh et al., 2023, Frontiers in Pharmacology). This represents an emerging area of clinical investigation.

Evidence strength: Very preliminary — case series and scoping review only.

5. Body Systems Associated with Kalanchoe pinnata

Reproductive/Obstetric system: Tocolysis (preterm labor inhibition), dysmenorrhea, overactive bladder in postmenopausal women
Urinary system: Kidney stone prevention and dissolution, overactive bladder, urinary tract infections (traditional)
Immune system: Immunomodulatory and immunosuppressive effects documented in animal models
Musculoskeletal/Inflammatory system: Anti-inflammatory and antinociceptive effects in preclinical models
Endocrine/Metabolic system: Antidiabetic (hypoglycaemic) effects in animal models
Cardiovascular system: Antihypertensive effects in animal models; risk of cardiotoxicity at higher doses via bufadienolide content
Gastrointestinal system: Anti-ulcer activity demonstrated in experimental animals; traditional uses for gastritis and heartburn
Dermatological/Wound healing: Traditional poultice use for burns, wounds, and boils; some preclinical wound healing data
Nervous system: Sedative and CNS depressant effects in animal models; case series for restless legs syndrome
Infectious disease: Antileishmanial, antimicrobial, and antiviral activities in vitro

6. Dosage Forms and Reported Dosages

In the randomized controlled trial for overactive bladder, the medication was administered at a dosage of 3 × 2 capsules B. pinnatum 50% (350 mg) per day or placebo (lactose) over 8 weeks.

In the J. Ethnopharmacology animal study by Ojewole (2005), Bryophyllum pinnatum leaf aqueous extract (BPE) was used at doses of 25–800 mg/kg i.p.

There are no reports in the scientific literature that describe the amounts of plant or standardized dosages for ethnomedicinal uses. Dose standardization across clinical preparations — whether as tablets, capsules, press juice, or decoctions — has not been established in large-scale clinical trials.

7. Safety Considerations and Interactions

Bufadienolide-Mediated Cardiotoxicity

The primary toxic principles of Kalanchoe spp. are cardiotoxic bufadienolides present in all parts of the plant. These compounds are related to the same cardiotoxic agents responsible for toxicity of Bufo spp. toads and have a mechanism of action similar to digoxin. Bufadienolides inhibit Na-K adenosine triphosphatase (ATPase) activity in the myocardial cell membrane, increasing intracellular sodium and decreasing intracellular potassium, which results in reduction of the normal membrane resting potential. The medicinal use of these compounds remains limited by their narrow therapeutic index and the risk of development of cardiotoxic effects.

Bufadienolides and phenanthrene are recognized as toxic compounds. Two calves fed for 48 hours with K. pinnata have been reported to have died due to ataxia and severe cardiac arrhythmia.

Clinical Signs of Toxicosis

Clinical signs of Kalanchoe species toxicosis include depression, excessive salivation, and gastrointestinal upset, and generally occur beginning a few hours after plant ingestion. The glycosides in Kalanchoe species can also act directly on the gastrointestinal tract, causing hemorrhagic enteritis, abdominal pain, and diarrhea. Hyperkalemia occurs, especially in severe toxicosis.

Potential Immunosuppressive Effects

Long-term use should be approached with caution because of potential immunosuppressant effects documented in preclinical studies. This immunosuppressive activity has been demonstrated in murine models using aqueous extract (Bergmann et al., 2006, as cited in multiple reviews).

Potential Drug Interactions

Given the digitalis-like mechanism of bufadienolides, clinically relevant pharmacodynamic interactions are plausible with: cardiac glycosides (e.g., digoxin), antiarrhythmic agents, and drugs affecting electrolyte balance (diuretics). Concerns have been raised regarding toxicity, dosage standardization, and herb–drug interactions. No human pharmacokinetic drug interaction studies have been published to date.

General Safety Profile in Human Studies

In the Swiss clinical studies using standardized leaf press juice preparations, pregnant women receiving B. pinnatum showed significantly fewer adverse effects compared to those receiving beta-agonists for preterm labor. However, these observations apply specifically to the standardized, low-dose pharmaceutical preparations used in that context and should not be extrapolated to unprocessed plant preparations or higher doses.

References

Health Conditions

Health conditions that Kalanchoe pinnatum may help support.

No conditions available.

Body Systems

Body systems that Kalanchoe pinnatum may help support.

No body systems available.