Note: This monograph does not include okra (Abelmoschus esculentus, formerly classified as Hibiscus esculentus) or Norfolk Island hibiscus (Lagunaria patersonii).
Background
The Hibiscus genus contains several species, many of which have been used medicinally. For instance, Hibiscus rosa-sinensis has been documented in the ancient Indian scriptures. Hibiscus sabdariffa has been used as a folk medicine in Canada, and appears promising in treatment of hypertension (high blood pressure). Hibiscus cannabinus has been studied to treat head lice, although there is currently insufficient available evidence in this area.
Hibiscus sabdariffa and compounds isolated from it (for example, anthocyanins and hibiscus protocatechuic acid) are likely candidates for future studies. There is limited reported safety data about hibiscus, although it is popularly used as a tea.
Based on ethnobotanical study, Hibiscus tiliaceus has been used throughout the Vanuatu archipelago to speed childbirth. Hibiscus sabdariffa L., has been used as a folk medicine in Canada. Hibiscus rosa-sinensis has been documented to have been used for several ailments in the ancient Indian scriptures.
Evidence
DISCLAIMER:
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Hypertension (high blood pressure):
Extracts of hibiscus may lower the systolic and diastolic pressure. Additional studies are needed to confirm these results, although the use of hibiscus for lowering blood pressure looks promising.
Grade: B
Lice:
Currently, there is limited available evidence evaluating the effects of hibiscus for the treatment of lice. Additional study is warranted in this area.
Grade: C
Tradition
WARNING:
DISCLAIMER:
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below. Antibacterial (melioidosis), antifungal, antioxidant, antipyretic (fever reducer), antiviral, atherosclerosis (hardening of the arteries), cancer, contraceptive, flavoring agent, hypercholesterolemia (high cholesterol), leukemia, liver diseases, liver protection, pain (antinociceptive), renal stone disease, weight loss.
Dosing
Adults (18 years and older):
There is no proven effective dose for hibiscus, although an herbal infusion prepared with 10 grams of dry calyx from Hibiscus sabdariffa with 0.51 water (9.6mg anthocyanins content), daily before breakfast showed similar results as captopril 25 milligrams twice a day for four weeks.
Children (younger than 18 years):
There is no proven safe or effective dose for hibiscus in children.
Safety
DISCLAIMER:
Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.
Allergies
Avoid in individuals with a known allergy or hypersensitivity to hibiscus, its constituents, or members of the Malvaceae family. Reported allergy symptoms include skin rash and hives.
Side Effects and Warnings
There is limited reported safety data about hibiscus, although it is popularly used as a tea.
Although not well studied in humans, excessive doses of hibiscus for relatively long periods may have antifertility effects. One study found that hibiscus tea contained polycyclic aromatic hydrocarbons (PAHs). PAHs have been associated with birth defects and cancer. The sources of PAHs in food are predominantly from environmental pollution and food processing. Use cautiously in patients with hypertension or hypotension (high or low blood pressure), as hibiscus may lower blood pressure.
Pregnancy and Breastfeeding
Hibiscus is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence. However, Hibiscus tiliaceus has been used throughout the Vanuatu archipelago to speed childbirth. In theory, excessive doses of hibiscus for relatively long periods may have antifertility activity, and caution is advised.
Interactions
Interactions with Drugs
Although not well studied in humans, hibiscus may have anticancer effects. Thus, caution is advised when taking hibiscus with other anticancer agents.
Extracts of hibiscus may lower the systolic and diastolic pressure. Patients taking blood pressure lowering agents should use hibiscus cautiously due to additive effects. Consult with a qualified healthcare professional, including a pharmacist, to check for interactions.
Zobo drink (made from hibiscus) may change the way certain anti-inflammatory agents, such as acetaminophen, are processed in the body. Caution is advised when taking anti-inflammatory agents and hibiscus within a two-hour period of one another.
Antiviral effects have been observed in preliminary laboratory study. In theory, hibiscus taken with other antiviral agents may have additive effects.
Hibiscus rosa-sinensis may have estrogenic activity, although the clinical significance is unclear. Use hibiscus cautiously in patients taking hormone altering agents, such as hormone replacement therapy or birth control pills.
Interactions with Herbs and Dietary Supplements
Although not well studied in humans, hibiscus may have anticancer effects. Thus, caution is advised when taking hibiscus with other anticancer agents.
Extracts of hibiscus may lower the systolic and diastolic pressure. Patients taking herbs that lower blood pressure should use hibiscus cautiously due to additive effects. Consult with a qualified healthcare professional, including a pharmacist, to check for interactions.
In theory, Karkadi beverage (Hibiscus sabdarifa) may reduce the efficacy of antimalarial herbs and supplements.
Antiviral effects have been observed in preliminary laboratory study. In theory, hibiscus taken with other herbs with antiviral activity may have additive effects.
Hibiscus rosa-sinensis may have estrogenic activity, although the clinical significance is unclear. Use hibiscus cautiously in patients taking hormone altering herbs or supplements.
Attribution
This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): J. Kathryn Bryan, BS (Natural Standard Research Collaboration); Nicole Giese, MS (Natural Standard Research Collaboration); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration).
Bibliography
DISCLAIMER:
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Ali BH, Al Wabel N, Blunden G. Phytochemical, pharmacological and toxicological aspects of Hibiscus sabdariffa L.: a review. Phytother Res 2005;19(5):369-375.
Brunold C, Deters A, Knoepfel-Sidler F, et al. Polysaccharides from Hibiscus sabdariffa flowers stimulate proliferation and differentiation of human keratinocytes. Planta Med. 2004;70(4):370-373.
Chang YC, Huang HP, Hsu JD, et al. Hibiscus anthocyanins rich extract-induced apoptotic cell death in human promyelocytic leukemia cells. Toxicol Appl Pharmacol 6-15-2005;205(3):201-212.
Chen JJ, Huang SY, Duh CY, et al. A new cytotoxic amide from the stem wood of Hibiscus tiliaceus. Planta Med 2006;72(10):935-938.
El Basheir ZM, Fouad MA. A preliminary pilot survey on head lice, pediculosis in Sharkia Governorate and treatment of lice with natural plant extracts. J.Egypt.Soc.Parasitol. 2002;32(3):725-736.
Frank T, Janssen M, Netzel M, et al. Pharmacokinetics of anthocyanidin-3-glycosides following consumption of Hibiscus sabdariffa L. extract. J Clin Pharmacol 2005;45(2):203-210.
Herrera-Arellano A, Flores-Romero S, Chavez-Soto MA, et al. Effectiveness and tolerability of a standardized extract from Hibiscus sabdariffa in patients with mild to moderate hypertension: a controlled and randomized clinical trial. Phytomedicine. 2004;11(5):375-382.
Hou DX, Tong X, Terahara N, et al. Delphinidin 3-sambubioside, a Hibiscus anthocyanin, induces apoptosis in human leukemia cells through reactive oxygen species-mediated mitochondrial pathway. Arch Biochem Biophys. 8-1-2005;440(1):101-109.
Kim MS, Kim JK, Kim HJ, et al. Hibiscus extract inhibits the lipid droplet accumulation and adipogenic transcription factors expression of 3T3-L1 preadipocytes. J.Altern.Complement Med. 2003;9(4):499-504.
Lin HH, Huang HP, Huang CC, et al. Hibiscus polyphenol-rich extract induces apoptosis in human gastric carcinoma cells via p53 phosphorylation and p38 MAPK/FasL cascade pathway. Mol Carcinog. 2005;43(2):86-99.
Muthu SE, Nandakumar S, Rao UA. The effect of methanolic extract of Tamarindus indica Linn. on the growth of clinical isolates of Burkholderia pseudomallei. Indian J Med Res 2005;122(6):525-528.
Tseng TH, Lee YJ. Evaluation of natural and synthetic compounds from East Asiatic folk medicinal plants on the mediation of cancer. Anticancer Agents Med Chem 2006;6(4):347-365.
Tseng TH, Kao TW, Chu CY, et al. Induction of apoptosis by hibiscus protocatechuic acid in human leukemia cells via reduction of retinoblastoma (RB) phosphorylation and Bcl-2 expression. Biochem.Pharmacol. 8-1-2000;60(3):307-315.
Varavithya V, Phongkitkarun S, Jatchavala J, et al. The efficacy of roselle (Hibicus sabdariffa Linn.) flower tea as oral negative contrast agent for MRCP study. J Med Assoc Thai 2005;88 Suppl 1:S35-S41.
Wu PL, Wu TS, He CX, et al. Constituents from the stems of Hibiscus taiwanensis. Chem Pharm Bull (Tokyo) 2005;53(1):56-59.
Remember, keep this and all other medicines out of the reach of children,
never share your medicines with others, and use this medication only for the indication prescribed.
