title: Xysmalobium undulatum (uzara) - review of an antidiarrhoeal traditional medicine.
abstract: BACKGROUND
  Xysmalobium undulatum, commonly known as uzara, is traditionally used as an antidiarrhoeal and to treat stomach cramps, dysmenorrhoea and afterbirth cramps. In addition, it was reportedly used to treat anxiety and other conditions relating to mental health.
  
  
  OBJECTIVE
  To unite the botanical aspects, ethnopharmacology, phytochemistry, biological activity, pharmacokinetic and pharmacodynamic data, toxicity and commercial aspects of the scientific literature available on uzara.
  
  
  METHODS
  An extensive review of the literature covering 1917-2014 was carried out. Electronic databases including Scopus, Pubmed, Google Scholar and Google were used to assemble the data. All abstracts, full-text articles and books written in English and German were examined and included.
  
  
  RESULTS
  The phytochemistry of uzara has been comprehensively investigated and at least 18 compounds have been isolated and characterised. Uzara contains mainly cardenolide glycosides such as uzarin and xysmalorin and cardenolide aglycones such as uzarigenin and xysmalogenin. Limited scientific studies on the biological activity of uzara have been done. In vitro antisecretory antidiarrhoeal action was confirmed. Central nervous system activity was conflicting, in vitro and in vivo (animals) studies were inconclusive and no clinical studies have been performed. No antimutagenic effects have been reported and no toxicity up to date has been associated with uzara consumption. Significant cross-reactivity of uzara compounds with commercial digoxin and digitoxin assays may interfere with therapeutic drug monitoring.
  
  
  CONCLUSIONS
  The key traditional uses associated with uzara have been investigated in vitro and in vivo (animal), but clinical trial data is lacking.
authors.affiliation: Department of Pharmaceutical Sciences, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa.
authors.forename: Ilze
authors.initials: I
authors.lastname: Vermaak
authors.affiliation: Department of Pharmaceutical Sciences, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa.
authors.forename: Gill M
authors.initials: GM
authors.lastname: Enslin
authors.affiliation: Department of Pharmaceutical Sciences, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa.
authors.forename: Thomas O
authors.initials: TO
authors.lastname: Idowu
authors.affiliation: Department of Pharmaceutical Sciences, Faculty of Science, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa. Electronic address: viljoenam@tut.ac.za.
authors.forename: Alvaro M
authors.initials: AM
authors.lastname: Viljoen
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology; D000930:Antidiarrheals / Q000737:chemistry / Q000627:therapeutic use; D029062:Apocynaceae; D002301:Cardiac Glycosides / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D002491:Central Nervous System Agents / Q000737:chemistry / Q000627:therapeutic use; D006027:Glycosides / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008519:Medicine, Traditional; D008517:Phytotherapy; D028321:Plant Preparations / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D018517:Plant Roots; D013329:Structure-Activity Relationship; D014945:Wound Healing / Q000187:drug effects
chemical_list: D000890:Anti-Infective Agents; D000930:Antidiarrheals; D002301:Cardiac Glycosides; D002491:Central Nervous System Agents; D006027:Glycosides; D028321:Plant Preparations
keywords: Central nervous system; Diarrhoea; Digitoxin; Digoxin; Uzara; Xysmalobium undulatum