Aloe barbadensis Mill

01 Identity and provenance

Accepted binomial: Aloe barbadensis Mill
Common names: Aloe Vera
Family (APG IV): Asphodelaceae
Part used: Leaves
Verification tier: Tier 2 · Verified Clinical columns reviewed and a source is on record.
Reviewer note (2026 audit): CORRECTED - Chemical composition / class: Lupeol is a pentacyclic triterpenoid, not a phytosterol.
Reference not supplied - claim unverified against primary literature.

02 Constituent chemistry

Chemical class	Marker compound	Synthetic analogue in use
polysaccharide	Acemannan, glucomannan Leaves	carboxymethyl cellulose, HPMC, PVA, PEG, Hyaluronic acid
Triterpenoid	Lupeol Leaves	none
Anthraquinone	Aloe-emodin Leaves	none
Anthraquinone Glycoside	Aloin (Barbaloin) Leaves	none

The analogue column is what makes the interaction reasoning tractable: where a constituent has a marketed structural counterpart, the counterpart's interaction profile is the starting hypothesis for the plant.

Looking up structures and physicochemical properties from PubChem…

03 Stated application

Reported activity: Topical creams and ointments, oral drug delivery
Anti-inflammatory, wound healing, bowel disease, anti cancer
laxative, antioxidant
Marketed in: Topical gel : patanjali, Himalya Oral juice: Kapiva, Dabur, Forever
capsule, tablet
Reported adverse effects: hypoglycemia, fall in blood pressure,dizziness
hypokalemia, dehydration, muscle weakness, diarrhea

04 Interaction matrix

Source column, verbatim: Antidiabetic drugs, antihypertensive diuretics
Normalised onto 3 canonical drug classes below.

Curated from the reviewed source

Drug class	Severity	Mechanism type	Provenance	Expected effect
Antidiabetic drugs (insulin, sulfonylureas, biguanides, GLP-1, SGLT2) Endocrine	3Major	PD-additive	curated B	Symptomatic hypoglycaemia, sweating, tremor, confusion; severe events rep…	why ▾
Chemistry of this pair. Hydrocolloids raise luminal viscosity and physically entrap co-administered drug molecules, delaying and reducing absorption. Class mechanism. Hypoglycaemic botanicals act through insulin secretagogue, insulin-sensitising, alpha-glucosidase-inhibiting or glucose-transport routes. Added to a titrated pharmacological regimen the effects summate rather than plateau. Expected Symptomatic hypoglycaemia, sweating, tremor, confusion; severe events reported with insulin and sulfonylureas. Management Increase self-monitoring frequency for 2 weeks after starting or stopping. Anticipate a downward dose adjustment of insulin or sulfonylurea. Onset rapid Evidence B - reviewed clinical column, source pending Matched on “antidiabetic drugs” Find evidence for this pair Map this mechanism
Diuretics Renal	3Major	PD-additive + electrolyte-mediated	curated B	Hypokalaemia, hyponatraemia, dehydration, muscle weakness, cramps, arrhyt…	why ▾
Chemistry of this pair. Hydroxyanthracene derivatives are colonic prokinetics activated by gut flora; chronic use produces potassium loss through the colon. Class mechanism. Aquaretic and saluretic botanicals add to renal potassium and sodium loss. Anthraquinone laxatives compound this through colonic potassium loss, and glycyrrhizin causes mineralocorticoid-like retention of sodium with kaliuresis. Expected Hypokalaemia, hyponatraemia, dehydration, muscle weakness, cramps, arrhythmia; potentiation of digoxin toxicity through low potassium. Management Check potassium, sodium and creatinine 1-2 weeks after starting. Avoid the combination entirely in patients also on digoxin. Onset rapid Evidence B - reviewed clinical column, source pending Matched on “diuretics” Find evidence for this pair Map this mechanism
Antihypertensives Cardiovascular	2Moderate	PD-additive	curated B	Orthostatic hypotension, dizziness, syncope and falls; or loss of blood-p…	why ▾
Class mechanism. Vasodilator, diuretic, ACE-inhibitory and calcium-antagonist activity in botanical extracts adds to prescribed blood-pressure lowering. A minority (ephedrine-, glycyrrhizin- and caffeine-bearing) act in the opposite direction and antagonise control. Expected Orthostatic hypotension, dizziness, syncope and falls; or loss of blood-pressure control with pressor botanicals. Management Home BP log for 2 weeks after any change. Warn about postural symptoms; review in the elderly and in those on multiple agents. Onset rapid Evidence B - reviewed clinical column, source pending Matched on “antihypertensive” Find evidence for this pair Map this mechanism

Predicted from constituent chemistry

These edges are not clinical findings. Each one is a rule inference: a constituent class in this plant is known to act on a target that the drug class also acts on. They are shown because a blank cell reads as “safe”, and for a Tier 1 entry a blank cell only means “not yet looked at”. Treat them as a literature-search agenda, not as a warning.

Drug class	Severity	Mechanism type	Provenance	Expected effect
Cardiac glycosides (digoxin, digitoxin) Cardiovascular	4Contraindicated	PD-additive + PK-transporter + assay interference	predicted D	Nausea, xanthopsia, bradyarrhythmia, AV block, ventricular tachycardia an…	why ▾
Chemistry of this pair. Hydroxyanthracene derivatives are colonic prokinetics activated by gut flora; chronic use produces potassium loss through the colon. Class mechanism. Cardenolide- and bufadienolide-bearing plants are themselves Na+/K+-ATPase inhibitors, so co-administration is pharmacological overdose. Several also inhibit intestinal P-glycoprotein, raising digoxin exposure, and cross-react with digoxin immunoassays so that serum levels become uninterpretable. Expected Nausea, xanthopsia, bradyarrhythmia, AV block, ventricular tachycardia and death; falsely reassuring or falsely high assay results. Management Treat as an absolute contraindication. If exposure has occurred, manage on ECG and clinical grounds, not on assay values, and consult toxicology about digoxin-specific Fab. Onset rapid Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism
Corticosteroids Endocrine	3Major	PD-additive + PK-CYP3A4	predicted D	Pseudohyperaldosteronism: hypertension, hypokalaemia, oedema, myopathy; C…	why ▾
Chemistry of this pair. Hydroxyanthracene derivatives are colonic prokinetics activated by gut flora; chronic use produces potassium loss through the colon. Class mechanism. Glycyrrhizin inhibits 11-beta-hydroxysteroid dehydrogenase type 2 and prolongs cortisol half-life, potentiating mineralocorticoid effect. Anthraquinone laxatives compound steroid-driven potassium loss, and CYP3A4 inhibition raises systemic corticosteroid exposure. Expected Pseudohyperaldosteronism: hypertension, hypokalaemia, oedema, myopathy; Cushingoid features at unchanged steroid dose. Management Restrict licorice-containing products. Check potassium and blood pressure. Reduce steroid dose if features of excess appear. Onset rapid Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism
Laxatives and antidiarrhoeals Gastrointestinal	3Major	PD-additive	predicted D	Cramping, diarrhoea, electrolyte loss, melanosis coli with chronic anthra…	why ▾
Chemistry of this pair. Hydroxyanthracene derivatives are colonic prokinetics activated by gut flora; chronic use produces potassium loss through the colon. Class mechanism. Anthraquinone and mucilage botanicals add to stimulant and bulk laxative action; tannin-rich astringents oppose it. Expected Cramping, diarrhoea, electrolyte loss, melanosis coli with chronic anthraquinone use; or constipation and obstruction risk with astringents plus inadequate fluid. Management Limit stimulant laxative botanicals to under 2 weeks. Ensure adequate fluid intake with any bulk-forming product. Onset rapid Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism
Antibacterials and anthelmintics Infection	2Moderate	PK-chelation + PK-CYP	predicted D	Treatment failure from subtherapeutic antibiotic concentrations, or raise…	why ▾
Chemistry of this pair. Hydrocolloids raise luminal viscosity and physically entrap co-administered drug molecules, delaying and reducing absorption. Class mechanism. Cation- and tannin-rich botanicals chelate tetracyclines and fluoroquinolones; efflux-pump-inhibiting and CYP-modulating constituents alter macrolide, rifamycin and azole exposure. Anthelmintic botanicals add to praziquantel and albendazole effect. Expected Treatment failure from subtherapeutic antibiotic concentrations, or raised toxicity of azoles and macrolides. Management Separate doses by 2-3 hours. Do not rely on botanical antimicrobials in place of an indicated antibiotic. Onset unspecified Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism
Iron, calcium and mineral supplements Nutrition	2Moderate	PK-chelation	predicted D	Failure of iron-deficiency correction, unexplained non-response to oral i…	why ▾
Chemistry of this pair. Hydrocolloids raise luminal viscosity and physically entrap co-administered drug molecules, delaying and reducing absorption. Class mechanism. Tannins, phytates, oxalates and mucilage form insoluble complexes with divalent and trivalent cations in the gut lumen, reducing absorption of both the mineral and any co-administered chelating drug. Expected Failure of iron-deficiency correction, unexplained non-response to oral iron or calcium. Management Separate mineral doses from tannin- and fibre-rich botanicals by at least 2 hours; take iron with ascorbate instead. Onset unspecified Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism
Thyroid hormones and antithyroid drugs Endocrine	2Moderate	PK-absorption + PD-modulation	predicted D	Iatrogenic hyper- or hypothyroidism, unexplained TSH drift, loss of euthy…	why ▾
Chemistry of this pair. Hydrocolloids raise luminal viscosity and physically entrap co-administered drug molecules, delaying and reducing absorption. Class mechanism. Guggulsterone stimulates thyroid function and T4-to-T3 conversion; goitrogenic glucosinolates and lithospermic acid suppress it; high-fibre and cation-rich botanicals bind levothyroxine in the gut and reduce absorption. Expected Iatrogenic hyper- or hypothyroidism, unexplained TSH drift, loss of euthyroid control. Management Separate levothyroxine from fibre and mineral products by 4 hours. Recheck TSH 6-8 weeks after any botanical change. Onset unspecified Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism

05 Hazard register

The audit recorded no hazard beyond the interaction profile. The controlled-vocabulary field reads not assessed, which means the assessment has not been done rather than that it came back clear.

06 Confusable material

These entries could be mistaken for this one in trade, in the herbarium, or in a prescription. Powdered material is often indistinguishable, so the check is macroscopic, microscopic and chromatographic rather than nominal.

Aloe ferox

Cape Aloe

Asphodelaceae

Same genus (Aloe)

07 Mechanism map

Chemistry sorts to the left, pharmacology to the right. Dashed edges are predicted. Drag nodes, scroll to zoom, export at 3× for a figure.

species

chemical class

marker compound

drug class

expected effect

hazard

08 Open literature

Abstract-scoped query built from this binomial, its common names and its marker compounds, run live against Europe PMC, PubMed and OpenAlex, then ranked locally against an evidence hierarchy.

Checking openFDA spontaneous reports…

09 Isomechanistic neighbours

Species whose interaction profile overlaps this one, ranked by shared severity weight rather than by count — a shared contraindication counts for more than a shared minor signal. Practical use: these are the plants you should not stack with this one, because the mechanisms summate.

Species	Family	Shared classes	Jaccard
Rubia cordifolia Manjistha	Rubiaceae	6	0.43
Senna alexandrina Senna	Fabaceae	6	0.40
Echinacea purpurea Echinacea	Asteraceae	6	0.40
Panax ginseng Ginseng	Araliaceae	6	0.46
Senegalia senegal Gum Acacia	Fabaceae	5	0.56
Salvia hispanica Chia	Lamiaceae	5	0.56

10 References and notes

No citation is on record for this entry. That is itself the finding: the audit flagged it, and it is why the entry does not carry an A evidence grade.

Curator notes

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