Cutch

Other Names

Acacia catechuAcacia catechuoidesAcacia chundraAcacia polyacanthaAcacia sundraAcacia wallichianaAcacie au cachouBagaBlack CatechuBlack CutchCachouCachuCashooCatechuCatechu TreeCatecuCutch TreeDantadhavanaDark CatechuGayatriGum CatechuJapan EarthKaachuKaathKachinamaraKachuKadiraKaggaliKaggalinaraKamuguKarangalliKaringaliKarintaaliKarungaliKarungkaliKathKathaKatthaKeo cauKhadiraKhairKhairaKharaKhariraKhayarKhayerKherKheraKhersalKhoyerKoggigidaKoirMadanMimosa cateMimosa catechuMimosa catechuoidesMimosa chundraMimosa spinosissimaMimosa sundraMung-tingNyaPakuPale CatechuPegu CutchPinangPohon akasia katecuSa-cheSeesiatSeesiat nuaSenegalia catechuSenegalia chundraShaSisiat-nuaSundraSupariTallatumaTerra JaponicaTun-sa-seWadalee Gum

Synopsis

Cutch (Acacia catechu / Senegalia catechu): A Comprehensive Reference

1. Identity, Botanical Classification, and Natural Source

Cutch, also known as black catechu or simply catechu, is a hard, reddish-brown extract produced from the heartwood of a deciduous tree whose current accepted scientific name is Senegalia catechu, widely treated in the pharmacological and medical literature under its longstanding synonym Acacia catechu (L.f.) Willd. Catechu is a hard, reddish-brown extract obtained from the heartwood of the deciduous tree Senegalia catechu (synonym Acacia catechu), a species in the Fabaceae family native to tropical regions of South and Southeast Asia, including India, Pakistan, Myanmar, and Thailand. The species belongs to the family Fabaceae (subfamily Mimosoideae), is known as Khair or Cutch tree, possesses diverse pharmacological actions, and has been widely used in Asia and different parts of the world.

Common names across languages are numerous and reflect the plant's deep cultural penetration across the Asian subcontinent. It is called Cutch tree in English, Kahir in Hindi, and Khadira in Sanskrit. It is also known as kattha (Urdu), khadir (Hindustani and Punjabi), khoyer (Bengali and Assamese), khair and babul (Hindi), kaath (Marathi), and kachu (Malay).

Botanical description: The tree is a deciduous thorny tree of up to 15–17 m height, native to central and east Africa, Southern Asia, Bhutan, China, India, Pakistan, Myanmar, and Nepal. It is a medium-sized tree with dark greyish-brown to dark brown bark, brown branches which are slender and puberulous when young but glabrescent later, a straight and grayish-brown stem, petiolate, bipinnately compound and alternate leaves, oblong and glabrous leaflets, and white to pale yellow flowers in 5–10 cm-long axillary spikes.

The extract itself is produced by a concentrated decoction process. Cutch extract is obtained historically by boiling the heartwood with water and evaporating the solution. Katha — the solid extract product — is made up of concentrated extracts of 10–20-year-old A. catechu trees and is used as an ingredient in paan (betel leaf masticatory), giving a red colour to saliva. The extract is produced by boiling and evaporating the heartwood, yielding a brittle, astringent substance rich in tannins (25–33%), catechins (such as catechin and epicatechin), flavonoids (including quercetin), and other polyphenols that contribute to its therapeutic and industrial applications.

Two commercial forms of catechu have been recognized historically. There are two types: black catechu and pale catechu. Black catechu is derived from Acacia catechu / Senegalia catechu, while pale catechu (also called gambir) originates from an unrelated species, Uncaria gambir, in the family Rubiaceae.

Common forms and preparations encountered in traditional and modern settings include: dried heartwood chips used in decoctions; solid block extract (katha/kattha); powders and capsules of the heartwood extract; gel preparations for topical and local drug delivery (including periodontal gels); standardized botanical extracts used in proprietary combination products; mouthwash and tooth-powder formulations; and fermented liquid preparations (arishta) in Ayurvedic pharmacy.

Acacia catechu extracts have played a role in chemistry, with various names of chemicals — catechin, catechol, and catecholamine — being derived therefrom. This etymological legacy underscores the historical significance of the plant in the development of modern organic chemistry.

2. Traditional and Historical Use

2.1 Ayurvedic Tradition (India)

Acacia catechu is a deciduous tree belonging to the family Fabaceae and has been widely used in Ayurveda for many years for the treatment and prevention of various diseases and/or disorders. The use of Acacia catechu dates back to at least the 7th century CE, mentioned in classical Ayurvedic texts like the Ashtanga Hridaya and Charaka Samhita. In these manuscripts, it is listed under the category of kashaya dravyas — astringent substances employed to bind and tone bodily tissues.

The Sanskrit synonyms for the plant reveal the traditional therapeutic framework. Synonyms include: Raktasara (extract of which is red in colour); Kantaki (having thorns); Kushtaghna (best kushtaghna dravya, indicating utility in skin diseases); Galaroganut (useful in diseases of the throat); Saradruma (useful part is the heartwood); and Dantadhavana (useful as a toothbrush).

Over centuries, the plant's status evolved from a local folk remedy to a mainstream Ayurvedic ingredient, seeing use in popular preparations like Dasmoola Kashayam and Khadirarishta. A famous Ayurvedic skin tonic — Khadirarishta — is prepared with this herb as the main ingredient. Khadira (Khadira being the Sanskrit name) was traditionally regarded as the premier remedy for skin disorders: the heartwood and bark are used in traditional medicine to treat sore throat and diarrhoea.

Tribal healers in central India also used khair bark decoction for wound healing and to staunch bleeding. The bark shows anti-helmintic, antipyretic, and anti-inflammatory properties and is used in the treatment of bronchitis, ulcers, psoriasis, anaemia, and gum troubles.

2.2 Unani/Persian Medicine

In medieval Persian medicine, the plant crossed paths with Unani practitioners who valued its anti-inflammatory effects in poultices for joint swellings. Its use in the Unani tradition appears to parallel the Ayurvedic emphasis on astringent and anti-inflammatory applications.

2.3 Southeast Asian and Folk Traditions

The benefits of khoyer, according to folk medicine practitioners in Bangladesh, include use for pain relief and blood sugar control in diabetics. The plant is also widely used as chew sticks in different parts of the world because of its potential antibacterial properties. The sap of A. catechu is commonly used for the treatment of diarrhoea and wounds in ruminants.

2.4 Industrial and Dye Use

Beyond medicine, cutch occupied an important industrial role. By the 19th century, British colonial botanists documented it for export as "catechu" tannin, primarily for leather tanning, though many Ayurvedic households always regarded its medicinal value as paramount. Its high tannin content made it a prized material for tanning leather, fixing natural dyes in textiles, and preserving fishing nets and ropes. Black catechu extract has been approved by the US FDA for food use as a natural flavouring substance and/or natural substance used in conjunction with flavours.

3. Key Constituents and Active Compounds

Chemical analysis of A. catechu across its various plant parts has identified a broad spectrum of phenolic, flavonoid, and tannin-class compounds. The main phytochemical compounds in A. catechu are protocatechuic acid, taxifolin, epicatechin, epigallocatechin, catechin, epicatechin gallate, procyanidin, phloroglucin, aldobiuronic acid, gallic acid, D-galactose, afzelchin gum, L-arabinose, D-rhamnose, and quercetin.

A PubMed-indexed chemical study further identified twelve compounds from the plant: 4-hydroxybenzoic acid, kaempferol, quercetin, 3,4′,7-trihydroxyl-3′,5-dimethoxyflavone, catechin, epicatechin, afzelechin, epiafzelechin, mesquitol, ophioglonin, aromadendrin, and phenol.

The most pharmacologically significant primary constituents are:

(+)-Catechin — The dominant flavan-3-ol of the heartwood. The phenolic compound catechin (3,3′,4′,5,7-pentahydroxyflavan) is abundant in this plant and shows anticancer, antioxidant, antiapoptotic, and anti-inflammatory properties. The primary components of the standardized extract flavocoxid are baicalin and catechin, concentrated and standardized to greater than 90% purity.
Epicatechin and Epigallocatechin — Additional flavan-3-ol stereoisomers contributing antioxidant and metabolic effects. Catechin and epicatechin present in Katha are used as food supplements. They are powerful antioxidants that act as insulin mimics and as antidiabetic agents and also enhance heart function.
Taxifolin (Dihydroquercetin) — A flavanone with documented antioxidant activity, present in notable quantities in the heartwood.
Procyanidins — Oligomeric condensed tannins contributing to the astringency and protein-binding properties of the extract.
Quercetin and Kaempferol — Flavonol aglycones with well-established anti-inflammatory and antioxidant mechanisms.
Phlobatannin and hydrolysable tannins — High-molecular-weight polyphenols responsible for much of the extract's astringent character and antimicrobial activity.

The aqueous extract of A. catechu heartwood has been shown to be a rich source of catechin and epicatechin, with smaller amounts of flavonoids; extraction with organic solvents such as ethyl acetate, ethanol, methanol, hexane, and chloroform results in products with differing chemical compositions and subsequently differing physiological and pharmacological activities.

4. Mechanisms of Action

4.1 Anti-inflammatory Pathways

Flavocoxid — the standardized combination of baicalin and catechin — acts as a dual balanced inhibitor of cyclooxygenase-1 (COX-1) and COX-2 peroxidase enzyme activities, with significant inhibition of 5-lipoxygenase (5-LOX) enzyme activity in vitro. Flavocoxid downregulates gene or protein expression of several inflammatory markers and exerts strong antioxidant activity in several experimental models. At the cellular level, nitric oxide (NO) production is significantly decreased both in LPS-stimulated and unstimulated macrophages treated with extracts, indicating the anti-inflammatory effect; the anti-inflammatory property of A. catechu has further been demonstrated by analysing the levels of TNF-α and IL-10 secretion in macrophages. TNF-α, a strong mediator of inflammatory response secreted by monocytes and macrophages, is involved in many clinical dilemmas associated with autoimmune disorders such as rheumatoid arthritis, inflammatory bowel diseases, and psoriasis; A. catechu inhibited the production of TNF-α.

4.2 Antioxidant Mechanisms

The antioxidant properties of A. catechu heartwood extract have been demonstrated in a variety of in vitro systems and in vivo studies in rats, mice, and cell culture systems. The antioxidant activity of the extract (ethanolic) may be attributed to its ability to donate electrons or hydrogen, as well as its direct radical scavenging abilities. This antioxidant activity is believed to be responsible for the anti-inflammatory, tissue protectant, antineoplastic, and analgesic activities that have been demonstrated in animal and cell culture systems.

4.3 Antidiabetic Mechanisms

The antidiabetic activity of the plant extracts has been shown via the reduction of enzymatic activities of α-glucosidase, α-amylase, and aldose reductase. Among the tested fractions, aqueous and ethyl acetate fractions showed the most α-glucosidase inhibitory activity, with IC50 values of 82.6 ± 0.3 and 130.2 ± 0.6 μg/mL, respectively, as compared to the reference drug acarbose (IC50 = 344.23 ± 1.03 μg/mL).

4.4 Astringent and Protein-Precipitating Action

Catechu contains tannins and flavonoids that interact with cellular receptors and enzymes, modulating immune responses and reducing oxidative stress. Pharmacodynamically, it exerts its effects through mechanisms such as protein precipitation, inhibition of microbial growth, and modulation of inflammatory pathways. The tannin-mediated protein precipitation accounts for the classical clinical uses of the extract as an astringent in conditions involving excess mucosal secretion, diarrhoea, and oral tissue tonification.

4.5 Antimicrobial Mechanisms

Ethanol extracts of A. catechu exhibit inhibitory activity against various microbes; however, in no case have the active chemical constituents for these antimicrobial activities been individually identified with certainty. The polyphenolic constituents — particularly catechin and procyanidins — are presumed to act by disrupting bacterial membrane integrity and inhibiting key microbial enzymes, consistent with the known mechanisms of plant-derived tannins and flavanols.

5. Scientific Evidence by Area of Use

5.1 Osteoarthritis and Joint Inflammation

This is the area with the strongest human clinical evidence for cutch-containing preparations. The most studied proprietary formulation is a combination of Scutellaria baicalensis and Acacia catechu extracts (marketed under designations including UP446 and flavocoxid/Limbrel®).

One study was designed to determine the safety of the medical food flavocoxid — a proprietary blend of free-B ring flavonoids and flavans from the root of Scutellaria baicalensis and the bark of Acacia catechu — in the dietary management of knee osteoarthritis. The 12-week, randomised, double-blind, placebo-controlled trial enrolled 59 patients with moderate osteoarthritis of at least one knee. Subjects were randomised to flavocoxid 250 mg twice a day versus identical placebo.

Controlled clinical trials and a postmarketing study have clearly shown that flavocoxid is as effective as naproxen in managing the signs and symptoms of osteoarthritis of the knee, and it has better upper gastrointestinal, renal, and respiratory safety profile than naproxen.

A separate clinical trial investigated short-term effects of the combination: A 1-week clinical trial was carried out to examine the extent to which UP446 — a natural proprietary blend of S. baicalensis and A. catechu — decreases knee joint pain, mobility, and biomarkers of inflammation in comparison to naproxen. Seventy-nine men and women (40–90 years old) diagnosed as having mild to moderate osteoarthritis consumed either 500 mg/day of the UP446 supplement or 440 mg/day of naproxen for 1 week in a double-blind randomised control trial. Pain, knee range of motion (ROM), and overall physical activity were evaluated at the start and end of treatment.

A larger, 12-week parallel-design RCT examined another combination product: The purpose of this study was to determine the effects of UP1306 on discomfort and function in adults with osteoarthritis of the knee. In a randomised, double-blinded, placebo-controlled, parallel design, 135 subjects received UP1306 — a standardised, proprietary extract of Morus alba and Acacia catechu — glucosamine chondroitin, or placebo for 12 weeks. Discomfort, stiffness, and activities of daily living measured by the WOMAC questionnaire and VAS (pain/discomfort) were improved within all groups. Range of motion and distance walked were improved. There were no changes in TNFα levels for any of the products.

Evidence appraisal: Human trial evidence for cutch/catechu in osteoarthritis is predominantly derived from studies using proprietary multi-ingredient combinations where the independent contribution of A. catechu alone cannot be cleanly isolated. Trials are generally short-term (1–12 weeks) and in relatively small populations. Results are promising but require confirmation in larger, longer-duration, single-ingredient trials.

5.2 Exercise-Induced Muscle Soreness (DOMS)

AmLexin contains a standardised blend of extracts from the heartwood of Acacia catechu and the root bark of Morus alba, and is known to possess antioxidant and anti-inflammatory properties. The aim of the study was to investigate the effects of this proprietary blend supplementation on muscular pain and redox balance in healthy runners, in comparison to a placebo. A double-blind placebo-controlled clinical trial was carried out over 9 weeks in a single centre. Thirty physically active male and female subjects within 18–70 years of age were randomised. Significant reductions in discomfort were observed in the major muscles and body parts such as the calves, quadriceps, hamstrings, and knees, which could be true reflections of the antioxidant and anti-inflammatory activity of AmLexin.

Evidence appraisal: This study is small (n=30), single-centre, and again tests a combination product. The evidence is preliminary and does not support definitive conclusions about cutch as a standalone intervention for DOMS.

5.3 Periodontal Disease and Oral Health

A randomised controlled clinical trial was conducted to evaluate the effect of local drug delivery (LDD) of Acmella oleracea (Akarkara) and Acacia catechu (kattha) gels as an adjunct to scaling and root planing (SRP) in generalised chronic periodontitis patients. Thirty patients with ninety sites, aged 25–65 years, with generalised chronic periodontitis having pocket probing depth (PPD) of ≥5 mm were selected. Evaluation of clinical parameters including gingival index (GI), plaque index (PI), gingival bleeding index (GBI), PPD, clinical attachment level (CAL), and relative attachment level (RAL) was done at baseline and at 1, 3, and 6 months; microbiological parameters were assessed at baseline and 6 months. Clinical parameters from baseline to 6 months demonstrated a significant reduction in mean GI, PI, GBI, and PPD and gain in CAL and RAL, with results being statistically significant.

A herbal tooth powder formulation which includes Acacia catechu, menthol, and camphor powder has been found to remove plaque stains and polish teeth surfaces without the use of abrasives. Epicatechin 3 gallate is used to treat dental caries and periodontal infections.

Evidence appraisal: The periodontal clinical trial had a small sample size (30 patients, 90 sites) and used a combination herbal gel alongside conventional treatment (SRP), making it impossible to attribute outcomes to A. catechu alone. Evidence remains preliminary; larger independent RCTs are needed.

5.4 Antidiabetic Effects

Antihyperglycaemic activity has been demonstrated in animal studies. At the enzyme-inhibition level (in vitro), among the tested fractions, aqueous and ethyl acetate fractions showed the most α-glucosidase inhibitory activity, with IC50 values of 82.6 ± 0.3 and 130.2 ± 0.6 μg/mL respectively, compared to acarbose (IC50 = 344.23 ± 1.03 μg/mL); in the α-amylase assay, the crude ethanol extract showed antidiabetic activity with an IC50 of 67.8 ± 1.8 μg/mL, compared to acarbose (IC50 = 6.1 ± 0.1 μg/mL).

Evidence appraisal: Antidiabetic evidence for A. catechu is currently limited to in vitro enzyme inhibition studies and animal models. No controlled human clinical trials specifically examining glycaemic outcomes of cutch supplementation were identified in the peer-reviewed literature. Claims of antidiabetic benefit in humans remain unsubstantiated by clinical trial data.

5.5 Hepatoprotection

One study investigated the hepatoprotective effects and possible mechanism of Acacia catechu in acetaminophen (APAP)-induced hepatotoxicity using a female Wistar rat model. Hepatotoxicity was induced by oral administration of acetaminophen (750 mg/kg body weight) for 24 h; the seed (400 mg/kg body weight) and bark (400 mg/kg body weight) extract-treated groups exhibited hepatoprotective effects, compared with the well-known clinical antidote N-acetylcysteine (NAC). Pretreatment with seed or bark extract groups decreased lipid peroxidation accumulation, reduced the liver function enzymes, and increased antioxidant defence enzymes; histopathology of seed extract-treated groups showed normal architecture, whereas bark extract-treated groups exhibited mild degree of vacuolations in hepatocytes with minimal sinusoidal congestion. The study concluded that A. catechu seed extract may be a promising agent for protecting the liver from APAP-induced hepatotoxicity.

Evidence appraisal: Hepatoprotective evidence is entirely preclinical (animal models). No human clinical trials on this indication exist. The findings are hypothesis-generating only.

5.6 Antimicrobial Activity

Acacia species extracts also show antiviral activity against dengue virus, human immunodeficiency virus (HIV), herpes simplex virus, and hepatitis B and C virus in experimental systems. Antibacterial activity has been evaluated in multiple in vitro studies: ethanol extracts of A. catechu exhibit inhibitory activity against various microbes, though in no case were the active chemical constituents for these activities identified.

Evidence appraisal: Antimicrobial data for A. catechu is predominantly in vitro. Clinical antimicrobial efficacy in humans has not been established via controlled trials. Results cannot be directly translated to clinical recommendations.

5.7 Immunomodulation

The effect of the plant on enhancement of haemagglutination (HA) titers, plaque-forming cell (PFC) assay, delayed-type hypersensitivity (DTH) reaction, and peritoneal macrophages indicates that it has an appreciable immunomodulatory effect. The increased antibody titer indicates that daily consumption of A. catechu decoction may provide immunity against infections in general.

Evidence appraisal: Immunomodulatory data is predominantly from preclinical (animal and cell culture) studies. Human evidence is absent.

5.8 Neuroprotection and Cognitive Function

Acacia catechu heartwood extract, already characterised for its high catechin content, is endowed with antioxidant properties. The aim of one study was to assess AC neuroprotection in both human neuroblastoma SH-SY5Y cells and rat brain slices treated with hydrogen peroxide. Catechins have been reported to possess potent iron-chelating, radical-scavenging, and anti-inflammatory activities and to exert neuroprotection.

One human clinical trial evaluated cognitive outcomes: This study evaluated the cognitive effects of combined Acacia catechu and Scutellaria baicalensis supplementation in healthy adults. In a randomised, double-blind, placebo-controlled trial, 26 males and 59 females (N=85; 43 ± 8 yrs) consumed the test product containing 240 mg stem extract of Scutellaria baicalensis and 51 mg heartwood extract of Acacia catechu (UP326) or placebo for four weeks. Significant time effects (p <0.001) were observed across cognitive function assessments, with no differences between groups. Energy and fatigue reports showed a significant time effect (p = 0.023), while no significant differences emerged in general health and well-being scores.

Evidence appraisal: The available human trial on cognitive function did not demonstrate a statistically significant group difference between the A. catechu/S. baicalensis combination and placebo. Neuroprotective preclinical data are preliminary. No conclusions supporting cognitive benefit can currently be drawn from human trial data.

6. Body Systems and Health Areas of Association

Based on the sum of traditional use and experimental evidence to date, A. catechu has been associated with the following body systems:

Musculoskeletal system — joint discomfort, osteoarthritis, exercise-induced muscle soreness
Gastrointestinal system — diarrhoea, peptic ulcers, dysentery (astringent/antidiarrheal)
Oral and dental health — periodontal disease, dental caries, gingival inflammation, oral ulcers
Integumentary (skin) — psoriasis, leprosy, eczema, wound healing
Endocrine/metabolic — blood glucose regulation (preclinical only)
Hepatic system — hepatoprotection (preclinical only)
Immune system — immunomodulation (preclinical)
Respiratory system — bronchitis, cough (traditional use)
Nervous system — neuroprotection (preclinical), cognitive function (human evidence negative)
Cardiovascular system — hypotensive effects noted in animal data

The plant has been extensively studied for its pharmacological activities, and the results show that it has potent immunomodulatory, hypoglycaemic, hepatoprotective, antidiarrheal, antipyretic, antinociceptive, antihyperlipidemic, antiulcer, antioxidant, antimicrobial, antidiabetic, antiproliferative, antibacterial, antifungal, haemolytic, and anti-inflammatory properties that make this plant very valuable.

7. Dosage Forms and Reported Dosages

Dosages in the available clinical and preclinical literature vary considerably by preparation, application, and study design. The following dosages are reported directly from the cited scientific sources:

Flavocoxid (Limbrel®) — oral, osteoarthritis: A 12-week, randomised, double-blind, placebo-controlled trial enrolled 59 patients; subjects were randomised to flavocoxid 250 mg twice a day versus identical placebo.
UP446 (Scutellaria/Acacia combination) — oral, OA: Seventy-nine subjects consumed either 500 mg/day of the UP446 supplement or 440 mg/day of naproxen for 1 week in a double-blind randomised control trial.
UP326 (Scutellaria/Acacia combination) — oral, cognitive function: Eighty-five subjects consumed the test product containing 240 mg stem extract of Scutellaria baicalensis and 51 mg heartwood extract of Acacia catechu or placebo for four weeks.
Seed and bark extract — animal hepatoprotection study: The seed (400 mg/kg body weight) and bark (400 mg/kg body weight) extract-treated groups exhibited hepatoprotective effects in a rat model.
Ethanolic seed extract — sub-acute oral toxicity study (rat): A. catechu seed extract was administered orally at doses of 250, 500, and 1000 mg/kg body weight daily for 28 days.
Periodontal gel — local drug delivery: A gel containing A. catechu (1%) was placed at test sites as local drug delivery in a split-mouth trial design.

No standardised human dosage for cutch/black catechu as a standalone supplement has been established in the peer-reviewed clinical literature. In spite of the fact that Acacia products have been used for many years and the general safety of catechins and epicatechins is well documented, few human studies have ever been conducted on the efficacy or safety of A. catechu heartwood extracts.

8. Safety Considerations and Drug Interactions

8.1 General Safety in Animal Models

In a 28-day sub-acute oral toxicity study in Wistar rats, the extract did not induce death or any significant changes in body weight, relative weight of vital organs, or haematological parameters up to a dose of 1000 mg/kg. Oral administration of the plant extract did not produce any significant changes in glucose levels, and there were no significant changes in the activity of both hepatotoxic and nephrotoxic marker enzymes in the serum. Oral administration also did not produce any significant changes in the levels of oxidative markers.

Several studies have shown that a two-ingredient combination product containing A. catechu extract exhibited no adverse effects when administered daily for up to 12 weeks, while exhibiting significant anti-inflammatory activity in subjects with osteoarthritis of the knee.

8.2 Hepatotoxicity Signal Associated with Flavocoxid

A clinically important safety signal emerged from postmarketing surveillance of flavocoxid (Limbrel®), the prescription medical food combining Acacia catechu and Scutellaria baicalensis extracts. To our knowledge, only three reports of acute toxic hepatitis related to ingestion of Chinese skullcap and black catechu have been elucidated in the literature. Black catechu is also known as cutch, dark catechu, or Acacia catechu. The relevant journal publication — Chalasani N, Vuppalanchi R, Navarro V, et al., "Acute liver injury due to flavocoxid (Limbrel), a medical food for osteoarthritis: a case series," was published in Annals of Internal Medicine 2012;156:857–60. It is important to note that, as individual attribution is difficult in combination products, the relative contribution of the A. catechu component versus S. baicalensis to these hepatotoxicity cases has not been definitively established.

8.3 Hypotensive Effect

Hypotension has been reported and is likely due to release of bradykinin and other vasodilatory chemicals. This cardiovascular effect, documented in animal pharmacology (Sham JS, Chiu KW, Pang PK, Planta Med 1984;50:177–80), has not been systematically evaluated in human clinical studies but warrants consideration in individuals taking antihypertensive medications.

8.4 Drug Interactions

Black catechu can significantly alter theophylline pharmacokinetics in vivo, possibly due to inhibition of CYP1A and P-glycoprotein activity; thus, precaution should be exercised when administering black catechu with CYP1A substrates. This pharmacokinetic interaction, if confirmed in humans, would be relevant for narrow-therapeutic-index drugs metabolised by CYP1A enzymes.

Acacia gum has been shown to reduce the absorption of drugs such as amoxicillin; the coexistence of amoxicillin and gum arabic in the upper gastrointestinal tract resulted in a pharmacokinetic interaction that significantly decreased the absorption of amoxicillin. While this relates to gum arabic (a product of other Acacia species) rather than cutch, the possibility of similar absorption-modifying effects from the tannin-rich content of A. catechu preparations cannot be excluded.

8.5 Pregnancy and Paediatric Use

There is no current clear evidence that the combination of Chinese skullcap and black catechu is safe during pregnancy, in nursing women, and in children. This reflects an absence of data rather than confirmed harm.

8.6 Knowledge Gaps

Even though the plant's metabolites are reported to have many different pharmacological uses, there is limited information about their toxicity or clinical trials. There are not many research studies (in vivo and clinical trials) clarifying the safety and utilisation of A. catechu as a food supplement. Thus, there is a need to further investigate the toxicity and safety aspects of A. catechu as a food product. Although the metabolites from the plant are reported with diverse pharmacological applications, there is little information in regards to toxicity and clinical trials on bioactive compounds of this plant.

9. Summary of Evidence Strength

Osteoarthritis/joint inflammation: Moderate — multiple small-to-medium RCTs exist, but all use combination products; A. catechu alone has not been tested against placebo in a well-powered trial.
Oral/periodontal health: Preliminary — one small RCT using combination topical gel; in vitro data supportive.
Antioxidant activity: Well-established in vitro and in animal models; not validated as a clinical endpoint in humans.
Antidiabetic effects: Preclinical only (in vitro enzyme inhibition and animal models); no human RCTs.
Hepatoprotection: Preclinical only (animal models); conflicting signals from human case reports of hepatotoxicity with a combination product.
Antimicrobial activity: In vitro only; no controlled human trials.
Cognitive function: One human RCT showed no significant group difference vs. placebo at 4 weeks.
Muscle soreness: Preliminary — one small trial using a combination product.

References

Health Conditions

Health conditions that Cutch may help support.

No conditions available.

Body Systems

Body systems that Cutch may help support.

No body systems available.