Arjuna
CombretaceaeTerminalia arjuna Wight & Arn.
Also known as: Arjun, Kumbuk, White Marudah
clinical_notes Clinical Summary
Arjuna (Terminalia arjuna) is a large deciduous tree native to the Indian subcontinent whose bark has been used in Ayurvedic medicine for over 3,000 years as a cardiac tonic.
Its triterpenoid saponins (arjunolic acid), flavonoids (luteolin), and oligomeric proanthocyanidins exert positive inotropic, antihypertensive, hypolipidemic, anti-ischemic, and antioxidant effects.
Clinical studies demonstrate improvement in left ventricular ejection fraction and functional class in heart failure, reduction in anginal frequency in stable angina, and antihypertensive effects.
A 2014 systematic review of 6 studies (390 patients) found benefit for stable angina though evidence quality was limited.
At standard doses (500 mg TID for up to 3 months), T.
arjuna is well-tolerated with only mild GI side effects reported; it should be used under medical supervision given its significant cardiac activity.
Pregnancy Safety
Possibly unsafe during pregnancy based on Ayurvedic tradition and lack of safety data. Some evidence for uterine effects. Avoid use during pregnancy.
Lactation Safety
Insufficient data on safety during lactation. Avoid use during breastfeeding as a precautionary measure.
warning Contraindications
- Anticoagulant or antiplatelet medications (warfarin, aspirin, clopidogrel, heparin) (caution)Theoretical
- Pregnancy (avoid)Theoretical
- Cardiac medications (digoxin, beta-blockers, calcium channel blockers) (caution)Theoretical
- Antidiabetic medications (caution)Theoretical
- High-dose or long-term use without monitoring (hepatotoxicity/hypothyroidism risk) (caution)Theoretical
vital_signs Clinical Profile
Primary Indications
- check_circle angina pectoris
- check_circle congestive heart failure
- check_circle coronary artery disease
- check_circle hypertension
- check_circle hypercholesterolemia
- check_circle ischemic cardiomyopathy
- check_circle dyslipidemia
- check_circle atherosclerosis
- check_circle ischemic mitral regurgitation
Therapeutic Actions
System Affinities
- check_circle cardiovascular system
- check_circle hepatic
- check_circle urinary tract
labs Active Constituents
arjunic acid
arjunolic acid
arjungenin
arjunglycosides I-III
terminic acid
tannins
ellagic acid
gallic acid
luteolin
arjunone
arjunolone
leucodelphinidin
leucocyanidin
oligomeric proanthocyanidins
phytosterols
calcium
magnesium
zinc
copper
history_edu Traditional Use
No TCM data available for this herb yet.
Traditional Uses Across Healing Systems
While many herbs lack controlled clinical trials, centuries of traditional practice across cultures provide valuable insight into their therapeutic applications.
Primary cardiac tonic (Hridaya Poshak) used for heart failure, angina (hritshool), hypertension, dyslipidemia, and atherosclerosis. Bark decoction (Arjuna Ksheerapaka) prepared by boiling bark in milk and water is the classical preparation for cardiac conditions.
Arjuna is considered one of the most important herbs in Ayurvedic cardiology. Classically combined with Ashwagandha and Punarnava for cardiac conditions. The Ksheerapaka (milk decoction) preparation is preferred as milk enhances extraction of both lipophilic and hydrophilic constituents.
Adopted in integrative cardiology as an adjunctive cardiac tonic for stable angina, heart failure, and hypertension based on clinical evidence and Ayurvedic tradition.
Used alongside conventional cardiac medications as adjunctive support; not a replacement for standard cardiac therapy
spa Parts Used
bark
- angina
- heart failure
- hypertension
- dyslipidemia
- coronary artery disease
Bark is the primary medicinal part. Traditional preparation: Arjuna Ksheerapaka (Ksheera pak) - boil 3-6g bark powder in equal volumes milk and water, reduce by half. Modern: standardized extract 500mg TID. Bark should be sourced from 10-15 year old trees for optimal constituent concentration.
shield Safety
Contraindications — Evidence Basis
Anticoagulant or antiplatelet medications (warfarin, aspirin, clopidogrel, heparin)
Arjunolic acid from T. arjuna bark demonstrates antiplatelet and anticoagulant action similar to acetylsalicylic acid in rat studies. Additive bleeding risk with anticoagulants. Monitor INR and platelet function; discontinue 2 weeks before surgery.
Pregnancy
Terminalia arjuna is considered possibly unsafe during pregnancy. Insufficient data; Ayurvedic tradition cautions against use. Avoid until adequate safety data are available.
Cardiac medications (digoxin, beta-blockers, calcium channel blockers)
T. arjuna has positive inotropic and antihypertensive effects. Additive or potentially synergistic effects with cardiac medications may cause excessive bradycardia or hypotension. Use only under medical supervision with cardiac monitoring.
Antidiabetic medications
T. arjuna may lower blood glucose levels; dose adjustments of antidiabetic medications may be needed. Monitor blood glucose closely.
High-dose or long-term use without monitoring (hepatotoxicity/hypothyroidism risk)
High-dose T. arjuna extract in animal studies caused hepatotoxicity (elevated LPO) and reduced thyroid hormone concentrations in euthyroid animals. At standard therapeutic doses for up to 3 months, no hepatic, renal, or metabolic toxicity has been reported in human clinical studies.
Monitoring Parameters
Monitor during use, especially with prolonged or high-dose therapy.
Blood pressure (systolic and diastolic)
Baseline and every 4 weeks in hypertensive patients on antihypertensive medicationsT. arjuna has antihypertensive effects; risk of additive hypotension with antihypertensive drugs
flagThreshold: Systolic BP <90 mmHg or symptomatic hypotension: reduce or discontinue antihypertensive medication under medical supervision
Liver enzymes (ALT, AST) and thyroid function (TSH, T4)
Baseline and at 3 months for long-term useHigh-dose T. arjuna caused hepatotoxicity and hypothyroidism in animal studies; prudent to monitor in long-term use or at higher doses
flagThreshold: ALT/AST >2x ULN or TSH >5 mIU/L: reduce dose or discontinue and evaluate
INR (International Normalized Ratio) / coagulation studies
Baseline and at 2-4 weeks in patients on anticoagulantsArjunolic acid has antiplatelet/anticoagulant properties; risk of additive bleeding with warfarin or antiplatelet drugs
flagThreshold: INR >3.0 or signs of unusual bleeding: reduce anticoagulant dose under medical supervision
Toxicity
Ethanolic extract at 2000 mg/kg orally in acute animal toxicology study produced no toxicity or death. Standard human clinical dose of 500 mg TID for up to 3 months considered safe. High chronic doses may cause liver and thyroid effects in animals.
At standard doses: mild gastritis, headache, constipation. At very high doses (animal data): hepatotoxicity, hypothyroidism. Clinical studies up to 24 months found no hepatic, renal, or hematological toxicity at 500 mg TID.
Discontinue at first signs of hepatotoxicity. Monitor liver and thyroid function in long-term use. Reduce dose if GI side effects occur.
Adverse Effects
CYP Metabolism
Terminalia arjuna may alter CYP450-mediated hepatic drug metabolism based on its high tannin content and in vitro data. Direct CYP inhibition studies are limited. Caution with narrow-therapeutic-index drugs metabolized by the liver; clinical data insufficient to quantify the interaction.
swap_horiz Interactions
Digoxin
Class: Cardiac glycoside
Terminalia arjuna bark contains saponin glycosides with positive inotropic effects comparable to digoxin in preclinical models. Combined use produces additive cardiac glycoside-like action, potentially leading to arrhythmia, AV block and symptomatic bradycardia. T. arjuna may also inhibit CYP3A4 and P-gp, raising digoxin plasma levels.
Avoid concomitant use unless under close specialist supervision. If used, check serum digoxin levels (target 0.5-0.9 ng/mL), serum electrolytes (K⁺, Mg²⁺), and ECG at baseline, 1 week, and monthly thereafter.
Atorvastatin
Class: HMG-CoA reductase inhibitor (statin)
Alcoholic and aqueous T. arjuna bark extracts demonstrate potent reversible non-competitive inhibition of CYP3A4, CYP2D6 and CYP2C9 in human liver microsomes (IC50 < 50 μg/mL). Atorvastatin is primarily metabolized by CYP3A4; combination may raise atorvastatin exposure and risk of myopathy/rhabdomyolysis.
Monitor for myalgia and obtain serum CK if symptoms occur. Consider using a statin less dependent on CYP3A4 (pravastatin, rosuvastatin). If atorvastatin is continued, consider a lower dose (e.g., 20 mg rather than 40-80 mg).
Metoprolol
Class: Beta-blocker
Metoprolol is a CYP2D6 substrate. T. arjuna bark extracts inhibit CYP2D6 with IC50 < 50 μg/mL, potentially raising metoprolol plasma levels. Additionally, T. arjuna has intrinsic negative chronotropic effects that are additive with beta-blockade.
Monitor heart rate and blood pressure closely; risk of symptomatic bradycardia is elevated. Consider reducing metoprolol dose by 25-50% if HR drops below 60 bpm. Compatibility studies on physicochemical parameters show no formulation interaction, but pharmacodynamic synergy remains a concern.
Warfarin
Class: Anticoagulant (vitamin K antagonist)
T. arjuna inhibits platelet activation in vitro and inhibits CYP2C9 (the principal enzyme metabolizing S-warfarin, with IC50 < 50 μg/mL). Both pharmacokinetic (reduced warfarin clearance → higher INR) and pharmacodynamic (antiplatelet) mechanisms increase bleeding risk.
Monitor INR weekly for the first month after initiating T. arjuna and then every 2 weeks. Warn patients about bleeding signs. Consider using a DOAC alternative if the combination raises significant concern.
Amlodipine
Class: Calcium channel blocker (antihypertensive)
T. arjuna exhibits mild hypotensive activity in humans and inhibits CYP3A4 (the primary enzyme metabolizing amlodipine). Both pharmacodynamic and pharmacokinetic mechanisms may produce additive hypotension.
Monitor BP during initiation; counsel about orthostatic dizziness. If symptomatic hypotension develops, reduce amlodipine by 2.5-5 mg. Home BP log recommended for the first month of combination.
hub Combinations
Synergistic pairings can enhance therapeutic outcomes, while knowing suitable substitutes helps when specific herbs are unavailable or contraindicated.
Synergistic Combinations
3Ashwagandha
Traditional UseClassical Ayurvedic combination (Ashwagandha Arjuna Ksheerapaka) for cardiac conditions. Ashwagandha provides adaptogenic stress-reduction and cardioprotective antioxidant support while Arjuna directly strengthens cardiac muscle. Together they address both the stress component and structural cardiac support in heart failure.
Traditional Ayurvedic formula with extensive historical use. Both herbs individually demonstrate cardioprotective effects in animal models and human studies.
Hawthorn
Limited EvidenceHawthorn (Crataegus) and Arjuna share complementary cardioprotective mechanisms — both enhance coronary blood flow, exert antioxidant effects, and improve myocardial contractility. Hawthorn proanthocyanidins are better studied in Western populations while Arjuna has extensive Ayurvedic clinical data. Combined for comprehensive cardiac support.
Both herbs have individual RCT evidence for cardiac support. Mechanistic synergy is well-supported. No direct combination RCTs available.
Turmeric
Limited EvidenceTurmeric (curcumin) provides complementary anti-inflammatory and anti-atherogenic activity to Arjuna cardiac tonic properties. Curcumin inhibits NF-kB inflammatory signaling in vascular endothelium while Arjuna OPCs prevent LDL oxidation. Integrative cardiologists commonly combine these herbs for cardiovascular inflammatory conditions.
Both herbs individually demonstrated cardioprotective and anti-inflammatory effects in human trials; combination supported by mechanistic rationale and clinical practice.
Traditional Pairings
1Amla
Traditional UseAmla (Phyllanthus emblica) is traditionally combined with Arjuna in Ayurvedic cardiovascular formulations (Arjunarishta). Amla provides high vitamin C content, potent antioxidant activity, and lipid-modulating effects that complement Arjuna cardiac tonic action.
Classical Ayurvedic pairing in Arjunarishta formulation. Both herbs have individual evidence for cardiovascular and lipid benefits.
science Studies
Clinical efficacy of water extract of stem bark of Terminalia arjuna (Roxb. ex DC.) Wight & Arn. in patients of chronic heart failure: a double-blind, randomized controlled trial
RCTThis double-blind, randomized, placebo-controlled trial assessed the clinical efficacy and safety of a standardized water extract of Terminalia arjuna stem bark in patients with chronic heart failure (CHF). Participants receiving the herbal extract showed improvements in cardiac function parameters compared to placebo over the study period, including improvements in quality of life and functional capacity. The study represents one of the best-designed clinical trials of Terminalia arjuna in CHF, using well-established outcome measures and a rigorous blinding protocol. While sample size and duration constraints were noted as limitations, the results provide meaningful clinical evidence supporting T. arjuna bark extract as a safe adjunct to standard CHF management.
Short-Term Adjuvant Therapy with Terminalia arjuna Attenuates Ongoing Inflammation and Immune Imbalance in Patients with Stable Coronary Artery Disease: In Vitro and In Vivo Evidence
RCTThis double-blind, randomized clinical trial enrolled 116 patients with stable coronary artery disease (CAD) who received Terminalia arjuna 500 mg twice daily or placebo as adjuvant therapy alongside standard medications. T. arjuna significantly down-regulated triglycerides, VLDL-cholesterol, and multiple immuno-inflammatory markers compared to placebo-treated subjects, with effects sustained over 6 months. Microarray and pathway analysis of representative samples confirmed downregulation of pro-inflammatory gene pathways, consistent with the reduction in cardiovascular risk markers. These findings provide both in vivo clinical and mechanistic molecular evidence for T. arjuna as a safe, evidence-based adjuvant to standard CAD pharmacotherapy.
medication Dosing
capsule
500 mg bark powder or standardized extract
TID (every 8 hours)
Standard dose used in the majority of clinical studies for angina and heart failure. Use only under medical supervision. Maximum studied duration: 3 months. Take with or after meals to reduce GI side effects.
decoction
3-6 g bark powder in 200 mL each milk and water, reduced to 200 mL (Ksheerapaka)
Once or twice daily
Traditional Ayurvedic preparation (Arjuna Ksheerapaka). Milk vehicle enhances extraction of both water-soluble and fat-soluble constituents. Add honey or ghee to taste. This preparation is described in classical Ayurvedic texts for cardiac conditions.
powder
1-2 g bark powder
BID-TID with warm water or milk
Crude bark powder used when standardized extracts are unavailable. Less precisely dosed; standardized extracts (to 20% arjunolic acid) preferred for clinical applications.
Disclaimer: This information is largely AI-generated and reviewed by human experts at Evara Health. It is intended for educational and clinical reference purposes only and should not replace professional medical advice.
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