HERBAL
MEDICINAL
PLANT
CLOVES
Syzygium aromaticum (L.) Merr. & L.M. Perry +++
BY
RETTODWIKART THENU
CLOVES
(klowvz)
Syzygium aromaticum (L.) Merr. & L.M. Perry +++
SUMMARY AND PHARMACEUTICAL COMMENT
The
pharmacological properties documented for cloves are associated with the
volatile oil, in particular with eugenol which has local anaesthetic action.
However, rigorous clinical research assessing the efficacy and safety of clove preparations
is required. Cloves should not be taken in doses greatly exceeding those used
in foods and caution should be exerted in patients taking anticoagulant or
antiplatelet therapy.
Spices
such as cloves have been used as food preservatives, disinfectants and
antiseptics for centuries (De et al 1999).
Modern research has confirmed that cloves are an effective preservative that
inhibit the growth of many food-poisoning and food-spoiling bacteria.
TRADE NAMES
Cloves
OTHER COMMON NAMES
Oil of cloves,
Oleum caryophylli, Eugenia carylophyllata,
Eugenia aromatica,
Caryophyllus aromaticus,
Myrtaceae
DESCRIPTION
MEDICINAL PARTS: The medicinal
parts are the oil extracted from the whole or macerated flower buds, the
pedicles and leaves, the dried flower buds and the not quite ripe fruit.
FLOWER AND FRUIT: The flowers are
in triply-triple-branched cymes. They are short-pedicled, whitish-pink,
approximately 6 mm wide and have 2 scale-like bracteoles. The calyx tube is 1
to 1.5 cm long and cylindrical. The 4 sepals are fleshy and there are 4 petals.
The fruit is 2 to 2.5 cm long, 1.3 to 1.5 cm wide and is crowned by 4 curved
sepals. The fruit is 1- seeded.
LEAVES, STEM AND ROOT: The plant is a
20 m high, pyramid- - shaped evergreen tree. The diameter of the trunk
is 40 cm. The branches are almost round. The leaves are 9 to 12 cm long and 3.5
cm wide. They are coriaceous, elliptical to lanceolate, short, obtusely tipped
and narrowing in a cuneate form to the petiole, which is 2.5 cm long. There is
1 main rib and more than 20 lateral ones.
CHARACTERISTICS: The taste and
odor are characteristic.
HABITAT: The plant is
indigenous to the Molucca Islands and is cultivated there and in Tanzania,
Madagascar, Brazil and other tropical regions.
PRODUCTION: Cloves consist
of the hand-picked and dried flower buds of Syzygium aromaticum (syn. Jambosa
caryophyllus, Eugenia caryophyllata).
SPECIES (FAMILY)
Syzygium
aromaticum (L.) Merr. & Perry
(Myrtaceae)
SYNONYM(S)
Caryophyllus aromaticus L., Eugenia aromatica (L.) Baill., Eugenia
caryophyllata Thunb.,
Eugenia
caryophyllus (Spreng.) Bull. &
Harr.
ORIGIN
Cloves are found in South
America, Sumatra, and Tanzania.
The
plant is indigenous to the Molucca Islands and is cultivated there and in Tanzania,
Madagascar, Brazil
and other
tropical regions.
PHARMACOPODIAL AND OTHER MONOGRAPHS
BHP 1996(G9)
BP 2007(G84)
Complete German Commission E(G3)
Martindale 35th edition(G85)
Ph Eur 2007(G81)
LEGAL CATEGORY (LICENSED PRODUCTS)
GSL(G37)
CONSTITUENTS
The
following is compiled from several sources, including General References G2 and
G58.
Volatile Oils Clove
bud oil (15–18%) containing eugenol (80– 90%), eugenyl acetate (2–27%),
b-caryophyllene (5–12%). Others include methylsalicylate, methyleugenol,
benzaldehyde, methylamyl ketone and a-ylangene.
Leaf Oil (2%) containing eugenol 82–88%.
Stem Oil (4–6%) with eugenol 90–95%. A more
comprehensive listing is provided elsewhere. (G22)
Other Constituents Campesterol,
carbohydrates, kaempferol, lipids, oleanolic acid, rhamnetin, sitosterol,
stigmasterol and vitamins.
CHEMICAL COMPONENTS
Volatile Oil (15-21%): chief components
eugenol (70-90%), eugenyl acetate (aceteugenol, up to 17%), beta-caryophyllene (5-12%)
Flavonoids: including
astragalin, isoquercitrin, hyperoside, quercetin-3,4'-di-0-glycoside
Tannins (10%): ellagitannins,
including eugenin
Triterpenes: oleanolic acid
(1%), crataegolic acid (maslic acid, 0.15%)
Steroids: sterols,
including beta-sitosterol
The
main constituent of clove oil is eugenol. Other components include
beta-caryophyllene, acetyl eugenol, isoeugenol, eugenine, kaemferol, tannins, gallic
acid, vitamin C, minerals (boron, calcium, chromium, iron, manganese,
magnesium, potassium, phosphorus), flavonoids (Nassar, 2006).
USES
USES
Marshmallow is used traditionally to suppress cough and
relieve sore throat and gastric disorders such as irritable bowel syndrome,
gastritis, and constipation. Topically, it is used to treat minor skin
disorders.
FOOD USE
Clove
is listed by the Council of Europe as a natural source of food flavouring
(category N2). This category indicates that clove can be added to foodstuffs in
small quantities, with a possible limitation of an active principle (as yet
unspecified) in the final product.(G16) Clove is commonly used in cooking, and
as a flavouring agent in food products. Previously, clove has been listed as
GRAS (Generally Recognised As Safe).(G41)
HERBAL USE
Clove
has been traditionally used as a carminative, anti-emetic, toothache remedy and
counter-irritant.(G2, G41, G64)
Clove
oil is stated to be a carminative, occasionally used in the treatment of
flatulent colic(G54) and is commonly used topically for symptomatic relief of
toothache.(G45)
Figure 1. Clove (Syzygium aromaticum).
Figure 2. Clove – dried drug substance (flowerbud).
ACTIONS
Clove oil possesses antihistamine, spasmolytic, mildly
antiseptic, anthelmintic, and larvicidal properties.
Topical Anesthetic Action
When applied topically, cloves have been found to
inhibit pros ta glan din synthesis, cyclooxygenase, and lipoxygenase. Eugenol,
one of the chemical components of cloves, is responsible for these actions
(Rasheed et al, 1984).
Antimicrobial Action
In underdeveloped countries where most people cannot
afford the high cost of medications, cloves have been used to treat diarrheal
diseases in children. In one study, the antibacterial effect of cloves was
tested using a decoction of aqueous dried extract. The extract showed activity
against Salmonella E., Shigella D., Shigella F., Escherichia
coli, and Enterobacter (Tsakala et al, 1996). Another study
investigated the effi cacy of cloves against cytomegalovirus (CMV). Cloves
demonstrated signifi - cant effectiveness against CMV in low concentrations in
vitro (Yukawa et al, 1996). Syzygium aromaticum showed active inhibition
of hepatitis C virus (HCV) when tested with 71 medicinal plant extract (Hussein
et al, 2000). Another study (Dorman et al, 2000) investigated the volatile oils
in several medicinal plants, including cloves. All oils exhibited signifi cant
antimicrobial effect (Dorman et al, 2000).
Other Actions
Cloves have shown slight antioxidant properties when
used on rats with afl atoxins (Abdel-Wahhab et al, 2005). This could be due to
two chemical components, eugenol and acetyl-eugenol, both phenols.
MAIN ACTIONS
Because
of cloves’ significant eugenol content, most pharmacological activity is based
on studies involving eugenol.
Local
Analgesic, Local Anaesthetic and Anti-Inflammatory
The
local analgesic and anti-inflammatory activity of clove oil is mainly due to
the eugenol component. Eugenol acts on contact to depress nociceptors, the sensory
receptors involved in pain perception (Brodin &
Roed 1984). Eugenol also inhibits prostaglandin biosynthesis through potent
cyclo-oxygenase-1 and -2 inhibitory activity (Huss et al 2002,
Kelm et al 2000) and modulates inflammatory pathways by inhibiting the release of
leukotrienes (Raghavenra et al 2006).
According
to experiments with an animal model, daily doses of eugenol produce a
cumulative effect after 5 days of continuous administration, producing a
statistically significant reduction in neuropathic pain (Guénette
et al 2007). Although eugenol is chiefly responsible for much of the
pharmacological activity of cloves, other constituents are also involved (Ghelardini et
al 2001a). Beta-caryophyllene is another key component of clove oil, which
exhibits significant anti-inflammatory and rapid local anaesthetic activity in
several animal models (Ghelardini et al 2001b, Muruganandan et
al 2001). Local anaesthetic effects develop within 5 minutes of
application and diminish after about 15 minutes.
Antiseptic
— Fungicidal, Antibacterial, Antiviral, Antiparasitic
Clove
oil has an inhibitory effect against yeasts and fungi in vitro (Arora
& Kaur 1999). Cloves are effective against species belonging to the Eurotium,
Aspergillus and Penicillium genera in vitro (Guynot et
al 2003) and clove essential oil has exhibited strong antifungal activity
against Aspergillus and aflatoxigenic strains (Bluma
et al 2008, Viuda-Martos et al 2007) and various other fungal
species (Park et al 2007).
Experiments
with animal models have identified significant activity against Candida
albicans. Vaginal candidiasis responded to treatment of topical application
of clove oil in animal models suggesting that further investigation is
warranted to determine clinical relevance (Ahmad et al 2005). Another
animal experiment found that oral intake of cloves reduced Candida albicans growth
in the alimentary tract (Taguchi et al 2005). It is likely that the
eugenol component is important for such effects, as in vitro experiments
identified that eugenol displays anticandidal activity by affecting the envelope
of the organism (Braga et al 2007, Fu et al 2007). Antibacterial
activity has also been demonstrated for cloves and several of its key
constituents. Cloves has activity against gram-negative, anaerobic, periodontal
oral pathogens, including Porphyromonas gingivalis and Prevotella
intermedia (Cai & Wu 1996).
Activity
has also been demonstrated against Bacillus subtilis, Listeria
monocytogenes, Salmonella enterica, Escherichia coli and Saccharomyces
cerevisiae (Burt & Reinders 2003, Chami et al
2005, De et al 1999, Dorman & Deans 2000, Friedman et al 2002, Fu et al 2007)
and Staphylococcus epidermidis (Fu et al 2007).
Aqueous
extract of cloves demonstrated a strong inhibitory action against six Helicobacter
pylori strains in vitro (Yang et al 2005).
Further research is required to determine the clinical relevance of these in
vitro findings and establish whether cloves may be utilised as an effective
treatment for common infections. In vitro assays have identified inhibitory
effects on hepatitis C virus protease (Hussein et al 2000) and
human cytomegalovirus (Shiraki et al 1998,
Yukawa
et al 1996). An animal model confirmed significant activity against herpes
simplex virus type 1 (Kurokawa et al 1998). An inhibitory effect against
parasitic growth has been demonstrated in vitro for clove oil (Santoro
et al 2007).
OTHER ACTIONS
Antihistamine Clove bud extracts inhibit
histamine release from mast cells in vivo and in vitro (Kim
et al 1997, 1998, Shakila et al 1996).
Antioxidant
Several
constituents within the flower have antioxidant activity, especially eugenol,
which has been the focus of most antioxidant research (Duke 2002). Studies with
cloves and eugenol have demonstrated protective effects against several agents,
which cause damage to cells and tissues via an oxidative stress mechanism. Cloves
illustrated a protective effect against a cytotoxic agent (peroxynitrite) that
causes damage to proteins, lipids and DNA (Ho et al 2008) and
significantly reversed isoprenaline-induced cardiac hypertrophy in rats (Choudhary
et al 2006). In other studies, eugenol was shown to reduce radiation-induced
membrane damage (Pandey et al 2006),
to prevent lipid peroxidation and increase glutathione (Kabuto
et al 2007).
Antispasmodic Both beta-caryophyllene and
eugenol have antispasmodic activity (Duke 2002).
Antiplatelet Eugenol inhibits platelet
aggregation in vitro (Srivastava 1993, Srivastava & Malhotra 1991).
It was more potent than aspirin in several experimental models
and equivalent to indomethacin in one (Srivastava
1993).
Anticarcinogenic
Eugenol
essential oil showed anticancer apoptosis activity on HL-60 human promyelocytic
leukaemia cells in vitro (Yoo et al 2005).
Further chemopreventive potential was explored in mice with induced lung
carcinogenesis. A clove infusion, administered orally, was found to significantly
reduce proliferating cells and increase apoptosis. The cloves downregulated some
growth-promoting proteins, while at the same time upregulating the expression
of some pro-apoptotic proteins (Banerjee et al 2006). A
later in vitro study confirmed apoptosis activity with eugenol (and its
analogues) and suggested that it may have a chemotherapeutic role (Carrasco
et al 2008). An aqueous infusion of cloves, administered orally, in a mouse
experiment delayed the formation and reduced skin papilloma (Banerjee
& Das 2005)
Antidiabetic
In
vitro tests have identified hypoglycaemic activity for cloves. It appears that
a phenolic compound in cloves may be the key constituent responsible and
acts by repressing the expression of genes, which control hepatic
gluconeogenesis (Prasad et al 2005). Commercially sold
culinary cloves were also shown to be potent inhibitors of fructose-mediated
protein glycation and so may have antidiabetic potential (Dearlove
et al 2008). Further research is required with in vivo models of
diabetes to determine whether these effects may have clinical significance.
Cognitive
Effects An
animal study found that intraperitoneally administered clove extract (200
mg/kg) improved shortterm memory recall but caused some impairment in learning
ability (Morshedi et al 2006).
CLINICAL USE
The
clinical effects of cloves and clove oil have not been significantly
investigated; however, an understanding of the herb’s pharmacological activity suggests
a role in the treatment of several conditions.
Toothache
and Relief of Dry Socket Pain
Clove
oil and dried clove buds are used in dentistry to relieve dental pain and
reduce infection. Based on the evidence available, Commission E has approved
cloves for use as a local anaesthetic and antiseptic (Blumenthal
et al 2000). In one study, clove oil was found to be as effective as
benzocaine as a topical anaesthetic before needle insertion in dentistry (Alqareer
et al 2006).
Oral
Hygiene Used
as an antiseptic and antibacterial agent for the oral mucosa, clove is used as
an ingredient in mouth rinses and gargles. Its established antiseptic activity provides
a theoretical basis for efficacy.
Herpes
Simplex Virus Type 1
One
study using a combination of acyclovir and cloves administered orally found
this to be superior to acyclovir alone in the treatment of herpes simplex virus
type 1 infection (Kurokawa et al 1995).
The
combination significantly reduced the development of skin lesions and/or
prolonged survival times of infected mice and reduced viral loads.
Headache
(as part of a combination)
Tiger
balm is a popular OTC preparation that contains clove oil, menthol, cassia oil,
camphor, cajuput oil and sometimes peppermint oil. It is generally used to
relieve the symptoms of sore muscles, but a randomised, double-blind study
found that it is also as effective as paracetamol in reducing headache severity
(Schattner & Randerson 1996). Although encouraging,
the role of cloves in this combination is difficult to assess from the study.
Type
2 Diabetes
In a
small study, 36 people with type 2 diabetes were given 0, 1, 2 or 3 g capsules
of cloves for 30
days.
All the groups administered with cloves had significantly lowered serum
glucose, triglycerides, total and LDL cholesterol and there was no change to
HDL cholesterol. After 10 days washout period all these parameters were still
significantly lower than at the start of the trial (Khan
et al 2006). Further research is warranted to confirm clinical use for type
2 diabetes and to assess any side effects with oral ingestion of cloves.
OTHER USES
Cloves
have been investigated as an agent to protect harvests from fungal
contamination (Ranasinghe et al 2002).
PHARMACOLOGICAL ACTIONS
IN VITRO AND ANIMAL STUDIES
The
anodyne and mild antiseptic properties documented for clove oil have been
attributed to eugenol.(G41) Clove oil is stated to possess antihistaminic and
antispasmodic properties.(G41) Eugenol, eugenol acetate and methyl acetate are
reported to exhibit trypsin-potentiating activity.(G41) Antibacterial, hypoglycaemic
and potent CNS-depressant activities have been documented for Syzygium cuminii L.,
a related species cultivated in India.(1)
CLINICAL STUDIES
There
is a lack of clinical research assessing the effects of cloves and rigorous
randomised controlled clinical trials are required.
ACTIVITIES
Analgesic
(2; APA; CAN; PHR; PH2; PIP; WAM); Anesthetic (1; CRC; HH2; KOM; PH2; TRA);
Anthelminthic (1; PNC); Antiaggregant (1; DAD; TRA); Antialzheimeran (1; COX;
FNF); Antiarthritic (1; COX; FNF); Antibacterial (1; KOM; PH2; PIP; TRA); Anticancer
(1; APA); Anticonvulsant (1; TRA); Antidote (f; CRC); Antiemetic (f; CAN; HH2);
Antiherpetic (1; HH2; TRA); Antihistaminic (1; CAN); Antiinflammatory (1; COX;
FNF); Antimutagenic (1; X7753104); Antinitrosating (1; X7753104); Antioxidant
(1; APA); Antiperspirant (f; CRC); Antiseptic (1; APA; CRC; HHB; KOM; PH2); Antispasmodic
(1; HH2; KOM; PH2; PIP); Antiviral (1; APA; KOM; PH2; PIP; TRA); Candidicide
(1; APA; TRA); Carminative (1; CAN; CRC); Counterirritant (1; CAN); Deodorant
(f; CRC); Digestive (f; CRC); Expectorant (f; CRC); Fungicide (1; KOM; PH2;
PIP; TRA); Insectifuge (1; CRC; WOI); Larvicide (1; APA); Parasympaticolytic
(1; TRA); Peristaltic (f; CRC); Rubefacient (f; CRC); Stimulant (1; CRC; FNF);
Stomachic (f; CRC); Tonic (f; CRC); Tranquilizer (1; TRA); Trichomonicide (1;
HH2); Trypsin-Potentiator (1; CAN); Vasodilator (1; TRA); Vermifuge (f; CRC).
INDICATIONS
Alzheimer’s (1; COX; FNF); Anorexia (f; PH2);
Arthrosis (1; COX; FNF); Aspergillus (1; HH2); Athlete’s Foot (15% tincture in
70% alcohol) (2; CAN); Bacteria (1; KOM; PH2; PIP; TRA); Bronchosis (2; PHR);
Bug Bite (1; APA); Bunion (1, TGP); Callus (f; CRC); Cancer (1; APA; COX; FNF;
X7753104); Candida (1; APA; HH2; TRA); Caries (f;
CRC); Childbirth (f; CRC); Cholera (f; CRC); Cold
(2; PHR; PH2); Colic (1; CAN; PH2); Convulsion (1; TRA); Cough (2; PHR); Cramp
(1; HH2; KOM; PH2; PIP); Dermatosis (1; APA); Diarrhea (1; APA; CRC; HH2);
Dyspepsia (f; CRC; HH2); Enterosis (f; CRC); Escherichia (1; HH2); Fever (2;
PHR); Fungus (1; CRC; HH2; KOM; PH2; PIP; TRA); Gas (1; CAN; CRC; HH2; PH2);
Gastrosis (f; CRC; PH2); Gingivosis (1; APA); Halitosis (1, LMP; PH2; TGP); Headache
(1; HH2; PH2); Heart (f; CRC); Hernia (f; CRC); Herpes (1; HH2; TRA); Hiccup
(f; CRC); Infection (2; APA; KOM; PHR; PH2; PIP; TRA); Infertility (f; CRC);
Inflammation (2; COX; FNF; KOM); Maculosis (1, TGP); Mucososis (1; APA);
Myalgia (f; HH2); Mycosis (1; KOM; PH2; PIP; TRA); Nausea (f; CRC); Nervousness
(1; TRA); Ophthalmia (f; PH2); Pain (2; APA; CAN; CRC; HH2; KOM; PHR; PH2; PIP;
TRA; WAM); Pharyngosis (2; APA; KOM; PH2; PIP); Phthisis (f; CRC); Polyp (f;
CRC); Retinosis (1, TGP); Rhinosis (f; CRC); Sore (f; CRC); Sore Throat (PIP);
Spasm (f; CRC); Staphylococcus (1; HH2); Stomatosis (2; APA; KOM; PH2; PIP);
Teething (1; WAM); Toothache (2; APA; CAN; HH2; PH2; TRA); Trichomonas (1; HH2);
Ulcer (f; PH2); Uterosis (f; CRC); Vaginosis (1; APA; HH2); Virus (1; APA; CRC;
KOM; PH2; PIP; TRA); Vomiting (f; CAN; HH2); Wart (f; CRC); Worm (f; CRC);
Wound (1; APA; CRC); Yeast (1; APA; HH2; TRA).
INDICATIONS AND
USAGE
Approved by
Commission E:
• Dental
analgesic
• Inflammation
of the mouth and pharynx
UNPROVEN USES: Clove oil is
used internally for stomach ulcers and externally for colds and headaches. It
is also used externally as a local analgesic and dental antiseptic.
INDIAN MEDICINE: The drug is used
for halitosis, toothache, eye disease, flatulence, colic, gastropathy, and
anorexia.
PRODUCT AVAILABILITY
Component in Cigarettes and Mouthwash;
Essential Oil; Tincture
PLANT PARTS USED: Dried Flower
Buds (clove oil is distilled from this plant part),
Leaf, Stem
DOSAGES
DOSAGES
·
Adult mouthwash: _1 oz of 1%-5% essential oil prn
·
Adult PO tincture: 5-30 drops (1:3 dilution) prn
·
Adult PO: 120-300 mg (Jellin et
al, 2008)
·
Adult topical: 1-5 drops essential oil prn
·
Adult topical tincture: 15%
for athletes foot (Jellin et al, 2008)
DOSAGES
Dosages for oral administration (adults) for traditional uses recommended
in older standard pharmaceutical reference texts are given below. In dentistry,
clove oil is applied undiluted using a plug of cottonwool soaked in the oil and
applied to the cavity of the tooth (see Contra-indications, Warnings).
·
Clove 120–300 mg.(G44)
·
Clove Oil 0.05–0.2 mL.(G44)
DOSAGES
·
120 – 320 mg clove (CAN); 100 – 300 mg powdered clove (PNC); 0.05 – 0.2 mL clove oil (CAN; PNC);
·
Mouthwashes with 1 – 5% EO
(KOM; PH2); 2 – 4 mL concentrated clove
infusion (PNC).
DOSAGES
MODE OF
ADMINISTRATION: As
a powdered, ground, or whole herb for the recovery of the essential oil, and
other galenic preparations for topical use.
DAILY DOSAGE:
Aqueous solutions corresponding to 1 to 5% essential
oil are used externally for mouthwashes. In dentistry, the undiluted essential
oil is used.
STORAGE:
Do not store the drug in plastic containers, and protect
it from light.
DOSAGES
·
Powder: 120–300 mg as
a single dose.
·
Oil: 0.05–0.2 mL as
a single dose.
·
Toothache or Gum Inflammation: oil of clove is applied
directly to the site.
·
Dry Socket: the area is
packed with dried flower buds steeped in oil.
·
Headache: one drop of
oil massaged into each temple or area of pain.
PRECAUTIONS AND ADVERSE REACTIONS
No
health hazards or side effects are known in conjunction with the proper
administration of designated therapeutic dosages. Allergic reactions to eugenol
occur rarely. In concentrated form, oil of clove may be irritating to mucosa.
According to one
review, contact dermatitis has been reported, and local application may cause
irritation to mucous membranes in sensitive individuals. Oral use of the oil
can cause nervous system depression, seizures, hepatic dysfunction and
irritation to mucosal tissues.
CONTRAINDICATIONS, INTERACTIONS, AND SIDE EFFECTS
CLASS 1
(AHP). “Hazards and/or side effects
not known for proper therapeutic dosages” (PH2). CAN reports the eugenol in the
volatile oil to be an irritant. The oil is a dermal and mucous irritant,
sometimes causing cheilitis, dermatosis, and stomatosis. NO undiluted oil on
infants’ gums or throat (Dilution: 2–4 drops oil to 1 tsp almond, safflower, or
canola oil) (WAM). May interfere with anticoagulant therapy. “There are no
known problems with the use of clove during pregnancy and lactation, provided
that doses do not greatly exceed the amounts used in foods” (CAN). Clove bud
oil is reported to have an oral LD50 of 2650 mg/kg body weight in rats
(equaling that of the major ingredient, eugenol, which sensitizes some people,
causing contact dermatosis) (DAD). EO LD50 = 2650 mg/kg orl rat (CRC). Major
source of the COX-2 inhibitor, oleanolic acid, with clove up to 2% (COX). As
the best source of eugenol, clove (up to 20% eugenol) may share many of its
reported biological activities.
SIGNIFICANT INTERACTIONS
Cloves
have been found in vitro to strongly inhibit metabolism mediated by CYP3A4 and
CYP2D6. In vivo studies are currently under progress and clinical relevance has
yet to be established (Usia et al 2006). If cloves are only used topically, these interactions are
unlikely to be relevant.
CONTRA-INDICATIONS,
WARNINGS
None
documented for the bud, leaf or stem. It is recommended that clove oil should
be used with caution orally and should not be used on the skin.(G58) Repeated
application of clove oil as a toothache remedy may result in damage to the
gingival tissue.(G45) In view of the irritant nature of the volatile oil,
concentrated clove oil is not suitable for internal use in doses larger than
those recommended. There is limited evidence from in vitro investigations that eugenol
inhibits prostaglandin synthesis,(2) and coagulation disorders have been
reported following childhood ingestion of clove oil.(3, 4)
Drug interactions
None documented. However, the potential for preparations of clove oil to
interact with other medicines administered concurrently, particularly those
with similar or opposing effects, should be considered. Eugenol, a major consituent
of clove oil, inhibits prostaglandin synthesis, although the clinical relevance
of this, if any, is unclear.
Pregnancy and lactation There
are no known problems with the use of clove during pregnancy or lactation,
provided that doses taken do not greatly exceed the amounts used in foods.
CONTRAINDICATIONS
CLASS
1 HERB. Until more research is
available, do not use cloves medicinally during pregnancy and breastfeeding. Do
not give them to children. Essential oil should be used only when diluted in a
carrier oil.
SIDE EFFECTS/ADVERSE REACTIONS
CNS: Depression,
seizures
EENT: Tissue
irritation, airway injury
HEMA: Disseminated
intravascular coagulation
INTEG: Skin
irritation
RESP: Bronchospasm,
pulmonary edema
INTERACTIONS
DRUG
Anticoagulants, platelet inhibitors, salicylates: Cloves may increase the effect of these products.
LAB TEST
PT, INR, AST, ALT, alkaline phosphatase: Cloves may increase these levels.
EFFECTS
Clove
is antiseptic, antibacterial, antifungal, antiviral, spasmolytic and a local
anaesthetic.
SIDE-EFFECTS, TOXICITY
There
is a lack of clinical safety data and toxicity data for clove oil and further
investigation of these aspects is required. Clove oil is stated to be a dermal
and mucous membrane irritant;(G58) contact dermatitis, cheilitis, and stomatitis
have been reported for clove oil.(G51) The irritant nature of the oil can be
attributed to the eugenol content. Eugenol is also stated to have sensitising properties.(G51)
An LD50 (rat, by mouth) value for clove oil is stated as 2.65 g/kg body
weight.(G22)
PRACTICE POINTS
·
Clove
flower buds and clove oil has antiseptic, analgesic, anti-inflammatory and
local anaesthetic properties.
·
It
is directly applied to relieve the symptoms of toothache and dry socket.
·
Clove
oil is also used in mouth rinses and gargles to improve oral hygiene.
·
Massaging
one drop of oil into the temples has been used to treat headache.
·
This
herb and its essential oil should not be taken internally.
PATIENTS’ FAQs
What will this
herb do for me?
Clove flower buds and clove oil have antiseptic,
anti-inflammatory, analgesic and local anaesthetic properties that are useful
in the treatment of toothache, dry socket and common mouth infections.
Massaging one drop of the oil into the
temples may relieve the symptoms of headache.
When will it
start to work?
Research suggests that effects are
almost immediate, although short lasting.
Are there any
safety issues?
Clove buds and clove oil should not be
taken internally, and only applied externally, although using cloves as a spice
in cooking may give you some of the antioxidant benefits.
CLIENT CONSIDERATIONS
ASSESS
·
Assess the reason the client is
using cloves medicinally.
·
Assess for allergic reactions
(bronchospasm, pulmonary edema). If allergic symptoms are present, use of the
herb should be discontinued and emergency measures instituted.
ADMINISTER
·
Instruct the client to store
cloves in a cool, dry place, away from heat and moisture.
·
Instruct the client to dilute
essential oil in a carrier oil.
TEACH CLIENT/FAMILY
·
Caution the client not to use
cloves medicinally in children or those who are pregnant or breastfeeding until
more research is available.
PREPARATIONS
PROPRIETARY MULTI-INGREDIENT PREPARATIONS
Austria:
Mariazeller. Brazil: Balsamo Branco. Czech Republic: Naturland Grosser
Swedenbitter; Stomatosan. Germany:
Inconturina;
Klosterfrau Melisana; Melissengeist. Italy: Biophase Shampoo; Saugella Uomo.
Portugal: Midro. Russia: Doppelherz Melissa (Доппельгерц Мелисса); Maraslavin (Мараславин);
Original Grosser Bittner Balsam (Ориги- нальный Большой Бальзам Биттнера).
South Africa: Clairo; Melissengeist; Spiritus Contra Tussim Drops. Switzerland:
Odontal; Tisane pour les problemes de prostate. UK: Melissa Comp.; Revitonil.
REFERENCE
Barnes, J., Anderson, L. A., and Phillipson, J. D. 2007. Herbal
Medicines Third Edition. Pharmaceutical Press. Auckland and
London.
Braun
Duke, J. A. with Mary Jo Bogenschutz-Godwin, Judi duCellier, Peggy-Ann K.
Duke. 2002. Handbook of Medicinal Herbs 2nd Ed. CRC Press
LLC. USA.
Gruenwald, J., Brendler,
T., Jaenicke, Ch. 2000. PDR for Herbal
Medicines. Medical Economics Company, Inc. at Montvale, NJ
07645-1742. USA
Linda S-Roth. 2010. Mosby’s Handbook Of Herbs & Natural
Supplements, Fourth Edition. Mosby Elsevier. USA
Figure
3. Primary Chemical Components and Possible Actions
(Linda, S-R. 2010)
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