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The roots of cryptolepis, also known as nibima, kadze, gangamau, Ghanaian quinine and yellow-dye root (Cryptolepis sanguinolenta) have been used in Ghanaian traditional medicine for treatment of malaria for many generations. A Ghanaian drug company developed an herbal tea formulation trademarked as PhytoLaria based on this plant, and the clinical evaluation of its potential as a herbal drug treatment for malaria was conducted, with the results published in this issue of the journal by Bugyei, et al (page 3). The active antiplasmodial components found in the root are known to be the indoquinoline alkaloids, which independently have been to have shown to have both in vitro and in vivo activity against Plasmodium falciparum,including chloroquine-resistant strains.1-5 A previously published open label anti-malarial clinical study on the water extract of this plant containing the Cryptolepis alkaloids taken orally indicated efficacy comparable to chloroquine.6 Therefore, the authors expected that the tea bag formulation, which contains significant amounts of the Cryptolepis alkaloids, would also be clinically efficacious.

An herbal tea bag preparation, free of preservatives (including chloroform found on other herbal preparations), based on 2.5 grams of dried ground roots of C. sanguinolenta, was studied in forty four patients with clinical features of uncomplicated malaria. Potential patients who had taken chloroquine or sulfadoxine/pyremethamine within the previous two and four weeks, respectively, where excluded from this study. In three open label out-patient settings in Ghana, the patients were dosed three times daily for five days under the WHO extended seven day test, and followed for 28 days post-treatment.