Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

• PO: Cathartic laxative.
• Topical: Use on burns/sunburns, wounds, irritated skin, psoriasis; topical anti-infective.

Contraindicated in:

• Intestinal obstruction
• Inflammatory intestinal diseases (including Crohn's disease)
• Appendicitis and abdominal pain of unknown origin
• OB: Safety not established
• Pedi: Oral aloe not appropriate for children <12 yr. Topically applied aloe gel-containing formulations have been safely used in clinical trials.

Use Cautiously in:

• Renal disease
• Fluid or electrolyte abnormalities
• Diabetes
• Alcohol-containing products should be used cautiously in patients with known intolerance or liver disease
• Pedi: Cautious use in children >12 yr.

Derm: Contact dermatitis, skin irritation.

Endo: hypoglycemia.

F and E: HYPOKALEMIA, dehydration.

GI: Cramping, diarrhea, laxative dependence (chronic use).

GU: hematuria.

Natural-Drug Products:

• Combining oral aloe with potassium-wasting drugs (e.g., diuretics, other laxatives, corticosteroids, cisplatin, amphotericin B) may worsen hypokalemia. Hypokalemia may ↑ risk of toxicity from digoxin and some antiarrhythmics.
• May have additive effects with antidiabetic agents.
• May ↑ bleeding risk with warfarin.
• Alcohol-containing preparations may interact with disulfiram and metronidazole.

Natural-Natural Products:

• ↑ hypokalemia risk with licorice and horsetail.
• Additive effects with stimulant laxative herbs and herbs with hypoglycemic potential.
• ↑ bleeding risk with antiplatelet herbs.

• Alone or in combination with other herbal medicinals: ^OTC;
• Capsules: ^OTC;
• Juice: ^OTC;
• Tincture (1:10 in 50% alcohol): ^OTC;
• Topical or gel or applied directly from cut plant: ;

• PO (Adults): Constipation—100–200 mg aloe or 50 mg of aloe extract taken in the evening. Do not use for >1–2 wk without medical advice; Juice—1 teaspoonful tid after meals.
• Topical (Adults): Aloe gel can be applied liberally to affected areas 2–3 times daily.

Aloe vera, Cape aloe, Aloe latex, Burn plant, Curacao aloe

• PO: Exerts a laxative effect by causing increased mucous secretion and peristalsis. The cathartic effects occur within 10 hr. Water and electrolyte reabsorption are inhibited.
• Topical: May help accelerate wound healing through inhibition of thromboxane A2 and increased microcirculation preventing ischemia in wounds, although the evidence is inconsistent. May have some activity against gram-positive, gram-negative bacteria and yeast.

• Relief of constipation.
• Improved wound healing.

Therapeutic Classification: laxatives, wound/ulcer/decubiti healing agent

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-life: Unknown.

• Constipation: Instruct patients with pre-existing intestinal disorders (e.g., ulcerative colitis, Crohn’s disease, irritable bowel syndrome) not to take aloe juice without the advice of a health care professional.
• Counsel patients that the oral juice should not be taken if they are experiencing abdominal pain, nausea, vomiting, or fever.
• Inform patients that occasional constipation may not be an issue but persistent constipation may represent a more serious health problem and to consult their health care professional.
• Advise patients to expect laxative response to the oral juice in 8–12 hr.
• Caution patients that the laxative effects may be dramatic and that accompanying dehydration and electrolyte imbalances may occur. If severe diarrhea occurs or persists, seek out treatment from their health care professional.
• Advise patients other than those with spinal cord injury that laxatives should only be used for short-term therapy. Although this is considered by some to be a natural way of correcting constipation it still carries the risk of electrolyte imbalance and dependency with chronic use.
• Encourage patients to use other forms of bowel regulation: increasing bulk in the diet, increasing fluid intake, and increasing mobility, as appropriate. Normal bowel habits are individualized and may vary from 3 times/day to 3 times/wk.
• Advise patients to consume 1500–2000 mL/day of fluids during therapy to prevent dehydration.
• Caution patients with a known cardiac history not to take this herbal supplement without the advice of their health care professional because of the risk of hypokalemia worsening arrhythmias.
• Caution patients with cardiac history to avoid straining during bowel movements (Valsalva maneuver).
• Topical: Advise patients that topical applications should only be used for minor burns, abrasions, or wounds. Wounds of larger size or more serious burns should be treated by a health care professional.
• Instruct patients using topical application on a non-intact skin surface about signs and symptoms of infection (milky or discolored drainage, redness, warmth, swelling, pain) and to promptly seek out treatment of a health care professional if this occurs.
• Counsel patients that if improvement in the wound is not occurring or it worsens, stop treatment with aloe vera and seek the advice of a health care professional.
• Warn patients with risk factors for delayed wound healing (e.g., diabetic patients, vascular disease) not to self-medicate with aloe vera without the approval of their health care professional.

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