Arjuna (Terminalia arjuna)

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15. Safety

Adverse effects in trials. Across two angina studies with 78 participants, the systematic review counted 15 adverse events: constipation 4, headache 3, body ache 3, abdominal discomfort 2, and one each of dizziness, pedal oedema and transient cardiac failure [22]. The review does not say which two studies, so these events cannot be tied to a preparation, and one of its studies tested a multi-herb product. In the long-term coronary cohort, gastritis (2) and constipation (1) were the only effects reported over up to 4 years 9 months, with no change in blood count or liver and kidney tests [29]. No adverse events related to the intervention were reported in the healthy-adult trial [26]; liver tests did not deteriorate in the diabetes trial, and no adverse effect was recorded in its arjuna arm [28]. A review chapter summarises mild gastritis, headache and constipation, and no metabolic, renal or hepatic toxicity over more than 24 months [9]. Grade: clinical data, very low certainty; small numbers, short follow-up in most trials, and no rare adverse event could have been detected.

Case reports. None found in the sources read for this version. Stockley’s Drug Interactions (8th edition, 2008) has no arjuna monograph and names T. arjuna only as one ingredient of the multi-herb product Liv.52, in an alcohol interaction [41].

Toxicology. Rats and rabbits given bark at 10 g/kg orally for 40 days showed no histopathological change in heart, liver or kidney; the intraperitoneal LD50 of an extract in mice was 2.5 g/kg [9]. An acute oral study found no toxicity at a limit dose of 2000 mg/kg of ethanolic extract; one animal study found lower thyroid hormone levels and higher hepatic lipid peroxidation with high doses of bark extract, which a review interprets as a reason to avoid high intakes [12]. These two findings are reported from a review; the primary papers were not read for this version.

Contraindications. None established. Conditions for which arjuna is used (angina, heart failure, hypertension) require medical diagnosis and management; the bark is an adjunct only.

Herb-drug interactions.

AIP comment (Medicine): the prothrombin-time data are old and uncontrolled, but the effect reported was large, and the people who take arjuna are those most likely to be on warfarin or antiplatelet drugs. Anyone on warfarin or another anticoagulant should not start arjuna without an INR check arranged with the prescriber within the first week or two and after any change of dose. Anyone on a narrow-therapeutic-index drug, a combination of cardiac medicines or glucose-lowering drugs should use it only with monitoring arranged with the prescriber. Tell the surgical or dental team before a procedure. Stockley’s (2008) is silent on arjuna [41]; that silence means the interaction has not been studied.

Pregnancy. No human or animal reproductive-toxicity data were found in the sources read. The evidence-based pregnancy and lactation reference held in the AIP reference library has no arjuna entry [42]. A listed medicine containing the bark must carry "Not recommended for use by pregnant and lactating women" [3]. Grade: no data; the regulatory warning applies; not recommended.

Lactation. No data on transfer into breast milk or on effects in the breastfed infant [42]. The same label warning applies [3]. Grade: no data; the regulatory warning applies; not recommended.

Children. No data. A listed medicine must carry "Not suitable for children" [3]. Older people. Trial participants were mostly middle-aged and older adults with heart disease [22, 29]; no age-specific signal was reported.

Overdose. No human overdose reports found.

TGA safety information. The TGA website was searched in September 2026 for "arjuna" (4 results: three ARTG product entries and one product cancelled at the sponsor’s request) and "Terminalia" (72 results: 68 ARTG entries, 3 articles, 1 consultation). Neither search returned a safety alert, recall, product-defect notice or medicine safety advisory for arjuna [43]. The Database of Adverse Event Notifications (medicines) opens behind an interactive terms page and a report viewer that could not be driven by the automated search in September 2026; a manual search for "arjuna" and "Terminalia" remains an open action (section 20). Until it is done, the absence of Australian adverse-event reports is unconfirmed.

Contamination risk. See section 10: metal contamination of Ayurvedic products [20] makes a heavy-metal result on every lot part of safe use.

Referral. Where arjuna is considered alongside heart medicines, consult a degree-qualified herbalist with competencies and adequate training in pharmacognosy.