aloe

General

Pronunciation
AL-oh [Pronunciation]

Trade Name(s)

• Aloe vera

• Cape aloe

• Aloe latex

• Burn plant

• Curacao aloe

Ther. class.
laxatives
wound ulcer decubiti healing agent

Action

• PO: Exerts a laxative effect by increasing colonic motility, reducing water absorption from the bowel and stimulating bowel, chloride secretion and water content.

• Topical: May help accelerate wound healing through inhibition of thromboxane A2 and increased microcirculation, although the evidence is inconsistent. May have some activity against gram-positive, gram-negative bacteria and yeast.

Therapeutic Effect(s):

• Relief of constipation.

• Improved wound healing.

Pharmacokinetics

Absorption: Unknown.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: Unknown.

TIME/ACTION PROFILE

ROUTE	ONSET	PEAK	DURATION
PO, Topical	unknown	unknown	unknown

Contraindication/Precautions

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.

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 old.

Adverse Reactions/Side Effects

Derm: Contact dermatitis, skin irritation.

Endo: hypoglycemia.

F and E: HYPOKALEMIA, dehydration.

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

GU: hematuria.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Natural Products-Drug

• 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 antidiabetics .

• May ↑ bleeding risk with warfarin .

• Alcohol -containing preparations may interact with disulfiram and metronidazole .

Natural Products-Natural Products

• ↑ hypokalemia risk with licorice and horsetail .

• Additive effects with stimulant laxative herbs and herbs with hypoglycemic potential .

Route/Dosage

• 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 3–5 times daily..

Availability

• 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

Assessment

Constipation

• Assess for abdominal distention, presence of bowel sounds, and usual pattern of elimination.

• Assess color, consistency, and amount of stool produced.

Topical

• Perform baseline skin assessment prior to applying aloe to minor wounds, burns, and abrasions. Observe the size, character, and location of the affected area prior to the application of aloe.

• Note topical response assessing for increased inflammation, drainage, pain, warmth, and/or pruritus.

Lab Test Considerations

• Monitor serum potassium in patients with chronic use and CBC in patients who self medicate and experience bloody diarrhea or have ulcerative colitis or Crohn's disease.

Potential Nursing Diagnoses

• Constipation

• Impaired skin integrity

• Deficient knowledge , related to medication regimen

Implementation

• PO: Administer laxative at bedtime to induce a bowel movement in the morning.

• Topical: Wash hands and then apply liberally to affected area of skin. Cover broken areas of skin with a light nonadhering dressing (e.g., band-aid dressing with Telfa lining) to facilitate keeping area clean. Do not apply an occlusive dressing over site of application.

Patient/Family Teaching

• Constipation: Instruct patients with preexisting 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 cathartic 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 a 1500–2000 mL/day during therapy to prevent dehydration.

• Direct 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 nonintact 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.

Evaluation/Desired Outcomes

• A soft, formed bowel movement.

• Evacuation of the colon.

• Relief of sunburn pain.

• Wound healing in small localized burns or abrasions.