Get Your Personalized Supplement StackSupplement Stack Quiz

Notoginseng extract

Also known as: Notoginseng, Tienchi ginseng, Sanqi, Panax notoginseng (Burk.) F.H. Chen, Panax notoginseng

Overview

Notoginseng extract is derived from the roots of Panax notoginseng, a plant indigenous to China, traditionally utilized for cardiovascular and cerebrovascular conditions. Its primary active compounds are Panax notoginseng saponins (PNS), including ginsenosides and notoginsenosides. This herbal supplement is primarily used in the treatment and prevention of acute ischemic stroke (AIS) and as an adjunct therapy in diabetic nephropathy. It exhibits neuroprotective, anti-inflammatory, antiplatelet, and microcirculatory improvement properties, often administered as injections or oral formulations. Research on Notoginseng is moderately advanced, with multiple randomized controlled trials (RCTs) and systematic reviews, particularly from Chinese research centers, supporting its efficacy and safety.

Benefits

Notoginseng extract offers significant benefits, particularly for acute ischemic stroke (AIS) and diabetic nephropathy. For AIS, systematic reviews and meta-analyses indicate that Panax notoginseng saponins injections (PNSI) improve neurological deficits, reduce disability, and may lower mortality when used as an adjunct therapy after intravenous thrombolysis. Effect sizes show statistically significant improvements in neurological function scores and disability rates. In diabetic nephropathy, combination therapy including Panax notoginseng significantly improves clinical effective rates, reduces urinary albumin excretion rate (UAER), and enhances renal function markers. Secondary benefits include antiplatelet and anti-inflammatory actions, contributing to vascular protection and improved microcirculation. These benefits are observed in adult patients with ischemic stroke (ages 18-75) and diabetic nephropathy patients, with improvements seen within days to weeks post-stroke and weeks to months for diabetic nephropathy.

How it works

Notoginseng primarily exerts its effects through antiplatelet aggregation, achieved by inhibiting platelet activation and aggregation pathways. It provides neuroprotection via anti-inflammatory actions and reduction of oxidative stress, thereby mitigating damage in ischemic conditions. The extract also improves microcirculation and endothelial function, enhancing blood flow and tissue perfusion. Its active saponins interact with the cardiovascular and central nervous systems, improving cerebral blood flow and reducing ischemic injury. Key molecular targets include pathways involved in platelet activation, inflammatory cytokines, and oxidative stress mediators. While oral saponins have moderate bioavailability, injectable forms (PNSI) ensure rapid systemic delivery and quicker onset of action.

Side effects

Notoginseng extract is generally well-tolerated in clinical trials, with no serious adverse events directly attributed to PNSI or oral extracts. Common side effects, reported in over 5% of users, include mild gastrointestinal discomfort and transient headaches. Uncommon side effects (1-5%) may involve allergic reactions and injection site reactions, particularly with injectable forms. Rare side effects (less than 1%) have not been significantly reported in large randomized controlled trials. Caution is advised regarding potential additive effects with anticoagulants and antiplatelets, as Notoginseng possesses antiplatelet properties. Contraindications include known hypersensitivity to Panax species and caution in individuals with bleeding disorders. Safety in pregnant or breastfeeding women has not been well-established, though elderly patients have shown good tolerance in stroke trials.

Dosage

The minimum effective dose of Notoginseng extract varies by formulation, with injectable doses in stroke trials typically standardized per protocol. Optimal dosage ranges are consistent with traditional Chinese medicine guidelines, though exact standardized dosing can differ. A maximum safe dose has not been clearly defined, as clinical trials have reported no dose-limiting toxicity at therapeutic levels. For acute ischemic stroke, early administration post-stroke (within days) is critical for neurological benefit, with injectable PNSI being the preferred form. Oral formulations are generally used for chronic conditions like diabetic nephropathy. Injectable forms bypass first-pass metabolism, ensuring rapid absorption, while oral bioavailability may be influenced by gut flora and specific formulation. No specific cofactors are required, although it is often used in combination with other traditional Chinese medicine herbs.

FAQs

Is Notoginseng extract safe for stroke patients?

Yes, large RCTs and meta-analyses indicate good safety and efficacy when used as adjunct therapy post-ischemic stroke.

How soon after stroke should it be administered?

Early administration post-thrombolysis (within days) is associated with better neurological outcomes.

Can it be combined with other medications?

Generally yes, but caution is advised with anticoagulants due to potential additive antiplatelet effects.

How long until benefits are seen?

Neurological improvements are typically observed within days to weeks after treatment initiation.

Is it effective for other conditions?

Evidence supports its benefit in diabetic nephropathy when combined with other traditional Chinese medicine herbs.

Research Sources

https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2024.1376025/full – This systematic review and meta-analysis of multiple RCTs on AIS patients post-thrombolysis found that Panax notoginseng saponins injections (PNSI) significantly reduce mortality and improve neurological function. The study highlights the short-term benefits of PNSI in acute stroke management, though it notes limitations in long-term data.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2806292 – This large, multicenter, double-blind randomized controlled trial involving approximately 3000 AIS patients in China demonstrated that Panax notoginseng saponins were superior to placebo in improving stroke outcomes. The study provides high-quality evidence for the efficacy of Notoginseng in a clinical setting, although it was limited to a Chinese population.
https://onlinelibrary.wiley.com/doi/10.1155/2021/4694076 – This systematic review and meta-analysis of RCTs on AIS patients concluded that Panax notoginseng saponins (PNS) improve neurological deficits and reduce disability, while maintaining a safe profile. The research synthesizes findings from various studies, providing strong evidence for PNS efficacy in stroke recovery, despite some heterogeneity among the included studies.
https://onlinelibrary.wiley.com/doi/10.1155/2023/2945234 – This meta-analysis of RCTs involving 1342 diabetic nephropathy patients found that combination therapy including Panax notoginseng and Astragalus significantly improved renal function and reduced proteinuria. The study suggests a beneficial role for Notoginseng in managing diabetic nephropathy, though it notes that the combined therapy limits the ability to isolate the effects of Notoginseng alone.
https://pubmed.ncbi.nlm.nih.gov/34335808/ – This PubMed entry refers to a study (likely the same as the Wiley Online Library 2021 entry) that supports the efficacy of Panax notoginseng saponins in improving neurological outcomes and reducing disability in acute ischemic stroke patients. It reinforces the evidence base for Notoginseng's role in stroke recovery, highlighting its safety profile.