Terminalia arjuna
Summary
Terminalia arjuna bark has small, mostly Indian trials in heart disease. A 2026 meta-analysis of 9 heart-failure trials (537 patients) found less left-ventricular mass but no significant change in ejection fraction, and the largest single trial (100 patients) found no ejection-fraction benefit. Angina evidence was judged insufficient. All trials used it alongside standard heart medicines.
Key facts
- Bark of the arjuna tree, used in Ayurveda as a cardiotonic; extracts contain triterpenoids (arjunic acid), glycosides, flavonoids and tannins[3][1]
- 9 trials, 537 patients: left-ventricular mass fell, HDL rose, ejection fraction did not change significantly[1]
- 100 heart-failure patients, 750 mg twice daily for 12 weeks: no change in ejection fraction[4]
- A 2014 systematic review found poor-quality studies and no significant pooled differences[2]
- 6 graded human outcomes on this page
- October 13, 2026
How it works
ProposedArjuna bark contains triterpenoids, glycosides and antioxidant flavonoids, tannins and proanthocyanidins, and is described as having anti-ischaemic and anti-failure effects. In people, it lowered lipid peroxidation and LDL in one trial and preserved red-cell antioxidant enzymes in another; how it might act on the heart is proposed.[3][4][6]
What the human research says
Human trials only, one row per outcome. The form column shows what each trial actually tested. Grades follow our evidence-grading policy.
At a glance: strongest evidence per outcome
| Outcome | Grade | Effect | Strongest evidence | Rows |
|---|---|---|---|---|
| Heart failure | Grade B | No effect | RCT · n = 100 · 2016 | 3 rows |
| Cholesterol | Grade D | Mixed | RCT · n = 105 · 2001 | 1 row |
| Angina | Grade D | Improved | Crossover RCT · n = 58 · 2002 | 1 row |
| Endurance | Grade D | Improved | RCT · n = 32 · 2017 | 1 row |
Every graded row
| Outcome | Effect | Grade | Best evidence | PMID |
|---|---|---|---|---|
| Ejection fraction in chronic heart failure | No effect | Grade B | RCT · n = 100 · 2016 Patients with NYHA class II heart failure and ejection fraction 40% or less on standard drugs Form: Standardised water extract of arjuna stem bark · Dose: 750 mg twice daily · Duration: 12 weeks No change in ejection fraction versus placebo (24.3% vs 25.5%, p=0.4) or in secondary outcomes except red-cell catalase; post-hoc subgroup gains in walk distance and symptoms. | 26988798 (opens PubMed)Source [4] |
| Left-ventricular mass, ejection fraction, lipids and blood pressure in heart failure | Mixed | Grade C | Meta-analysis · n = 537 · 2026 Adults with heart failure in 9 trials Form: Terminalia arjuna preparations, added to usual treatment · Dose: Varied · Duration: Varied Left-ventricular mass fell (mean difference −44.3) and HDL rose (+3.5), but ejection fraction improved only non-significantly (+1.85, p=0.1) and blood pressure, triglycerides and LDL did not change. | 42389976 (opens PubMed)Source [1] |
| Cholesterol and lipid peroxidation in coronary heart disease | Mixed | Grade D | RCT · n = 105 · 2001 Patients with coronary heart disease not on lipid-lowering drugs Form: Arjuna bark powder · Dose: 500 mg/day · Duration: 30 days Total cholesterol fell 9.7% and LDL 15.8% within the arjuna group; lipid peroxides fell 29.3% (vitamin E: 36.4%). | 11225136 (opens PubMed)Source [6] |
| Angina frequency and treadmill performance in stable angina | Improved | Grade D | Crossover RCT · n = 58 · 2002 Men with chronic stable angina Form: Arjuna bark extract (IPC-53) · Dose: 500 mg every 8 hours · Duration: 1 week per treatment Angina episodes and rescue nitrate use fell (5.7 vs 18.2 mg/week isosorbide dinitrate) and treadmill exercise time rose (6.1 vs 4.8 min) versus placebo. | 12086380 (opens PubMed)Source [3] |
| Ejection fraction and exertion in exercising young men | Improved | Grade D | RCT · n = 32 · 2017 Healthy men aged 18–40 doing regular endurance exercise Form: Proprietary arjuna extract (E-OJ-01) · Dose: 400 mg/day · Duration: 56 days Ejection fraction rose and right-ventricular performance index and perceived exertion fell versus placebo; CK-MB and troponin did not change. | 27930383 (opens PubMed)Source [7] |
| Symptoms and echocardiography in refractory heart failure | Improved | Grade D | Crossover RCT · n = 12 · 1995 Patients with NYHA class IV heart failure, mostly dilated cardiomyopathy Form: Arjuna bark extract · Dose: 500 mg every 8 hours · Duration: 2 weeks per treatment Ejection fraction rose (35% vs 30%) and NYHA class, ventricular volumes and stroke volume improved versus placebo. | 7649665 (opens PubMed)Source [5] |
Forms
| Form | Elemental % | Absorption (human data) | GI tolerance | Studied for |
|---|---|---|---|---|
| Arjuna bark extract (standardised) | Varies[3][4][5][7] | No human absorption data.[3][4] | Well tolerated in a 12-week trial of 750 mg twice daily.[4] | Heart failure, angina and athlete trials (400–1,500 mg/day) |
| Arjuna bark powder | Varies[6] | No human absorption data.[6] | No adverse effects reported in the abstract of the 30-day trial.[6] | Cholesterol trial in coronary heart disease (500 mg/day) |
Studied doses
Doses studied in human trials ranged from 400 mg/day of an extract (8 weeks) and 500 mg/day of bark powder (30 days) to 1,500 mg/day given as 750 mg twice daily (12 weeks) or 500 mg every 8 hours (1–2 week crossover periods).[3][4][5][6][7]
Interactions
Published interactions only: each row cites a source. No row means none was found in our sources, not that a combination is safe.
Medicines
- Heart medicinesRCTEvery trial gave arjuna on top of standard heart drugs, but no human interaction studies have been published, including with digoxin or anticoagulants; in angina it reduced rescue nitrate use.[3][4][5]
- Drugs cleared by CYP3A4, CYP2D6 or CYP2C9PK studyAlcoholic and water extracts of arjuna bark strongly inhibited all three enzymes in human liver microsomes, which could raise levels of these drugs; not yet tested in people.[8]
Who should be careful
- Heart failure and angina
- Arjuna was studied only as an add-on to prescribed heart medicines under specialist care; the largest heart-failure trial found no ejection-fraction benefit. Lab tests show it blocks enzymes that clear warfarin and several heart drugs, so prescribers should know about it.[4][1][8]
Talk to your pharmacist or clinician before starting a supplement, especially if you take prescription medicines.
How to read the label
- Studied dose is higher than many labelsMost heart trials used 1,500 mg/day of bark extract, split into two or three doses.[3][4][5]
- Extract vs bark powderTrials used standardised water extracts, a branded extract (E-OJ-01) or plain bark powder; results from one do not automatically apply to another.[4][6][7]
Cost per studied dose, without the sales pitch
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Cost per studied dose
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Frequently asked questions
Does Terminalia arjuna help heart failure?
Unclear. A meta-analysis of 9 trials found lower left-ventricular mass but no significant ejection-fraction change, and the largest single trial (100 patients) found no ejection-fraction benefit.[1][4]
Does arjuna help angina?
One 58-person crossover trial reported fewer angina episodes, but a systematic review judged the angina evidence poor and insufficient.[2][3]
Does arjuna lower cholesterol?
One 30-day study found total and LDL cholesterol fell within the arjuna group; the heart-failure meta-analysis found HDL rose but LDL did not change.[6][1]
Sources
- [1]Evaluation of the Therapeutic Potential and Safety of Terminalia arjuna in Heart Failure Management: A Systematic Review and Meta-analysis of Randomized Controlled Trials.. Ann Afr Med, 2026. meta-analysis
- [2]Terminalia arjuna in Chronic Stable Angina: Systematic Review and Meta-Analysis.. Cardiol Res Pract, 2014. systematic-review
- [3]Efficacy of Terminalia arjuna in chronic stable angina: a double-blind, placebo-controlled, crossover study comparing Terminalia arjuna with isosorbide mononitrate.. Indian Heart J, 2002. crossover-RCT
- [4]Clinical efficacy of water extract of stem bark of Terminalia arjuna (Roxb. ex DC.) Wight & Arn. in patients of chronic heart failure: a double-blind, randomized controlled trial.. Phytomedicine, 2016. RCT
- [5]Salutary effect of Terminalia Arjuna in patients with severe refractory heart failure.. Int J Cardiol, 1995. crossover-RCT
- [6]Antioxidant and hypocholesterolaemic effects of Terminalia arjuna tree-bark powder: a randomised placebo-controlled trial.. J Assoc Physicians India, 2001. RCT
- [7]Effect of E-OJ-01 on Cardiac Conditioning in Young Exercising Adults: A Randomized Controlled Trial.. Am J Ther, 2017. RCT
- [8]In vitro modulatory effects of Terminalia arjuna, arjunic acid, arjunetin and arjungenin on CYP3A4, CYP2D6 and CYP2C9 enzyme activity in human liver microsomes.. Toxicol Rep, 2015. animal-study
What changed
- Independent adversarial review: added in-vitro CYP3A4/CYP2D6/CYP2C9 inhibition (human liver microsomes) as an interaction caution, named digoxin and anticoagulants as unstudied combinations, and added industry and erratum notes. All PMIDs re-verified; evidence figures match abstracts.
- Adversarial second pass: every PMID re-checked against NCBI esummary (title, year, no retraction, erratum or expression-of-concern flags) and every number in each evidence row re-read against its PubMed abstract (PMC full text where the abstract lacked dose or duration). Countries and funding notes kept only where the abstract or full text states them; interactions listed only where a source supports them, otherwise stated as unstudied.
- First draft. Every PMID checked against NCBI E-utilities esummary (title and year taken from the record) and abstracts read for the cited rows.