Apo-infekt

There is no standardized FDA-approved dosage for Ailanthus Altissima Whole. Dosing is typically determined by the practitioner's philosophy (e.g., homeopathic vs. herbalist) and the specific formulation used.

• Homeopathic Preparations: For low-potency dilutions (such as 3X or 6X), the common dosage is 5 to 10 drops in a small amount of water, taken three times daily. For higher potencies (30C or 200C), doses are often infrequent, sometimes only once a week or month, depending on the severity of the symptoms.
• Herbal Tinctures (1:5 ratio): Practitioners may suggest 1 to 2 mL (approximately 30 to 60 drops) diluted in water, taken up to three times per day.
• Powdered Whole Plant: In traditional contexts, 500 mg to 1,000 mg per day may be used, though this carries a higher risk of gastrointestinal irritation.

Ailanthus Altissima Whole is generally not recommended for use in children under the age of 12 due to the presence of potent alkaloids and a lack of safety data. Some homeopathic practitioners may use highly diluted (30C or higher) forms for children, but this must only be done under strict medical supervision. The raw or concentrated extract is considered potentially toxic to the developing hepatic and renal systems of pediatric patients.

Renal Impairment

Because the metabolites of Ailanthus Altissima are primarily excreted via the kidneys, individuals with a glomerular filtration rate (GFR) below 60 mL/min should exercise extreme caution. Dose reductions of at least 50% are typically advised by clinical herbalists, or the substance should be avoided entirely to prevent accumulation and toxicity.

Hepatic Impairment

The liver is responsible for processing the quassinoids found in the whole plant. Patients with cirrhosis, hepatitis, or elevated liver enzymes should avoid Ailanthus Altissima Whole, as it may exacerbate liver stress or lead to hepatotoxicity (liver damage).

Elderly Patients

Geriatric patients often have reduced organ reserve and may be taking multiple medications. For patients over 65, it is recommended to start at the lowest possible dose (e.g., 25% of the standard adult dose) to assess tolerance and monitor for signs of central nervous system depression or gastrointestinal upset.

• Administration: Liquid tinctures should be diluted in at least 2 ounces of water to minimize irritation to the oral mucosa (lining of the mouth).
• Timing: It is generally recommended to take this botanical agent between meals (at least 30 minutes before or 2 hours after eating) to ensure optimal absorption, unless gastrointestinal upset occurs.
• Storage: Store all preparations in a cool, dry place, away from direct sunlight and strong odors (especially for homeopathic forms, which can be 'antidoted' by strong scents like camphor or menthol).
• Form Integrity: Do not crush or chew capsules unless specifically instructed. If using the whole plant in a tea (decoction), ensure it is strained thoroughly to remove irritating fibers.

If a dose is missed, it should be taken as soon as remembered. However, if it is almost time for the next scheduled dose, skip the missed dose and resume the regular schedule. Do not double the dose to make up for a missed one, as this increases the risk of alkaloid-related toxicity.

Signs of an overdose of Ailanthus Altissima Whole include severe nausea, vomiting, dizziness, cold sweats, and a significant drop in heart rate (bradycardia). In extreme cases, it may lead to respiratory depression or stupor. If an overdose is suspected, contact a Poison Control Center immediately or seek emergency medical attention. Treatment is generally supportive, focusing on gastric lavage (stomach pumping) and maintaining airway patency.

> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose without medical guidance, as botanical concentrations can vary between manufacturers.

Individuals taking Ailanthus Altissima Whole frequently report gastrointestinal disturbances. These are often the result of the plant's high concentration of bitter quassinoids, which stimulate gastric acid secretion. Common symptoms include:

• Nausea and Queasiness: A persistent feeling of stomach upset, often occurring shortly after ingestion.
• Loose Stools: Increased frequency of bowel movements, which may become watery if the dose is too high.
• Abdominal Cramping: Mild to moderate 'twinges' or spasms in the mid-abdominal region.
• Dizziness: A brief sensation of lightheadedness, particularly when moving from a sitting to a standing position (orthostatic hypotension).

• Headache: A dull, aching sensation, often localized to the frontal or temporal regions.
• Lethargy: An unusual feeling of tiredness or 'brain fog' that may interfere with daily activities.
• Anorexia: A temporary loss of appetite or distaste for food.
• Contact Dermatitis: If the whole plant or its liquid extract touches the skin, some individuals may develop a red, itchy rash or small blisters (phytodermatitis).

• Bradycardia: An abnormally slow heart rate (fewer than 60 beats per minute), which may cause fainting or shortness of breath.
• Hepatotoxicity: Elevated liver enzymes indicating stress or damage to the liver tissue.
• Visual Disturbances: Blurred vision or a sensitivity to bright lights.
• Stupor: A state of near-unconsciousness or insensibility, typically only seen with extremely high doses or accidental ingestion of the raw plant.

> Warning: Stop taking Ailanthus Altissima Whole and call your doctor immediately if you experience any of these.

• Anaphylaxis: Signs include hives, difficulty breathing, swelling of the face, lips, or tongue, and a rapid drop in blood pressure. This is a life-threatening allergic reaction.
• Severe Vertigo: Intense spinning sensations that make walking or standing impossible.
• Cardiac Dysrhythmia: Feeling like your heart is skipping beats, fluttering, or beating too hard/fast, which may indicate an effect on the heart's electrical system.
• Jaundice: Yellowing of the skin or the whites of the eyes, which is a hallmark sign of acute liver failure.
• Respiratory Distress: Feeling unable to catch your breath or experiencing chest tightness.

Prolonged use of Ailanthus Altissima Whole (beyond 4-6 weeks) is not well-studied and is generally discouraged. Potential long-term risks include:

• Cumulative Neurotoxicity: The alkaloids may accumulate in nervous tissue, leading to chronic tremors or cognitive slowing.
• Nutritional Deficiencies: Due to its effect on the GI tract and potential to cause chronic loose stools, long-term use may interfere with the absorption of essential vitamins and minerals.
• Suppression of Bone Marrow: Although rare, some related quassinoids have shown the potential to affect blood cell production in animal studies; however, this has not been definitively proven in humans using standard doses.

No FDA black box warnings currently exist for Ailanthus Altissima Whole because it is not an FDA-approved drug. However, many clinical herbalists treat it as a 'low-dose botanical,' meaning it has a narrow therapeutic index and should be treated with the same caution as a drug with a black box warning regarding potential toxicity and organ stress.

Report any unusual symptoms to your healthcare provider. Monitoring of liver and kidney function is advised for anyone using this substance for more than two consecutive weeks.

Ailanthus Altissima Whole is a potent botanical agent that contains bioactive alkaloids and quassinoids. It should never be viewed as a 'mild' herb. Patients must be aware that botanical supplements are not regulated with the same rigor as prescription drugs, and the concentration of active ingredients can vary by as much as 300% between different brands. Always ensure you are using a product from a reputable manufacturer that provides a Certificate of Analysis (CoA).

No FDA black box warnings for Ailanthus Altissima Whole. However, the plant is listed by various toxicological databases as potentially hazardous if consumed in its raw, unprocessed state due to high concentrations of ailanthone.

• Allergic Reactions / Anaphylaxis Risk: Individuals with known allergies to the Simaroubaceae family of plants must avoid this product. Cross-reactivity may occur, leading to severe skin reactions or systemic allergic responses.
• Hepatotoxicity: There is a theoretical risk of liver injury. Patients with pre-existing liver disease should avoid use. If you notice dark urine, pale stools, or persistent nausea, discontinue use immediately.
• Cardiovascular Effects: Because the plant may induce bradycardia (slow heart rate), individuals with heart block, congestive heart failure, or those taking beta-blockers must consult a cardiologist before use.
• Neurological Impact: The 'depressing' effect of the alkaloids on the central nervous system means it may enhance the effects of other sedatives. Caution is required for patients with a history of clinical depression or chronic fatigue syndrome.

If your healthcare provider approves the use of Ailanthus Altissima Whole for an extended period, the following monitoring is recommended:

1. 1Liver Function Tests (LFTs): To check for elevations in ALT, AST, and bilirubin.
2. 2Complete Blood Count (CBC): To ensure there is no suppression of white blood cells or platelets.
3. 3Basic Metabolic Panel (BMP): To monitor kidney function (creatinine and BUN) and electrolyte balance, especially if the patient experiences diarrhea.

Ailanthus Altissima Whole may cause significant drowsiness, dizziness, or a 'spaced-out' feeling. Do not drive a vehicle, operate heavy machinery, or engage in hazardous activities until you know how this substance affects you. The risk of impairment is higher during the first few days of use or when the dose is increased.

Alcohol should be strictly avoided while taking Ailanthus Altissima Whole. Alcohol can potentiate the sedative effects of the plant's alkaloids and increase the metabolic burden on the liver, significantly raising the risk of hepatotoxicity and central nervous system depression.

While Ailanthus Altissima Whole is not known to be addictive, sudden discontinuation after prolonged use may result in a 'rebound' of inflammatory symptoms. It is generally advised to taper the dose over a period of 5 to 7 days. If you experience severe headaches or irritability during this time, contact your healthcare provider.

> Important: Discuss all your medical conditions, including any history of heart, liver, or kidney disease, with your healthcare provider before starting Ailanthus Altissima Whole.

• Amiodarone and Digoxin: Ailanthus Altissima Whole may have additive effects on heart rate and rhythm. Combining it with potent anti-arrhythmics or cardiac glycosides can lead to dangerous bradycardia or heart block.
• Hepatotoxic Drugs (e.g., Methotrexate, Ketoconazole): Using this botanical alongside drugs known to cause liver damage significantly increases the risk of acute liver failure.

• Anticoagulants and Antiplatelets (e.g., Warfarin, Clopidogrel): There is preliminary evidence that quassinoids may affect platelet aggregation. Combining these can increase the risk of bruising and internal bleeding. Prothrombin time (PT/INR) should be monitored closely.
• CNS Depressants (e.g., Benzodiazepines, Opioids, Sleep Medications): The alkaloids in the whole plant may enhance the sedative effects of these drugs, leading to excessive respiratory depression or extreme lethargy.

• Antidiabetic Medications: Ailanthus Altissima may affect blood glucose levels. Patients on insulin or oral hypoglycemics (like Metformin) should monitor their blood sugar more frequently to avoid hypoglycemia (low blood sugar).
• Antihypertensives: Since the plant can lower blood pressure and heart rate, it may enhance the effect of blood pressure medications, potentially causing fainting or dizziness.

• Grapefruit and Grapefruit Juice: Grapefruit inhibits the CYP3A4 enzyme, which is likely involved in the metabolism of Ailanthus alkaloids. This can lead to toxic levels of the botanical in the bloodstream.
• High-Fat Meals: Taking the supplement with a very high-fat meal may increase the absorption of lipophilic (fat-soluble) quassinoids, potentially increasing the risk of side effects.
• Caffeine: While it might seem that caffeine would counteract the lethargy caused by the plant, it can actually lead to increased gastrointestinal irritation and heart palpitations.

• St. John's Wort: This herb induces CYP450 enzymes and may reduce the effectiveness of Ailanthus Altissima Whole by speeding up its clearance from the body.
• Valerian and Kava: These herbs have sedative properties and, when combined with Ailanthus, can cause severe drowsiness and impaired motor function.
• Garlic and Ginkgo: Both have mild blood-thinning effects and may increase bleeding risks when used with this botanical.

• Liver Enzyme Tests: May show false elevations or reflect actual herbal-induced stress.
• Glucose Testing: May result in lower-than-expected readings.
• Coagulation Studies: May show a slight prolongation of bleeding time.

For each major interaction, the management strategy involves either avoiding the combination or having a healthcare professional perform regular blood work to ensure safety.

> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, including over-the-counter drugs.

Ailanthus Altissima Whole must NEVER be used in the following circumstances:

1. 1Pregnancy and Lactation: The quassinoids in the plant, such as ailanthone, have demonstrated embryotoxic and potentially teratogenic (birth defect-causing) effects in animal studies. Furthermore, the alkaloids can pass into breast milk and pose a significant risk of toxicity to a nursing infant.
2. 2Severe Hepatic Insufficiency: Individuals with Child-Pugh Class C cirrhosis or acute liver failure cannot process the plant's compounds, leading to rapid systemic toxicity.
3. 3Active Peptic Ulcer Disease: The bitter constituents stimulate the production of gastric acid, which can worsen existing ulcers and potentially lead to gastrointestinal perforation or hemorrhage.
4. 4Known Hypersensitivity: Any previous allergic reaction to Ailanthus altissima or related species in the Simaroubaceae family.

Conditions requiring a careful risk-benefit analysis by a physician include:

• Bradycardia or Heart Block: Due to the plant's potential to further slow the heart rate.
• Hypotension (Low Blood Pressure): The plant may cause a further drop in pressure, leading to syncope (fainting).
• Depressive Disorders: The central nervous system-depressing effects may exacerbate symptoms of clinical depression or seasonal affective disorder.
• Renal Insufficiency: Patients with moderate kidney disease (Stage 3 CKD) require strict dose monitoring.

Patients who are allergic to other members of the Sapindales order may exhibit cross-sensitivity to Ailanthus Altissima Whole. This includes potential reactions in individuals sensitive to citrus fruits or certain types of mahogany wood, although the clinical evidence for this specific cross-reactivity is primarily anecdotal.

> Important: Your healthcare provider will evaluate your complete medical history, including any underlying conditions, before prescribing or recommending Ailanthus Altissima Whole.

Ailanthus Altissima Whole is classified as Category X equivalent in herbal medicine, meaning it is strictly contraindicated during pregnancy. Research indicates that quassinoids can interfere with protein synthesis and cellular division in the developing fetus. There is a documented risk of spontaneous abortion (miscarriage) and developmental abnormalities. If you become pregnant while taking this substance, stop use immediately and consult your obstetrician.

It is unknown exactly how much of the active alkaloids from Ailanthus Altissima Whole pass into human breast milk, but given their low molecular weight and lipophilic nature, significant transfer is likely. Due to the potential for neurotoxicity and gastrointestinal distress in the infant, breastfeeding mothers should avoid this product. A 'pump and dump' period of at least 48 hours is recommended if a single dose was taken accidentally.

Safety and efficacy have not been established in the pediatric population. The 'Whole' plant extract contains concentrations of ailanthone that are far too potent for the metabolic capacity of children. Use in children is generally considered unsafe and is not recommended by major botanical safety handbooks like the AHPA Botanical Safety Handbook.

Older adults are at an increased risk for side effects due to age-related declines in renal and hepatic clearance. There is also a significantly higher risk of falls due to the dizziness and orthostatic hypotension (blood pressure drop upon standing) associated with this botanical. Polypharmacy (taking multiple medications) in the elderly also makes drug-botanical interactions a primary concern. Geriatric patients should be monitored for signs of confusion or excessive sedation.

In patients with impaired kidney function, the excretion of polar metabolites is delayed. For those with a GFR between 30 and 59 mL/min, a 50% dose reduction is suggested. It is not recommended for patients with a GFR below 30 mL/min or those on hemodialysis, as the clearance characteristics of quassinoids during dialysis are unknown.

For patients with mild hepatic impairment (Child-Pugh Class A), use with extreme caution and frequent monitoring of LFTs. For moderate to severe impairment (Child-Pugh B and C), the use of Ailanthus Altissima Whole is contraindicated due to the high risk of further liver injury and systemic accumulation of toxic alkaloids.

> Important: Special populations require individualized medical assessment. Never start a new supplement regimen in these groups without professional guidance.

Ailanthus Altissima Whole acts through a variety of molecular pathways. The primary active quassinoid, ailanthone, is known to be a potent inhibitor of the eukaryotic translation process. It binds to the 80S ribosome, thereby inhibiting protein synthesis in sensitive cells, which explains its investigated anti-tumor and antiparasitic properties. Additionally, the plant contains canthin-6-one alkaloids, which exhibit antifungal and antibacterial activity by disrupting the cell wall and interfering with DNA replication in pathogens.

In inflammatory models, the whole plant extract has been shown to downregulate the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). This occurs through the inhibition of the phosphorylation of IκBα, which prevents the translocation of NF-κB into the nucleus, effectively 'turning off' the genetic switches for inflammation.

The onset of action for gastrointestinal symptoms is relatively rapid (1-2 hours), while the systemic anti-inflammatory effects may take several days of consistent dosing to become apparent. The duration of effect for a single dose is typically 4 to 6 hours. There is no evidence of the development of pharmacological tolerance, but the risk of cumulative toxicity increases with the duration of use.

| Parameter | Value |

|---|---|

| Bioavailability | Estimated < 15% (Oral) |

| Protein Binding | Approximately 65-75% |

| Half-life | 2.5 - 4.0 hours |

| Tmax | 1.0 - 1.5 hours |

| Metabolism | Hepatic (CYP3A4 suspected) |

| Excretion | Renal (>70%), Fecal (<20%) |

• Molecular Components: Quassinoids (Ailanthone, Amarolide), Alkaloids (1-methoxycanthin-6-one), Terpenoids, and Volatile Oils.
• Solubility: Active constituents are generally soluble in ethanol and moderately soluble in hot water.
• Structure: The quassinoids are degraded triterpenoids with a characteristic lactone ring system which is essential for their biological activity.

Ailanthus Altissima Whole is classified as a Botanical Therapeutic Agent or a Homeopathic Mother Tincture. Within the therapeutic hierarchy, it is considered an 'Alterative' and 'Anthelmintic' in traditional herbalism, and a 'Deep-acting Anti-psoric' in some homeopathic traditions.