Tribulus terrestris

Health Care Professional Information

Scientific Name
Tribulus terrestris
Common Name

Caltrop, Puncture vine, Gokhru, Al-Gutub, Ba ji li

Clinical Summary

Tribulus is a perennial herb that grows in the subtropical regions of eastern and western Asia, southern Europe, and Africa. It is used in traditional medicine for chest pain, dizziness, skin and eye disorders, and to expel kidney stones. Preliminary studies indicate that tribulus has analgesic (1), antihypertensive (2) (3), anti-inflammatory (4) antioxidant (5) (6), diuretic (7), hypoglycemic (8), antibacterial and antifungal (9) (10), and anticancer properties (11) (12).
Tribulus is marketed as a dietary supplement to enhance sexual function and for body building. It has been shown to increase sperm production in rats. (13) However, its effects on testosterone levels are mixed (14) (15) (16).

Due to its purported hormonal activities, prostate cancer patients should avoid this product.

Purported Uses
  • Cancer treatment
  • Hypertension
  • Infertility in both sexes
  • Impotency
  • Infections
  • Rheumatic pain
  • Kidney stone
Constituents
  • Protodioscin
  • Gitonin
  • Tigogenin
  • Furostanol
  • Beta-Sitosterol
  • Stigmasterol
  • Spirosta-3,5-diene
  • Hecogenin
  • Ruscogenin
  • Quercetin
  • Trubulusamides A and B
    (3) (6)
Mechanism of Action

A methanol extract of tribulus demonstrated COX-2 inhibition activity (4) suggesting this herb's anti-inflammatory effects. Tribulus also exerts a protective effect in diabetic rats by inhibiting oxidative stress (6) and by lowering the levels of glycosylated hemoglobin and cholesterols (8). Consumption of tribulus causes motor neuron adverse effects in animals by affecting the gamma-aminobutyric acid (GABA) receptors (18). The methanolic and aqueous extracts of tribulus exert antihypertensive effects via relaxation of the arterial smooth muscle, through nitric oxide release and membrane hyperpolarization (3). The aqueous extract also has angiotensin converting enzyme (ACE)-inhibition activity (2) that can help lower blood pressure.
Tribulus extract was shown to limit the formation of calcium oxalate and calcium hydrogen phosphate dihydrate crystal (21) (22), mineral compounds that can cause kidney stones.
Tribulus increases sperm production in rats (13) but does not alter testosterone levels in animals or humans (15) (16). In a study conducted in rats with ovarian cysts, tribulus extract showed a luteinizing effect related to gonadotropin-like activity (20).

Tribulus extracts induce apoptosis and suppresses cancer cell proliferation by activating caspase 3; dephosphorylating extracellular signal-related kinase (ERK) 1 and 2 (15); and by inhibiting Nuclear Factor (NF-kappa B) signaling (12). Saponins from tribulus inhibit Multiple-Drug Resistance (MDR) of cancer cells (11). In animal models, administration of oral tribulus resulted in a significant reduction in tumor incidence, tumor burden and cumulative number of papillomas (19).

Adverse Reactions
  • Case Reports: Hepato-, nephro- and neurotoxicities have been reported with use of tribulus (17).
  • Tribulus has been shown to cause motor neuron disease in animals (18).
Herb-Drug Interactions
  • Diruetics: Tribulus may increase the effects of other diuretic drugs (7).
  • Antihypertensive drugs: Tribulus has angiotensin converting enzyme (ACE)-inhibition activity and therefore, may have an additional hypotensive effect (2) (3).
  • Antidiabetics: Tribulus may have additive hypoglycemic effects (8).
  • Clopidogrel: May increase the risk of blood clots.
    Stent thrombosis has been reported in patients following concurrent use of clopidogrel and an herbal formula containing tribulus (23).
Dosage (Inside MSKCC Only)
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References
  1. Heidari MR, Mehrabani M, Pardakhty A, et al. The analgesic effect of Tribulus terrestris extract and comparison of gastric ulcerogenicity of the extract with indomethacine in animal experiments.Ann N Y Acad Sci. Jan 2007;1095:418-427.
  2. Sharifi AM, Darabi R, Akbarloo N. Study of antihypertensive mechanism of Tribulus terrestris in 2K1C hypertensive rats: role of tissue ACE activity. Life Sci. Oct 24 2003;73(23):2963-2971.
  3. Phillips OA, Mathew KT, Oriowo MA. Antihypertensive and vasodilator effects of methanolic and aqueous extracts of Tribulus terrestris in rats. J ethnopharmacol. Apr 6 2006;104(3):351-355.
  4. Hong CH, Hur SK, Oh OJ, et al. Evaluation of natural products on inhibition of inducible cyclooxygenase (COX-2) and nitric oxide synthase (iNOS) in cultured mouse macrophage cells. J ethnopharmacol. Nov 2002;83(1-2):153-159.
  5. Kamboj P, Aggarwal M, Puri S, et al. Effect of aqueous extract of Tribulus terrestris on oxalate-induced oxidative stress in rats. Indian J nephrol. Jul 2011;21(3):154-159.
  6. Amin A, Lotfy M, Shafiullah M, et al. The protective effect of Tribulus terrestris in diabetes.Ann N Y Acad Sci. Nov 2006;1084:391-401.
  7. Al-Ali M, Wahbi S, Twaij H, et al. Tribulus terrestris: preliminary study of its diuretic and contractile effects and comparison with Zea mays. J ethnopharmacol. Apr 2003;85(2-3):257-260.
  8. El-Tantawy WH, Hassanin LA. Hypoglycemic and hypolipidemic effects of alcoholic extract of Tribulus alatus in streptozotocin-induced diabetic rats: a comparative study with T. terrestris (Caltrop). Indian j exp biol. Sep 2007;45(9):785-790.
  9. Al-Bayati FA, Al-Mola HF. Antibacterial and antifungal activities of different parts of Tribulus terrestris L. growing in Iraq.J Zhejiang Univ Sci B. Feb 2008;9(2):154-159.
  10. Zhang JD, Cao YB, Xu Z, et al. In vitro and in vivo antifungal activities of the eight steroid saponins from Tribulus terrestris L. with potent activity against fluconazole-resistant fungal pathogens. Biol & pharm bull. Dec 2005;28(12):2211-2215.
  11. Ivanova A, Serly J, Dinchev D, et al. Screening of some saponins and phenolic components of Tribulus terrestris and Smilax excelsa as MDR modulators. In Vivo. Jul-Aug 2009;23(4):545-550.
  12. Kim HJ, Kim JC, Min JS, et al. Aqueous extract of Tribulus terrestris Linn induces cell growth arrest and apoptosis by down-regulating NF-kappaB signaling in liver cancer cells. J ethnopharmacol. Jun 14 2011;136(1):197-203.
  13. Martino-Andrade AJ, Morais RN, Spercoski KM, et al. Effects of Tribulus terrestris on endocrine sensitive organs in male and female Wistar rats. J ethnopharmacol. Jan 8 2010;127(1):165-170.
  14. Singh S, Nair V, Gupta YK. Evaluation of the aphrodisiac activity of Tribulus terrestris Linn. in sexually sluggish male albino rats.J Pharmacol Pharmacother. Jan 2012;3(1):43-47.
  15. Neychev VK, Nikolova E, Zhelev N, et al. Saponins from Tribulus terrestris L are less toxic for normal human fibroblasts than for many cancer lines: influence on apoptosis and proliferation. Exp Biol Med (Maywood). Jan 2007;232(1):126-133.
  16. Saudan C, Baume N, Emery C, et al. Short term impact of Tribulus terrestris intake on doping control analysis of endogenous steroids. Forensic Sci Int. Jun 10 2008;178(1):e7-10.
  17. Talasaz AH, Abbasi MR, Abkhiz S, et al. Tribulus terrestris-induced severe nephrotoxicity in a young healthy male.Nephrol Dial Transplant.Nov 2010;25(11):3792-3793.
  18. Bourke CA. Abnormal turning behaviour, GABAergic inhibition and the degeneration of astrocytes in ovine Tribulus terrestris motor neuron disease. Aust Vet J. Jan-Feb 2006;84(1-2):53-58.
  19. Kumar M, Soni AK, Shukla S, et al. Chemopreventive potential of Tribulus terrestris against 7,12- dimethylbenz (a) anthracene induced skin papillomagenesis in mice. Asian Pac J Cancer Prev. Apr-Jun 2006;7(2):289-294.
  20. Dehghan A, Esfandiari A, Bigdeli SM. Alternative treatment of ovarian cysts with Tribulus terrestris extract: a rat model.Reprod Domest Anim. Feb 2012;47(1):e12-15.
  21. Joshi VS, Parekh BB, Joshi MJ, et al. Inhibition of the growth of urinary calcium hydrogen phosphate dihydrate crystals with aqueous extracts of Tribulus terrestris and Bergenia ligulata. Urol Res. May 2005;33(2):80-86.
  22. Aggarwal A, Tandon S, Singla SK, et al. Diminution of oxalate induced renal tubular epithelial cell injury and inhibition of calcium oxalate crystallization in vitro by aqueous extract of Tribulus terrestris. Int Braz J Urol. Jul-Aug 2010;36(4):480-488; discussion 488, 489.
  23. Vatankulu MA, Tasal A, Erdogan E, et al. [Three case reports of the use of herbal combinations resulted in stent thrombosis: herbal combinations; friend or foe?].Turk Kardiyol Dern Ars. Apr 2012;40(3):265-268.
  24. Rogerson S, Riches CJ, Jennings C, et al. The effect of five weeks of Tribulus terrestris supplementation on muscle strength and body composition during preseason training in elite rugby league players.J Strength Cond Res. May 2007;21(2):348-353.

Consumer Information

How It Works

Bottom Line: Tribulus has not been shown to treat or prevent cancer in humans.

Tribulus is an herb that grows in the subtropical regions of eastern and western Asia, southern Europe, and Africa. It is used in traditional medicine for chest pain, dizziness, skin and eye disorders, and to expel kidney stones. Tribulus is also marketed as a dietary supplement to improve sexual function and for body building due to the belief that it acts like testosterone in the body. However, this effect has not been confirmed. Studies done in lab and in animals show tribulus has medicinal effects against high blood pressure, diabetes, inflammation, infection, and cancer. However, there are no large scale studies conducted in humans.

Use of tribulus has been linked to adverse effects. Due to its potential hormonal activities, prostate cancer patients should avoid this herb until more is known about its safety.

Purported Uses
  • To treat cancer
    Tribulus showed anticancer activities in lab studies. It has not been tested in humans as a cancer treatment.
  • To lower blood pressure
    Tribulus extract can relax blood vessels and may help to lower blood pressure.
  • To enhance sexual function
    Tribulus increases sperm production in animal models. However, studies of its effects on testosterone levels gave mixed results.
  • To improve muscle strength and muscle mass
    A clinical study did not find any significant changes in muscle strength or mass with use of tribulus.
  • To treat infections
    Tribulus has antifungal activities in lab studies. Human data are lacking.
  • To reduce pain
    Tribulus extract reduced inflammation in lab studies. But human studies have not been done.
  • To treat kidney stones
    Tribulus can promote urination and can stop the formation of calcium compounds that cause kidney stones. However, these effects have not been studied in humans.
Do Not Take If
  • You are taking diruetics: Tribulus may increase the effects of diuretic drugs.
  • You are taking antihypertensive drugs: Tribulus may have an additional blood pressure lowering effect.
  • You are taking antidiabetics: Tribulus may have additive blood sugar lowering effects.
  • You are taking Clopidogrel: May increase the risk of blood clots.
Side Effects
  • Tribulus may cause liver, kidney, and nerve toxicities.
E-mail your questions and comments to aboutherbs@mskcc.org.