Graviola

Graviola

Graviola

Common Names

  • Guanabana
  • soursop
  • custard apple
  • brazilian paw paw

For Patients & Caregivers

Bottom Line: Graviola showed anticancer effects in lab studies. Human data are lacking.
Graviola contains chemicals called acetogenins, which are thought to be the active ingredient. Extracts of graviola have been shown to be effective against a number of viruses, bacteria, and parasites in test tubes. Laboratory studies have also shown graviola to be effective against some types of cancer cells. However, substances derived from graviola can damage nerve cells and cause neurological side effects similar to Parkinson’s disease. Graviola may also affect nuclear imaging because it has been shown to decrease the uptake of radiopharmaceuticals used in such procedures.

  • To treat cancer
    Graviola has been shown effective against cancer cells in lab studies. Human studies have not been conducted.
  • To treat herpes
    Graviola is effective against the herpes virus in laboratory experiments. Human studies are needed.
  • To fight infections
    Lab studies indicate that graviola may prevent certain infections. Human data are lacking.

Repeated use may increase liver and kidney toxicity.

You are taking blood pressure medications: Graviola may  increase their effects.
You are taking diabetic medications: Graviola may increase their effects.
You have liver or kidney disease: Graviola can cause liver and kidney toxicity with repeated use.
You are having nuclear imaging: Graviola can reduce tissue uptake of radiopharmaceuticals used for diagnosis or treatment.
You have low platelet count: Graviola may reduce platelet count.

  • Movement disorders and myeloneuropathy (neuropathy that affects the myelin sheath), with symptoms similar to those of Parkinson’s disease
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For Healthcare Professionals

Annona muricata

Graviola is a tree prevalent in the rain forests of Africa, South America, and Southeast Asia. The fruits (aka soursop) are consumed as food and the leaves and stems are used in traditional medicine symptoms associated with inflammation and infection. Graviola is also available as a dietary supplement and is widely promoted as an alternative treatment for cancer although clinical evidence is lacking.

Many of the health benefits from graviola are thought to be derived from its antioxidant property (1)(2)(3)(4). In animal studies, extracts from Graviola leaves showed anti-inflammatory (5), analgesic (6), antidiabetic (7), antiulcer (8) and antiviral (9) effects. The leaf extracts also have antimicrobial activities (10)(11). Graviola extracts from the leaf, fruit, and seed have been tested in laboratories for their anticancer effects. Some studies show these extracts to be active against breast (3), lung (12), colon (13), prostate (14), pancreas (15)(16), liver (17), skin cancer (18), and leukemia (19) cell lines. However, graviola products have not been studied in cancer patients.

Consumption of graviola has been associated with adverse effects. Alkaloids extracted from graviola may cause neuronal dysfunction and degeneration leading to symptoms of Parkinson’s disease (20)(21). Graviola may decrease the uptake of radiopharmaceuticals used in nuclear imaging (22) and lower platelet counts (23).

  • Cancer treatment
  • Herpes
  • Infections
  • Parasitic infections
  • Sedation
  • Acetogenins: annosquamin B, bullatacin, annosquatin B, annonacin, annonacin A and annomuricin A muricins J, K, and L
  • Alkaloids
  • Quinolines and isoquinolines
  • Annopentocins
  • Coreximine and reticuline
  • Volatile oils: α-pinene, β-pinene, ρ-mentha-2,4(8)-diene ,β-elemene, germacrene D
  • Flavonol triglycoside: quercetin 3-O-rhamnosylsophoroside
  • Phenolics
    (11)(20)(21)(24)(25)(26)(27)(28)

Annonaceous acetogenins, phytochemicals isolated from the leaves, bark, and twigs of graviola, are thought to be the active ingredients of graviola. The ethanolic extract of Annona muricata shows in vitro antiviral activity against the Herpes simplex virus (9), and antimicrobial activity against Leishmania (11).

Alkaloids from graviola are detrimental to the survival of dopaminergic nerve cells in vitro. This may result in neuronal dysfunction and degeneration. Graviola-induced cell death was inhibited by glucose supplementation suggesting that cell death may have been caused by energy depletion (20). Graviola has also been shown to stimulate serotonin receptors (24). An ethanolic extract produced cell-stimulating behaviors either by increased mitochondrial turnover indicating stimulation in protein production or by preparation to leave the G1 phase, perhaps due to promitotic stimulus present within the extract which acts like a growth factor (28).

In animal models, the antidiabetic effects of graviola are due to its antioxidant, hypolipidemic and protective effects in pancreatic beta-cells, which improves glucose metabolism (7). In rodent models of hepatic cancer, although constituents of graviola led to reduced tumor growth, the acetogenin bullatacin caused liver and kidney toxicity via increasing calcium concentration, ROS production, and Bax expression and Bax/Bcl-2 ratio with repeated treatment (25). Graviola extract demonstrated antiulcer effect by increasing nitric oxide and prostaglandin E2 activities (8).

Graviola fruit extract has anti-inflammatory and analgesic actions by inhibiting cyclooxygenase (COX)-1 and COX-2 and by blocking opioid receptors (5).

Graviola extracts were effective against the growth of adriamycin-resistant human mammary adenocarcinoma (MCF-7/Adr) by blocking access of cancer cells to ATP and by inhibiting the actions of plasma membrane glycoprotein (29). They also inhibited expression of HIF-1α, NF-κB, glucose transporters, and glycolytic enzymes resulting in decreased glucose uptake and ATP production in pancreatic cancer cells (15), and downregulated EGFR expression in breast cancer cells (16). Phenolic compounds in graviola also demonstrate free-radical scavenging potential against human breast carcinoma cells (30) and in promyelocytic leukemia cells (19). Extracts of acetogenin muricins J, K, and L have antiproliferative effects against human prostate cancer cells, with the effect of muricin K being strongest (27). In colon and in lung cancer cell lines, the ethanolic extract of graviola caused cell cycle arrest at G1 phase by up-regulating Bax and down-regulating Bcl-2 proteins (13)(12).

Repeated use may increase liver and kidney toxicity (25).

Patients with hypertension or hyperglycemia (31)(32)
Patients with liver or kidney disease (25)

Movement disorders and myeloneuropathy with symptoms mimicking Parkinson’s disease (20)(21)

Antidiabetics: Graviola may have additive effects resulting in hypoglycemic symptoms (8).
Antihypertensives: Graviola may have additive effects resulting in hypotension (22).
P-glycoprotein (P-gp) substrates: Graviola contains acetogenins that are known to inhibit P-gp and may affect the metabolism of substrate drugs (31)

Nuclear imaging (radiopharmaceutical biodistribution): Graviola significantly decreased uptake of radioactivity per gram of tissue in bladder, kidney, and blood in animal models (22).
Blood glucose test: Graviola may reduce blood glucose levels (31).
Blood pressure readings: Graviola may reduce blood pressure readings (32).
Platelet count: Graviola reduced platelet count in an animal model (23)


  1. George VC, Kumar DR, Suresh PK, et al. Antioxidant, DNA protective efficacy and HPLC analysis of Annona muricata (soursop) extracts. J Food Sci Technol. Apr 2015;52(4):2328-2335. doi: 10.1007/s13197-014-1289-7

  2. Zamudio-Cuevas Y, Diaz-Sobac R, Vazquez-Luna A, et al. The antioxidant activity of soursop decreases the expression of a member of the NADPH oxidase family. Food Funct. Feb 2014;5(2):303-309. doi: 10.1039/c3fo60135h

  3. Gavamukulya Y, Abou-Elella F, Wamunyokoli F, et al. Phytochemical screening, anti-oxidant activity and in vitro anticancer potential of ethanolic and water leaves extracts of Annona muricata (Graviola). Asian Pac J Trop Med. Sep 2014;7s1:S355-363. doi: 10.1016/s1995-7645(14)60258-3

  4. Ishola IO, Awodele O, Olusayero AM, et al. Mechanisms of analgesic and anti-inflammatory properties of Annona muricata Linn. (Annonaceae) fruit extract in rodents. J Med Food. Dec 2014;17(12):1375-1382. doi: 10.1089/jmf.2013.0088

  5. de Sousa OV, Vieira GD, de Jesus RGdPJ, et al. Antinociceptive and anti-inflammatory activities of the ethanol extract of Annona muricata L. leaves in animal models. Int J Mol Sci. 2010;11(5):2067-2078. doi: 10.3390/ijms11052067

  6. Florence NT, Benoit MZ, Jonas K, et al. Antidiabetic and antioxidant effects of Annona muricata (Annonaceae), aqueous extract on streptozotocin-induced diabetic rats. J Ethnopharmacol. Feb 3 2014;151(2):784-790. doi: 10.1016/j.jep.2013.09.021

  7. Moghadamtousi SZ, Rouhollahi E, Karimian H, et al. Gastroprotective activity of Annona muricata leaves against ethanol-induced gastric injury in rats via Hsp70/Bax involvement. Drug Des Devel Ther. 2014;8:2099-2110. doi: 10.2147/dddt.s70096

  8. Padma P, Pramod NP, Thyagarajan SP, et al. Effect of the extract of Annona muricata and Petunia nyctaginiflora on Herpes simplex virus. J Ethnopharmacol. May 1998;61(1):81-83. doi:

  9. Mohd Abd Razak MR, Afzan A, Ali R, et al. Effect of selected local medicinal plants on the asexual blood stage of chloroquine resistant Plasmodium falciparum. BMC Complement Altern Med. 2014;14(1):492. doi: 10.1186/1472-6882-14-492

  10. Jaramillo MC, Arango GJ, Gonzalez MC, et al. Cytotoxicity and antileishmanial activity of Annona muricata pericarp. Fitoterapia. Apr 2000;71(2):183-186. doi:

  11. Moghadamtousi SZ, Kadir HA, Paydar M, et al. Annona muricata leaves induced apoptosis in A549 cells through mitochondrial-mediated pathway and involvement of NF-kappaB. BMC Complement Altern Med. 2014;14:299. doi: 10.1186/1472-6882-14-299

  12. Zorofchian Moghadamtousi S, Karimian H, Rouhollahi E, et al. Annona muricata leaves induce G(1) cell cycle arrest and apoptosis through mitochondria-mediated pathway in human HCT-116 and HT-29 colon cancer cells. J Ethnopharmacol. Oct 28 2014;156:277-289. doi: 10.1016/j.jep.2014.08.011

  13. Asare GA, Afriyie D, Ngala RA, et al. Antiproliferative activity of aqueous leaf extract of Annona muricata L. on the prostate, BPH-1 cells, and some target genes. Integr Cancer Ther. Jan 2015;14(1):65-74. doi: 10.1177/1534735414550198

  14. Torres MP, Rachagani S, Purohit V, et al. Graviola: a novel promising natural-derived drug that inhibits tumorigenicity and metastasis of pancreatic cancer cells in vitro and in vivo through altering cell metabolism. Cancer Lett. Oct 1 2012;323(1):29-40. doi: 10.1016/j.canlet.2012.03.031

  15. Dai Y, Hogan S, Schmelz EM, et al. Selective growth inhibition of human breast cancer cells by graviola fruit extract in vitro and in vivo involving downregulation of EGFR expression. Nutr Cancer. 2011;63(5):795-801. doi: 10.1080/01635581.2011.563027

  16. Liaw CC, Chang FR, Lin CY, et al. New cytotoxic monotetrahydrofuran annonaceous acetogenins from Annona muricata. J Nat Prod. Apr 2002;65(4):470-475. doi:

  17. Hamizah S, Roslida AH, Fezah O, et al. Chemopreventive potential of Annona muricata L leaves on chemically-induced skin papillomagenesis in mice. Asian Pac J Cancer Prev. 2012;13(6):2533-2539. doi:

  18. Pieme CA, Kumar SG, Dongmo MS, et al. Antiproliferative activity and induction of apoptosis by Annona muricata (Annonaceae) extract on human cancer cells. BMC Complement Altern Med. 2014;14(1):516. doi: 10.1186/1472-6882-14-516

  19. Lannuzel A, Michel PP, Caparros-Lefebvre D, et al. Toxicity of Annonaceae for dopaminergic neurons: potential role in atypical parkinsonism in Guadeloupe. Mov Disord. Jan 2002;17(1):84-90. doi:

  20. Lannuzel A, Hoglinger GU, Champy P, et al. Is atypical parkinsonism in the Caribbean caused by the consumption of Annonacae? J Neural Transm Suppl. 2006(70):153-157. doi:

  21. Holanda CM, Barbosa DA, Demeda VF, et al. Influence of Annona muricata (soursop) on biodistribution of radiopharmaceuticals in rats. Acta Cir Bras. Mar 2014;29(3):145-150. doi: 10.1590/s0102-86502014000300001

  22. Awodele O, Ishola IO, Ikumawoyi VO, et al. Toxicological evaluation of the lyophilized fruit juice extract of Annona muricata Linn. (Annonaceae) in rodents. J Basic Clin Physiol Pharmacol. Dec 18 2013:1-11. doi: 10.1515/jbcpp-2013-0085

  23. Roman G. Tropical myeloneuropathies revisited. Curr Opin Neurol. Oct 1998;11(5):539-544. doi:

  24. Chen Y, Chen JW, Zhai JH, et al. Antitumor activity and toxicity relationship of annonaceous acetogenins. Food Chem Toxicol. Aug 2013;58:394-400. doi: 10.1016/j.fct.2013.05.028

  25. Thang TD, Dai DN, Hoi TM, et al. Study on the volatile oil contents of Annona glabra L., Annona squamosa L., Annona muricata L. and Annona reticulata L., from Vietnam. Nat Prod Res. 2013;27(13):1232-1236. doi: 10.1080/14786419.2012.724413

  26. Sun S, Liu J, Kadouh H, et al. Three new anti-proliferative Annonaceous acetogenins with mono-tetrahydrofuran ring from graviola fruit (Annona muricata). Bioorg Med Chem Lett. Jun 15 2014;24(12):2773-2776. doi: 10.1016/j.bmcl.2014.03.099

  27. Nawwar M, Ayoub N, Hussein S, et al. A flavonol triglycoside and investigation of the antioxidant and cell stimulating activities of Annona muricata Linn. Arch Pharm Res. May 2012;35(5):761-767. doi: 10.1007/s12272-012-0501-4

  28. Oberlies NH, Chang CJ, McLaughlin JL. Structure-activity relationships of diverse Annonaceous acetogenins against multidrug resistant human mammary adenocarcinoma (MCF-7/Adr) cells. J Med Chem. Jun 20 1997;40(13):2102-2106. doi: 10.1021/jm9700169

  29. Adeyemi DO, Komolafe OA, Adewole OS, et al. Anti hyperglycemic activities of Annona muricata (Linn). Afr J Tradit Complement Altern Med. 2008;6(1):62-69. doi:

  30. Nwokocha CR, Owu DU, Gordon A, et al. Possible mechanisms of action of the hypotensive effect of Annona muricata (soursop) in normotensive Sprague-Dawley rats. Pharm Biol. Nov 2012;50(11):1436-1441. doi: 10.3109/13880209.2012.684690

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