March 22, 2017



Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • Alizarin Fluorine Blue, alizarin red, alizarin red S (ARS), alizarin S, alizarin sulfonic acid, alizarin yellow GG, alizarine, anthraquine, dyer's madder, faberrote, garance, Krapp, madder, madder plant, robbia, rubia, Rubia tintorum, Rubia tinctorum L., Rubia tinctorum radix.


  • Alizarin has been used as a staining agent for centuries. Originally alizarin vegetable dye was prepared from the madder plant Rubia tinctorum, but now a synthetic preparation is used that is chemically identical. Madder has been regarded as a mild diuretic.

  • The Ministry of Health of Russian Federation has approved alizarin as an antiviral preparation for acute and relapsing forms of herpes simplex infection of extragential and genital areas, herpetiform Kaposi's eczema, viral diseases of the oral cavity, herpes zoster and chicken pox in both children and adults.

  • Currently, there are no well-established therapeutic uses of alizarin. Precautions should be taken while handling this dye due to the lack of safety data.

Scientific Evidence


These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.


Viral infections

The limited available evidence suggests that alizarin may improve various herpes infections. Additional study is needed before a firm conclusion may be made.


*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).


The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Anemia, aphrodisiac, blood disorders, bone healing (ectopic), bruises, chicken pox, coloration of articular fluids, diuretic, eczema, edema (swelling), expectorant, flavoring agent, food additive, HIV, jaundice, kidney or bladder stones, leukemia, liver and gallbladder tonic, liver disease, menstrual disorders, paralysis, sciatica (leg pain), skin conditions, spleen disorders, tonic, urinary disorders, urinary tract inflammation, weight gain, wound healing.


The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

  • There is no dose that is proven safe or effective in adults. Madder bark has been prepared by using one teaspoon boiled in a covered container with 3 cups of water for 30 minutes. The liquid is cooled slowly in the closed container and taken cold, 1 to 2 cups per day. For herpes simplex lesions, a 0.2-0.5% ointment has been applied on the skin.

Children (younger than 18 years)

  • There is no dose that is proven safe or effective in children. Nonetheless, 0.1 gram alizarin tablets three times a day within five days of exposure to chickenpox has been taken by mouth. A 0.2% ointment applied on the skin has also been used.


The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.


  • Patients with a known allergy or hypersensitivity to alizarin, Rubia tinctorum, or other plants from the Rubiaceae family should not take alizarin preparations.

  • Contact dermatitis from handling stems and roots of Rubia tinctorum has been reported.

Side Effects and Warnings

  • There are few reports of adverse effects in humans associated with alizarin. However, alizarin may be toxic and should not be handled for long periods of time, rubbed in the eyes, or eaten. Alizarin is potentially carcinogenic (cancer causing) and mutagenic (capable of causing genetic changes). When taken by mouth, madder may turn urine, saliva, sweating, and breast milk to turn red. There is some concern that madder may stain contact lenses.

  • Contact dermatitis has been reported in two women, handling wild madder (Rubia peregrina) and madder (Rubia tinctorum).

  • Other side effects noted include nausea, vomiting, transient weakness, loss of muscle control, sub-acute toxicity, progressive listlessness, hyperirritability, insomnia, and abnormal breathing.

Pregnancy and Breastfeeding

  • Alizarin is not suggested in pregnant or breastfeeding women. Alizarin dye may cross the placenta. Extracts from madder plant (Rubia tinctorum) are likely unsafe when taken by mouth in pregnant women due to potential menstrual stimulation and genotoxic (damaging to the DNA) effects. The extract may also cause red-colored breast milk.


Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

  • Parts of the chemical structure of alizarin are similar to those in the tetracycline molecule. Therefore, there is a possibility of an additive interaction between alizarin and tetracyclines, such as demeclocycline.

Interactions with Herbs and Dietary Supplements

  • Currently, there is a lack of available scientific evidence describing herb and supplement interactions with alizarin.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).


Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Bardin T, Bucki B, Lansaman J, et al. [Alizarin red staining of articular fluids. Comparison of the results with electron microscopy and clinical data]. Rev.Rhum.Mal Osteoartic. 1987;54(2):149-154. View Abstract

  2. Blomeke B, Poginsky B, Schmutte C, et al. Formation of genotoxic metabolites from anthraquinone glycosides, present in Rubia tinctorum L. Mutat.Res 1992;265(2):263-272. View Abstract

  3. Brinkworth RI, Fairlie DP. Hydroxyquinones are competitive non-peptide inhibitors of HIV-1 proteinase. Biochim.Biophys.Acta 11-15-1995;1253(1):5-8. View Abstract

  4. de Ferreyra EC, Villarruel MC, Bernacchi AS, et al. Prevention of carbon tetrachloride-induced liver necrosis by the chelator alizarin sodium sulfonate. Exp Mol.Pathol. 1992;56(3):197-207. View Abstract

  5. Derksen GC, Lelyveld GP, van Beek TA, et al. Two validated HPLC methods for the quantification of alizarin and other anthraquinones in Rubia tinctorum cultivars. Phytochem.Anal. 2004;15(6):397-406. View Abstract

  6. Elbadawi A, Musto LA, Lilien OM. Combined alizarin red-reticulum stain for tissue localization of calcium deposits. Am J Clin.Pathol. 1981;75(3):355-356. View Abstract

  7. Kawasaki Y, Goda Y, Yoshihira K. The mutagenic constituents of Rubia tinctorum. Chem Pharm Bull.(Tokyo) 1992;40(6):1504-1509. View Abstract

  8. Lorenz D, Lucker PW, Krumbiegel G, et al. Pharmacokinetic studies of alizarin in man. Methods Find.Exp Clin.Pharmacol 1985;7(12):637-643. View Abstract

  9. Myers HM. Alizarin and tetracycline binding by bone mineral. Am J Phys.Anthropol. 1968;29(2):179-182. View Abstract

  10. Norton SA. Useful plants of dermatology. IV. Alizarin red and madder. J Am Acad.Dermatol. 1998;39(3):484-485. View Abstract

  11. Paul H, Reginato AJ, Schumacher, HR. Alizarin red S staining as a screening test to detect calcium compounds in synovial fluid. Arthritis Rheum. 1983;26(2):191-200. View Abstract

  12. Pharmacological Committee of Ministry of Health of Russian Federation. The Clinical Study of Allizarin. 1998.

  13. Poginsky B, Westendorf J, Blomeke B, et al. Evaluation of DNA-binding activity of hydroxyanthraquinones occurring in Rubia tinctorum L. Carcinogenesis 1991;12(7):1265-1271. View Abstract

  14. Rubin PL, Bisk F. Comparative efficacy of differing modes of administering alizarin red S in dogs. Oral Surg Oral Med Oral Pathol. 1969;28(1):122-125. View Abstract

  15. Westendorf J, Poginsky B, Marquardt H, et al. The genotoxicity of lucidin, a natural component of Rubia tinctorum L., and lucidinethylether, a component of ethanolic Rubia extracts. Cell Biol Toxicol. 1988;4(2):225-239. View Abstract

Copyright © 2013 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


March 22, 2017