American pawpaw (Asimina triloba)
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.
Acetogenin, alkaloids, American paw paw, annomontacin, Annonaceae (family), Annonaceous acetogenins, Annona cherimola, Annona diversifolia, Annona glabra, Annona muricata, Annona palustris, Annona purpurea, Annona reticulata, Annona squamosa, Annona squamosa X A. cherimola, Annona triloba L., annonacin, annonacin-A, asimicin, asimin, Asimina incarna, Asimina longifolia, Asimina obovata, Asimina parviflora, Asimina pygmaea, Asimina reticulata, Asimina tetramera, Asimina triloba (L.) Dunal, Asimina X nashii, asiminacin, asiminecin, asiminocin, asimitrin, asimilobin, asitrocin, asitrilobins, atemoya, benzyltetrahydroisoquinolone alkaloids, biriba, Brazilian pawpaw, bullanin, bullatacin, bullatacinone, bullatetrocin, bulletin, Carica papaya, cherimoya, coumaroyltyramine, custard apple, Deeringothamnus rugelii, Deeringothamnus puchellus, Disepalum, dog banana, dwarf pawpaw, feruloyltyramine, flag pawpaw, flavonoids, gigantetrocinone, Goniothalanus, graviola, guanabana, Hoosier banana, ilama, Indiana banana, isoannonacin, murisolinone, nicotiflorine, octanoate, opossum pawpaw, Ozark banana, papaya, paw paw, Paw Paw Cell-Reg®, poor man's banana, prairie banana, Rollinia mucosa, rutin, soncoya, soursop, squamolone, sugar apple, sweetsop, syringaresinol, trilobacin, trilobalicin, Uvaria, West Virginia banana, xylomaticin, Xylopia.
Note: American pawpaw (Asimina triloba) is not a papaya and should not be confused with Carica papaya or Annona muricata (graviola) although the species have similar common names and may be called "pawpaw."
American pawpaw (Asimina triloba) is a fruiting tree native to North America. However, plantings of the tree can be found in Asia, Australia, and Europe. Pawpaw extract is made from the twigs of the tree.
In the 1980s and 1990s, researchers at Purdue University isolated compounds from pawpaw bark extracts. Many of these compounds were found to have cytotoxic effects on cancer cell lines. Currently, there is a lack of available scientific evidence supporting the safety or effectiveness of pawpaw for any condition.
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.
Pawpaw extract may have some anticancer activity, but additional study is needed to make a firm recommendation.
Pawpaw extract in combination with thymol and tea tree oil in a shampoo formulation may be effective for the eradication of lice. Better-quality study using pawpaw alone is needed before a firm recommendation can 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.
Antibacterial, antifungal, anti-inflammatory (for the mouth and throat), antiprotozoal, antiviral, emetic (induced vomiting), fat substitute, fever reducer, food uses, insecticide (nematodes), pesticide, scarlet fever, skin rashes.
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)
Dosing from scientific studies has not been proven safe or effective. For cancer, 12.5-50 milligrams of extract has been taken by mouth four times a day with food for periods of up to 18 months. For lice, 40 milliliters of Paw Paw Lice Remover Shampoo® (0.5% pawpaw extract, 1% thymol, and 0.5% tea tree oil) applied three times to dry hair, once every 8 days for up to 24 days, has been used.
Children (younger than 18 years)
Dosing from scientific trials has not been proven safe or effective. For lice, 40 milliliters of Paw Paw Lice Remover Shampoo® (0.5% pawpaw extract, 1% thymol, and 0.5% tea tree oil) applied three times to dry hair, once every 8 days for up to 24 days, has 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.
Avoid in individuals with a known allergy or hypersensitivity to Asimina triloba, or any other members of the Annonaceae plant family (including other species of Asimina, and those in the genera Annona, Deeringothamnus, Disepalum, Goniothalanus, Rollinia, Uvaria, and Xylopia).
Side Effects and Warnings
There is a lack of safety information about pawpaw extracts. The constituents in pawpaw extract are cytotoxic. Taking pawpaw extract by mouth is not recommended without the supervision of a qualified healthcare professional, including a pharmacist.
Patients with gastrointestinal problems or a history of skin reactions should use pawpaw cautiously, because both nausea and vomiting have been reported after taking pawpaw by mouth.
Patients with known allergy or hypersensitivity to Asimina triloba, or any other members of the Annonaceae plant family should avoid pawpaw due to the possibility of developing urticaria ("hives"), reddening of the skin or itching.
Pregnancy and Breastfeeding
Use during pregnancy or breastfeeding is not recommended due to the cytotoxic effects of pawpaw extract.
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
Pawpaw extracts may interact with antioxidant medications. Caution is advised.
Interactions with Herbs and Dietary Supplements
The combined use of 7-keto and pawpaw extract may lessen the effect of 7-keto and combined use of these agents may be ineffective. Patients taking herbs and supplements should consult with a qualified healthcare professional, including a pharmacist, before combining therapies.
Pawpaw may interact with coenzyme Q10. It may also interact with antioxidant herbs and supplements. Caution is advised.
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.
Alali FQ, Liu XX, McLaughlin JL. Annonaceous acetogenins: recent progress. J Nat Prod 1999;62(3):504-540. View Abstract
Caparros-Lefebvre D, Elbaz A. Possible relation of atypical parkinsonism in the French West Indies with consumption of tropical plants: a case-control study. Caribbean Parkinsonism Study Group. Lancet 7-24-1999;354(9175):281-286. View Abstract
Haribal M, Feeny P. Combined roles of contact stimulant and deterrents in assessment of host-plant quality by ovipositing zebra swallowtail butterflies. J Chem Ecol. 2003;29(3):653-670. View Abstract
He K, Zhao GX, Shi G, et al. Additional bioactive annonaceous acetogenins from Asimina triloba (Annonaceae). Bioorg.Med.Chem. 1997;5(3):501-506. View Abstract
Kim EJ, Suh KM, Kim DH, et al. Asimitrin and 4-hydroxytrilobin, new bioactive annonaceous acetogenins from the seeds of Asimina triloba possessing a bis-tetrahydrofuran ring. J Nat Prod 2005;68(2):194-197. View Abstract
Martin JM, Madigosky SR, Gu ZM, et al. Chemical defense in the zebra swallowtail butterfly, Eurytides marcellus, involving annonaceous acetogenins. J Nat Prod 1999;62(1):2-4. View Abstract
McCage CM, Ward SM, Paling CA, et al. Development of a paw paw herbal shampoo for the removal of head lice. Phytomedicine 2002;9(8):743-748. View Abstract
McLaughlin, JL. A novel mechanism for the control of clinical cancer: inhibition of the production of adenosine triphosphate (ATP) with a standardized extract of paw paw (Asimina triloba, Annonaceae) (Unpublished). 2001.
McLaughlin JL, Zeng L, Oberlies NH, et al. Annonaceous acetogenins as new natural pesticide: Recent progress In: Phytochemicals for pest control. 1997;119-133.
Woo MH, Cho KY, Zhang Y, et al. Asimilobin and cis- and trans-murisolinones, novel bioactive Annonaceous acetogenins from the seeds of Asimina triloba. J.Nat.Prod. 1995;58(10):1533-1542. View Abstract
Woo MH, Chung SO, Kim DH. Asitrilobins C and D: two new cytotoxic mono-tetrahydrofuran annonaceous acetogenins from Asimina triloba seeds. Bioorg.Med.Chem. 2000;8(1):285-290. View Abstract
Woo MH, Kim DH, McLaughlin JL. Asitrilobins A and B: cytotoxic mono-THF annonaceous acetogenins from the seeds of Asimina triloba. Phytochemistry 1999;50(6):1033-1040. View Abstract
Wood R, Peterson S. Lipids of the pawpaw fruit: Asimina triloba. Lipids 1999;34(10):1099-1106. View Abstract
Ye Q, He K, Oberlies NH, Zeng L, et al. Longimicins A-D: novel bioactive acetogenins from Asimina longifolia (annonaceae) and structure-activity relationships of asimicin type of annonaceous acetogenins. J Med Chem 4-26-1996;39(9):1790-1796. View Abstract
Zhao GX, Chao JF, Zeng L, et al. The absolute configuration of adjacent bis-THF acetogenins and asiminocin, a novel highly potent asimicin isomer from Asimina triloba. Bioorg.Med.Chem. 1996;4(1):25-32. 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