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.
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.
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 for this use (it may not work) F: Strong scientific evidence against this use (it likley does not work)
Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. 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 healthcare provider. There may be other proposed uses that are not listed below.
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.
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.
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.
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.
Brinkworth RI, Fairlie DP. Hydroxyquinones are competitive non-peptide inhibitors of HIV-1 proteinase. Biochim.Biophys.Acta 11-15-1995;1253(1):5-8.
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.
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.
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.
Kawasaki Y, Goda Y, Yoshihira K. The mutagenic constituents of Rubia tinctorum. Chem Pharm Bull.(Tokyo) 1992;40(6):1504-1509.
Lorenz D, Lucker PW, Krumbiegel G, et al. Pharmacokinetic studies of alizarin in man. Methods Find.Exp Clin.Pharmacol 1985;7(12):637-643.
Myers HM. Alizarin and tetracycline binding by bone mineral. Am J Phys.Anthropol. 1968;29(2):179-182.
Norton SA. Useful plants of dermatology. IV. Alizarin red and madder. J Am Acad.Dermatol. 1998;39(3):484-485.
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.
Pharmacological Committee of Ministry of Health of Russian Federation. The Clinical Study of Allizarin. 1998.
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.
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.
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.
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.