Tawa-tawa is a popular herbal medicine not only in the Philippines but also in many other countries in the tropics where it is used to treat a variety of diseases, including respiratory ailments (cough, coryza, bronchitis, and asthma), female disorders, worm infestations in children, dysentery, jaundice, pimples, gonorrhoea, digestive problems, and tumors. The herb is considered safe for both adults and children in many traditional healing systems in the world. In the acute toxicity study conducted by researchers at University of Santo Tomas - The Research Center for the Natural and Applied Sciences (UST-RCNAS) on the spray-dried tawa-tawa of Herbanext, the extract did not produce toxicity even at a high dose of 10 g/kg based on rat model after 2 weeks. This result was consistent with the findings in a study conducted in India in 2016 where 10 g/kg did not product any sign of toxicity. Extrapolated, this means that 500 grams of the extract (the content of around 1,500 capsules) will not cause acute toxicity to a 50 kg adult. In a 90-day sub-chronic toxicity study conducted in Malaysia in 2013, no toxicity was detected on rats at a dose of 1.0 g/kg/day. There was no significant change in food and water consumptions, body weight change, haematological and biochemical parameters, relative organ weights, and gross findings compared to the control group. A recent nephrotoxicity and hepatotoxicity screening conducted on tawa-tawa extract at the National Institute of Molecular Biology and Biotechnology at UP Diliman also confirm the safety of the extract. Because tawa-tawa is normally consumed for only 3-5 day for treating dengue cases based in Philippine traditional practice, the risk of side effects is zero.

Plasma leakage is one of the major complications of dengue hemorrhagic fever (DHF) that leads to a majority of the fatalities observed by those who oversee the treatment of the disease. In both Dengue Fever (DF) and DHF, platelet count goes down, and due to the self-limiting nature of the disease, it eventually returns to normal (in most cases) following proper medical treatment. For patients who exhibit plasma leakage and succumb to the disease, this cannot be fully attributed to plasma leakage alone, because plasma leakage and decreased platelet count as manifestations of DF/DHF may in fact be interrelated. This is difficult to establish at present due to the complex immunopathogenesis of dengue infection. However, there is clear evidence that platelets are very much involved in maintaining vascular integrity. If vascular leakage is in fact affected by platelet count and functionality, then a mechanism that addresses platelet count, integrity, and/or functionality may as well address the problem of plasma leakage, at least from the point of view relating to thrombocytopenia (platelet loss). It is important to note however, that dengue infection apart from its effect on platelets, also affects the cells of the vascular endothelium as well as the endothelial glycocalyx (protein matrix), also contributing to vascular permeability. The compounds found in tawa-tawa, apart from being shown to exhibit anti-thrombocytopenic activity in preclinical studies and in one early clinical study, also exhibit antiviral activity, targeting dengue viral replication in in vitro cultures of infected cells. This shows the potential of compounds in tawa-tawa to not only address the clinical symptoms of dengue (thrombocytopenia and vascular leakage), but also address the replication of the virus in the body as well. The antiviral activity of tawa-tawa extract on DENV 1, 2 and 3 has been demonstrated locally in an in vitro study using the Focus Formation Assay at the St. Lukes Hospital.

The efficacy of tawa-tawa and its active constituents against dengue is well supported, and has been documented in a substantial number of studies ranging from in silico (computer-generated) simulations, in vitro (against infected cell cultures), and in vivo (in mice and people) models. It is hypothesized that there are two possible mechanisms by which tawa-tawa extracts work against dengue virus: as an anti-thrombocytopenic (prevents loss of platelets or increases platelet count), and an antiviral agent. An in silico study on quercetin, one of tawa-tawa’s active compounds was able to show that the compound inhibited the activity of several viral proteins involved in replication, even at minute concentrations. This was further supported by an in vitro study on viral cultures of dengue, wherein the compound was able to stop viral multiplication. One of the main clinical studies done on tawa-tawa, performed in India, was able to show that 70% of patients (out of a population of 125 patients) recovered from the symptoms of dengue (increased platelet count, relief from fever) after administration with tawa-tawa infusion (in addition to oral rehydration), as opposed to the group that was simply given the basic treatment protocol for dengue symptoms (i.e. oral rehydration). In terms of its anti-thrombocytopenic properties, tawa-tawa has been shown to increase platelet count in rat experimental models. Compared to its active compound quercetin, which has been researched on in many studies and is well understood as an antiviral compound, the compounds responsible anti-thrombocytopenic activity of tawa-tawa are not as clearly identified, despite its clear efficacy in mice and people. This is subject to further investigation to understand the molecular mechanism by which tawa-tawa functions in this manner.

An extract is an herbal preparation containing the active ingredient of a substance in concentrated form. After concentration, the extract undergoes spray-drying, which is a rapid drying method taking only a few seconds. This helps preserve the active components of tawa-tawa. Spray-drying is the same process used for making coffee powder and powdered milk, except that it is done at lower drying temperature for medicinal plant extracts.

Standardization, on the other hand, is a process whereby various laboratory tests and assay procedures are applied for the evaluation of raw material, intermediate product, and finished product, so as to confirm the presence of the desired compounds. For the tawa-tawa capsules, the spray-dried extract is standardized for the presence of selected markers, particularly certain flavonoids which are believed to be responsible for the antiviral and antithrombocytopenic activity of tawa-tawa. One of these compounds being laboratory tested in the Herbanext tawa-tawa capsule is quercetin.

It takes 5 grams of tawa-tawa powder to produce 1 gram of tawa-tawa extract. Because extracts are concentrated, dosing is lesser and thereby improving patient compliance. Being readily soluble in water (unlike powdered tawa-tawa), extracts will be absorbed by the body faster. The tawa-tawa extract is also tested multiple times by chromatographic tests from receipt of raw material to the final product. This allows the detection of adulterants and guarantees the presence of desired active compounds.

The recommended dosage for a 50-100 kg adult for standardized tawa-tawa extract is 6 capsules a day, to be equally divided into 3 doses to be taken 15 minutes before each meal (2 capsules at 3 times per day). For smaller bodyweights, maintain a dosage of around 1 capsule every 10 kg, to be divided equally 3 times per day. Contents of the capsule may be dissolved in water or milk if desired. Consumption is maintained for 3-5 days until the platelet count normalizes. Tawa-tawa is not intended to be consumed as a preventive or prophylactic measure against dengue. Instead, tawa-tawa, is taken to aid in the recovery from dengue infection. Tawa-tawa has mild diuretic action so it is important to drink the capsules with a full glass water.

Yes, it is strongly advised that patients seek proper hospital care to monitor platelet count and other important blood parameters. These tests are important to determine the severity of the infection. Dengue causes leakage of plasma so it is important to maintain adequate hydration. Severe dehydration can lead to Dengue Shock Syndrome which can be fatal.

Tawa-tawa extract is in concentrated form, providing a significantly higher content of active ingredient. Compared to capsulized powdered tawa-tawa leaves which just undergo drying and grinding, the manufacture of tawa-tawa extract undergoes multiple steps including extraction, concentration, sterilization, spray-drying, standardization, and compounding. The manufacturing process follows pharmaceutical standards and the product is tested for quality multiple times.

If you have a ready supply of fresh tawa-tawa, you can certainly prepare a fresh decoction every day and this will be equally effective. Many instructions can be found in the internet on how to do this. Just make sure that your source of tawa-tawa is clean. If you are living in an urban area, collecting tawa-tawa from the surroundings is not recommended as the plant is known to accumulate heavy metals. Tawa-tawa, based on animal studies and traditional use, has antipyretic activity and can help manage the symptoms of fever. It is important in this regard to consume just the right amount as excessive quantities can cause hypothermia.

The product is currently available online (www.dailyapplestore.com) and in its outlets in Quezon City, Bacolod, Cebu, Davao, and General Santos. The product will be available in selected pharmacies starting the 3rd week of August. Please check www.herbanext.com for a complete list of stores. The standardized tawa-tawa extract has a shelf life of 2 years.