What is Pau d'Arco?
Pau d'Arco (Tabebuia impetiginosa, also called Tabebuia avellanedae or lapacho) is an herbal supplement derived from the inner bark of several South American trees, primarily from the Amazon rainforest. It has been used for centuries in traditional medicine by indigenous populations.
Common Names: Lapacho, Taheebo, Ipe Roxo, Purple Lapacho
Active Compounds:
Lapachol: Primary bioactive compound with antimicrobial properties
Beta-lapachone: Related naphthoquinone with anticancer research interest
Quercetin: Flavonoid antioxidant
Other naphthoquinones: Various compounds contributing to therapeutic effects
Primary Functions & Benefits
Traditional Uses:
Treating infections (bacterial, fungal, viral, parasitic)
Supporting immune system function
Addressing inflammatory conditions
Promoting digestive health
Managing pain and inflammation
Supporting skin conditions
Research-Supported Benefits:
Antimicrobial activity: Shows activity against Candida, Staphylococcus, and other microorganisms
Anti-inflammatory effects: May reduce inflammatory markers
Antioxidant properties: Protects cells from oxidative damage
Potential anticancer activity: Laboratory studies show promise (not proven in humans)
Immune modulation: May enhance immune response
Wound healing: Traditional topical application for skin issues
Areas of Investigation:
Candida and yeast infections
Bacterial infections (internal and topical)
Inflammatory bowel conditions
Cancer support (highly experimental)
Psoriasis and eczema
Arthritis and joint pain
Recommended Dosages
Standardized Extract (Capsules/Tablets):
Typical dose: 500-1,000 mg, 2-3 times daily
Maximum: 3,000 mg per day divided into doses
Treatment duration: 2-4 weeks for acute use; consult practitioner for longer
Bark Tea (Decoction):
Preparation: 1-2 teaspoons (2-4 grams) dried inner bark per cup
Brewing: Simmer for 15-20 minutes
Dosage: 1-3 cups daily
Note: Tea may be less potent than standardized extracts
Tincture (Liquid Extract):
Typical dose: 1-2 mL (20-40 drops), 2-3 times daily
Ratio: Usually 1:4 or 1:5 (herb to liquid)
Topical Application:
Strong tea or tincture applied directly to affected skin areas
Commercial topical preparations as directed
Important: Quality varies significantly between products. Look for products standardized to lapachol or naphthoquinone content.
How Pau d'Arco Works
The primary mechanisms include:
Antimicrobial action: Lapachol disrupts microbial cell metabolism and reproduction
Oxygen radical generation: Creates reactive oxygen species toxic to pathogens but manageable by healthy cells
Immune stimulation: Increases production of immune cells and antibodies
Anti-inflammatory pathways: Inhibits pro-inflammatory mediators like NF-kB
Antioxidant activity: Neutralizes free radicals and reduces oxidative stress
Synergistic Supplements
Take WITH Pau d'Arco:
Probiotics: Support gut health during antimicrobial use (take 2-3 hours apart)
Vitamin C: Enhances immune function and antioxidant effects
Zinc: Supports immune response
Echinacea: Complementary immune support (short-term)
Oregano oil: Synergistic antimicrobial effects for infections
Berberine: Complementary antimicrobial and metabolic support
Beneficial Combinations:
Antifungal protocols often combine with caprylic acid, garlic, or grapefruit seed extract
Anti-inflammatory protocols may include curcumin or ginger
Immune support stacks with vitamin D, elderberry, or medicinal mushrooms
Interactions & What NOT to Take
Avoid Combining With:
Anticoagulant/antiplatelet drugs: May increase bleeding risk (warfarin, aspirin, clopidogrel)
Chemotherapy drugs: May interfere with treatment (consult oncologist)
Immunosuppressants: May counteract immunosuppressive therapy
Other blood thinners: Including high-dose fish oil, vitamin E, garlic supplements
Medications That May Interact:
NSAIDs: Increased bleeding risk
Diabetes medications: May affect blood sugar levels
Antibiotics: May alter effectiveness (theoretical)
Use Caution With:
Other antimicrobial herbs used simultaneously
High-dose vitamin K (may counteract effects)
Alcohol consumption (may increase liver stress)
Who Should Take Pau d'Arco
Ideal Candidates:
Individuals with recurrent Candida or yeast infections
Those with chronic fungal infections (athlete's foot, nail fungus)
People seeking natural antimicrobial support
Individuals with inflammatory conditions exploring herbal options
Those with compromised immune function (under supervision)
People with skin conditions like psoriasis or eczema (topical/internal)
May Benefit:
Individuals with digestive issues related to microbial imbalance
Those recovering from infections
People with chronic inflammation
Individuals interested in antioxidant support
Who Should AVOID or Use Caution
Contraindications:
Pregnant women: May stimulate uterus and cause complications
Breastfeeding mothers: Insufficient safety data
People with bleeding disorders: Hemophilia, thrombocytopenia
Scheduled for surgery: Discontinue 2-3 weeks before
Children under 12: Insufficient safety data
Use Extreme Caution:
Individuals on anticoagulant therapy
People with liver or kidney disease
Those with anemia (high doses may worsen)
Individuals with autoimmune conditions (may stimulate immune system)
People taking chemotherapy or radiation
Those with low blood pressure
Deficiency Symptoms
Pau d'Arco is not an essential nutrient, so there are no deficiency symptoms. It is a therapeutic herb used for specific health conditions rather than preventing nutritional deficiency.
However, conditions that might benefit from Pau d'Arco include:
Recurrent fungal or yeast infections
Chronic inflammatory states
Weakened immune function
Persistent skin conditions
Microbial imbalances
Toxicity & Side Effects
Common Side Effects (Mild):
Nausea
Digestive upset or diarrhea
Dizziness
Headache
Vomiting (with high doses)
Serious Side Effects (High Doses):
Bleeding: Increased bruising or bleeding
Anemia: Reduced red blood cell production
Liver toxicity: Rare but possible with excessive use
Severe nausea and vomiting: From lapachol toxicity
Toxic Doses:
Toxicity typically occurs at doses significantly higher than recommended (above 1.5-2 grams of pure lapachol)
Tea is generally safer than concentrated extracts
Most reported toxicity cases involved extremely high doses or long-term excessive use
Warning Signs to Stop Use:
Unusual bleeding or bruising
Severe digestive symptoms
Jaundice (yellowing of skin/eyes)
Severe fatigue or weakness
Allergic reactions (rash, itching, swelling)
Note: Start with lower doses to assess tolerance, especially with concentrated extracts.
Timing & Administration
Best Time to Take:
Between meals: On an empty stomach for antimicrobial effects (30-60 minutes before meals)
With meals: If experiencing digestive upset
Morning and afternoon: Avoid evening doses if experiencing mild stimulant effects
Consistency: Take at the same times daily for best results
Duration of Use:
Acute infections: 2-4 weeks
Chronic conditions: Up to 6-8 weeks, then take a break
Cycling recommended: Use for 4-6 weeks, then take 1-2 weeks off
Long-term: Only under practitioner supervision
With or Without Food:
Antimicrobial purposes: Empty stomach preferred
If nausea occurs: Take with small amount of food
Tea preparation: Can be consumed anytime
Topical: Apply to clean, dry skin 1-3 times daily
Special Considerations
Quality & Sourcing:
Use only inner bark (not outer bark)
Look for Tabebuia impetiginosa or Tabebuia avellanedae species
Choose reputable brands with third-party testing
Avoid products with unclear species identification
Consider organic or wildcrafted sources
Form Matters:
Capsules/tablets: Most consistent dosing
Tea: Traditional method, gentler but less standardized
Tinctures: Good absorption, flexible dosing
Topical: Useful for localized skin conditions
Individual Response:
Some people respond better to tea vs. extracts
Start low and increase gradually
Monitor for both benefits and side effects
Response time varies (days to weeks)
Antimicrobial Use:
May cause die-off reactions (Herxheimer reaction) when killing pathogens
Symptoms include temporary worsening, fatigue, flu-like feelings
Support with hydration and consider probiotics
Reduce dose if die-off is severe
Scientific Evidence Status
Strong Traditional Evidence:
Centuries of use in South American traditional medicine
Consistent anecdotal reports for infections
Laboratory Evidence:
Antimicrobial activity well-documented in vitro
Anticancer effects shown in cell and animal studies
Anti-inflammatory mechanisms identified
Human Clinical Evidence:
Limited: Very few high-quality human trials
Most evidence is observational or traditional
More research needed for specific conditions
Safety profile based primarily on traditional use and case reports
Current Research Interest:
Anticancer potential (early-stage research)
Antifungal applications
Anti-inflammatory mechanisms
Immune modulation effects
Summary & Key Takeaways
Pau d'Arco is a traditional South American herbal remedy with promising antimicrobial, anti-inflammatory, and immune-supporting properties. While laboratory research supports many traditional uses, high-quality human clinical trials are limited. It appears relatively safe at recommended doses but can cause bleeding risks at high doses or in sensitive individuals.
Bottom Line: Best suited for short-term use (2-8 weeks) for specific conditions like fungal infections or inflammatory issues. Always start with lower doses, avoid during pregnancy, and discontinue before surgery. Not a substitute for medical treatment of serious infections or cancer. Choose high-quality products from reputable sources, and consult healthcare providers, especially if taking medications or managing chronic conditions.
Quality matters significantly with this supplement, so invest in reputable brands with proper species identification and testing.