Clinical Review

Dengue fever

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4661 (Published 15 September 2015) Cite this as: BMJ 2015;351:h4661

Guidelines in using carica papaya leaf extract for Dengue fever patients

Carica Papaya leaf extract is now being widely used as a treatment for Dengue fever in many countries (1) and in some with the approval of their health authorities (2). A large ampunt of biomedical research has been done on this subject, including three randomised control clinical trials (3,4,5,6,7,8,9,10,11,12,13). There were no reported significant adverse effects following this treatment (7) and toxicology studies ruled out any toxic effects even at higher doses (14).

This research has shown many beneficial effects, including reduction in the duration of fever, duration of illness, hospital stay, most importantly fluid leak and the conversion of Dengue fever to Dengue haemorrhagic fever, rapid elevation of white blood cells and platelet counts. This treatment can be initiated at primary care level after confirming the diagnosis with NS1 antigen from the first day of fever.

Based on my clinical experience and clinical research, I recommend that papaya leave extract to be given from the first day of Dengue fever concurrently with the usual dengue management. This will reduce morbidity and mortality.

Guidelines in using carica papaya leaf extract for Dengue fever patients

1. In anyone suffering from fever, headache or body pain, it is advisable to do Dengue NS1 antigen test as early as possible.
2. If the Dengue NS1 antigen test is positive, it is very likely that you are suffering from Dengue fever.
3. When you are diagnosed with Dengue fever you should immediately get treatment from an allopathic doctor. Papaya leaf extract should be used in addition to the usual Dengue management.
4. Papaya leaf extract could be given at any stage of the disease. But for best results it should be given from the first day of fever.
5. Papaya leaf extracts could be taken as syrup; 30ml three times a day before meals for an adult and 5-10ml three times a day for a child until you have fully recovered from the illness. It is advised not to stop the treatment halfway.
6. A few sips of cold water could be taken immediately after the Papaya leaf extract, to overcome the bitter taste.
7. Do not take Papaya leaf extract if you are allergic to Papaya.

8. Method of preparation

• Get fresh healthy mature papaya leaves from a fruit-bearing tree.
• Wash the leaves thoroughly with running tap water and chop the leaves in to small pieces excluding the main stem (not necessary to remove the small stems in the leaves).
• Weigh 50g of papaya leaves and put it into a mortar and pestle.
• Add 50ml of boiled cool water and 25g of sugar.
• Pound the above mixture well for 15 minutes till a uniform pulp is made.
• Mix this pulp well and keep for about 30 minutes.
• Squeeze this pulp by hand and get the papaya leaf extract (do not use a cotton sieve to extract the juice).
• You can store this preparation for 24 hours in the lower compartment of the refrigerator (+4 oC)
• Shake the bottle well before the preparation is given.

References
1. Hettige S .Carica papaya leaf extract in Dengue fever. IMPA Journal |December 2015|Volume 09|Number 01, IMPA Journal; pg 11-14. [Internet]. 2016 [cited 24February2016]; Available from: https://www.dropbox.com/s/b8zejo8r7nx3l6e/09%20Impa%20Journal%20-%20volu...

2. Free Malaysia Today. Ministry studies papaya leaves to treat dengue. [Internet]. 2015 [Cited30 September 2015];Available from: http://www.freemalaysiatoday.com/category/nation/2015/05/16/ministry-stu...

3. Hettige S. Salutary effects of carica papaya leaf extract in dengue fever patients – a pilot study [Internet]. Sri Lanka: Sri Lankan Family Physician; 2008 [Cited 30 September2015]; 2008,29,17-19. Available from: http://cgpsl.org/wp-content/uploads/2013/11/119.pdf

4. Hettige S. Dengue: an escalating problem., Papaya leaves for speedy rise of platelet count in Dengue. British Medical Journal [Internet]. 2002 [Cited 30 September 2015];324(7353):1563-1566. Available from: http://www.bmj.com/rapid-response/2011/11/03/repapaya-leaves-speedy-rise...

5. Paknikar S, Sarala N. Papaya extract to treat dengue: A novel therapeutic option?. Annals of Medical and Health Sciences Research [Internet]. 2014 [Cited 6 November 2015];4(3):320. Available from: http://www.amhsr.org/article.asp?issn=2141-9248;year=2014;volume=4;issue...

6. Kumar. N. Dengue: an escalating problem., Papaya leaves for speedy rise of platelet count in Dengue. British Medical Journal [Internet]. 2002 [Cited 30 September 2015];324(7353):1563-1566. Available from: http://www.bmj.com/rapid-response/2011/11/03/papaya-leaves-speedy-rise-p...

7. Subenthiran S, Choon T, Cheong K, Thayan R, Teck M, Muniandy P et al. Carica papaya Leaves Juice Significantly Accelerates the Rate of Increase in Platelet Count among Patients with Dengue Fever and Dengue Haemorrhagic Fever. Evidence-Based Complementary and Alternative Medicine [Internet]. 2013 [Cited 6 November 2015];2013:1-7.Available from: http://www.hindawi.com/journals/ecam/2013/616737/

8. Senthilvel P, Lavanya P, Kumar K, Swetha R, Anitha P, Bag S et al. Flavonoid from Carica papaya inhibits NS2B-NS3 protease and prevents Dengue 2 viral assembly [Internet]. India: Biomedical Informatics; 2013 [Cited 30 September 2015]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842573/

9. Otsuki N, Dang N, Kumagai E, Kondo A, Iwata S, Morimoto C. Aqueous extract of Carica papaya leaves exhibits anti-tumor activity and immunomodulatory effects [Internet]. Japan: Elsevier Ireland Ltd., Journal of Ethnopharmacology; 2009 [Cited 30 September 2015]. Available from: http://herbalnet.healthrepository.org/bitstream/123456789/2193/1/sdartic...

10. Ranasinghe P, Ranasinghe P, Abeysekera W, Premakumara G, Perera Y, Gurugama P et al. In vitro erythrocyte membrane stabilization properties of Carica papaya L. leaf extracts [Internet]. Sri Lanka: Pharmacognosy Research; 2012 [Cited 30 September 2015]. Available from: http://www.phcogres.com/article.asp?issn=0974-8490;year=2012;volume=4;is...

11. Imaga N, Gbenle G, Okoch V, Akanbi S, Edeoghon S, Kehinde M et al. Antisickling property of Carica papaya leaf extract [Internet]. Nigeria: African Journal of Biochemistry Research; 2009 [Cited 30 September 2015]. Available from: http://www.academicjournals.org/article/article1380037616_Imaga%20et%20a...

12. Yunita F, Hanani E. The effect of carica papaya leaves extract capsule on platelet count and hematocrit level in dengue fever patient [Internet]. Indonesia: Int. J. Med. Arom. Plants,; 2015 [Cited 6 November 2015]. Available from: http://www.openaccessscience.com/pdf-files/vol2_4_dec2012/IJMAP_2_4_4_Ca...

13. World Health Organization. International Clinical Trials Registry Platform Search Portal [Internet]. 2013 [Cited 30 September 2015]. Available from: http://apps.who.int/trialsearch/Trial2.aspx?TrialID=SLCTR/2013/005

14. S. Z. Halim S, N. R. Abdullah N, A. Afzan A, Rashid B, Jantan I, Ismail Z. Acute toxicity study of Carica papaya leaf extract in Sprague Dawley rats [online]. 1st ed. Malaysia: Journal of Medicinal Plants Researc; 2011 [Accessed 30 September 2015]. Available from: http://www.researchgate.net/publication/230859605_Acute_toxicity_study_o...

Competing interests: No competing interests

26 February 2016
Sanath hettige
Consultant family physician
Postgraduate Institute of Medicine University of Colombo Sri Lanka Oil of Dermae research medical center & Laboratories , 92 Wattegedera road Maharagama Srilanka
92 Wattegedera road Maharagama Srilanka
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