Herb & supplement monograph

Sangre De Grado Drug Interactions, Uses, Effectiveness, Safety & More

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Reviewed by licensed pharmacists Sourced from Natural Medicines
Interaction report

Drugs that interact with Sangre De Grado

0 medications have a known interaction with Sangre De Grado, graded by severity. Select any drug for the full evidence-based detail.

We don’t currently list any known drug interactions for Sangre De Grado. This doesn’t guarantee none exist — always confirm with your pharmacist before combining supplements with your medications.

Read The List Like a Pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

  • Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
  • Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
  • Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
  • No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

  • Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
  • Probable. Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • Possible. Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
  • Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

  • Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
  • Each drug listed above links to the full report for that exact Sangre De Grado combination — clinical detail, likelihood, evidence level, and citations.
  • Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.
Monograph

Sangre De Grado: Uses, Safety & Side Effects

The bottom line

Sangre de Grado is a red tree sap from the Amazon rainforest used traditionally for diarrhea, wounds, and skin problems. Some of its compounds have been studied scientifically, and one purified ingredient (crofelemer) is used in a prescription anti-diarrhea drug, but the raw supplement itself has limited human research. Talk with a pharmacist or doctor before using it, especially if you are pregnant, breastfeeding, or have a health condition.

Scientific name
Croton lechleri
Family
Euphorbiaceae
Part used
Red sap (latex) from the bark of the tree
Common forms
Liquid sap, tincture, topical gel or cream, capsules, and a purified extract (crofelemer) used in some medicines
People commonly use it for
  • Diarrhea
  • Wound healing and skin sores
  • Digestive and stomach complaints
  • Insect bites and minor skin irritation
  • Sore throat and mouth ulcers

Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.

Safety at a glance
OverallUse caution

It has a long history of traditional use but limited safety data for supplements, so use cautiously.

PregnancyInsufficient reliable information

Insufficient reliable information available; avoid using.

Read the full pregnancy detail
BreastfeedingInsufficient reliable information

Insufficient reliable information available; avoid using.

Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

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Overview

Sangre de Grado, which means "dragon's blood" or "blood of the dragon" in Spanish, is a deep red sap that comes from the bark of Croton lechleri, a tree that grows in the Amazon rainforest of South America. When the bark is cut, it releases a thick, dark-red liquid that has been used for centuries in traditional Amazonian medicine.

People have traditionally applied the sap directly to the skin for cuts, wounds, and insect bites, or taken it by mouth for diarrhea and stomach problems. Today it is sold as a liquid sap, tincture, topical gel, or capsule. A purified compound from this plant, called crofelemer, is also used in a prescription medicine for certain types of diarrhea.

How it works

The red sap contains several natural plant compounds. One that has been studied is taspine, which lab research suggests may help with wound healing. The sap also contains proanthocyanidins (a group of plant antioxidants), and the purified extract crofelemer appears to reduce the flow of fluid and chloride into the intestines, which may explain its anti-diarrhea effect.

Other compounds in the sap have shown antioxidant, antimicrobial, and anti-inflammatory activity in laboratory tests. It is important to know that most of this information comes from test-tube and animal research, and results in those settings do not always carry over to people.

Effectiveness

Does Sangre De Grado work?

Evidence overview · 5 uses evaluated
3 Possibly effective 1 Leans ineffective 1 Insufficient evidence
How to read these evidence grades

Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.

1EffectiveStrong, consistent evidence it works.
2Likely EffectiveGood evidence, though not yet conclusive.
3Possibly EffectiveSome evidence suggests a benefit.
4Possibly IneffectiveSome evidence it may not help.
5Likely IneffectiveFairly strong evidence it doesn’t help.
6IneffectiveStrong evidence it doesn’t work.
7Insufficient Reliable Evidence to RateToo little research to say either way.
Possibly Effective Genital herpes
Rating & evidence shown verbatim from Natural Medicines

Some clinical research shows that topical application of a specific sangre de grado ointment (Virend, Shaman Pharmaceuticals), containing purified crofelemer (SP-303) 15%, three times daily for 21 days seems to be effective for treating genital and anal herpes simplex lesions in people with AIDS. Patients using this ointment were about 3 times more likely to experience complete healing of herpes lesions when compared with placebo. Another preliminary clinical study shows that this ointment is not effective for treating acyclovir-unresponsive mucocutaneous herpes simplex lesions in these patients. However, due to the small study size and lack of control, the validity of this latter study is unclear.

Possibly Effective HIV/AIDS-related diarrhea
Rating & evidence shown verbatim from Natural Medicines

A purified constituent of sangre de grado, crofelemer (Fulyzaq; Mytesi), is approved by the US Food and Drug Administration (FDA) for the treatment of non-infectious diarrhea in adult patients with HIV/AIDS who are on antiretroviral therapy. One large clinical study in this population shows that taking this product 125 mg twice daily for 4 weeks improved stool consistency and decreased the number of watery stools per day by 0.32 when compared with placebo. These patients were also about 2.2-fold more likely to achieve clinical response when compared with placebo. Clinical response was defined as having no more than 2 watery stools per week. In a 20-week extension study, up to 56% of patients taking crofelemer achieved clinical response.

Sources Ref 94708
Possibly Effective Travelers' diarrhea
Rating & evidence shown verbatim from Natural Medicines

A purified constituent of sangre de grado, crofelemer (SP-303), has been evaluated for the management of travelers' diarrhea. One clinical study shows that taking 125-500 mg orally four times daily for 2 days seems to be effective for symptomatic treatment of travelers' diarrhea when compared with placebo. In patients traveling to Jamaica or Mexico, the time to resolution of diarrhea was decreased by about 6-8 hours with crofelemer when compared with placebo. The risk of treatment failure was also decreased by 67% to 85% with crofelemer when compared with placebo.

Sources Ref 73090
Possibly Ineffective Irritable bowel syndrome (IBS)
Rating & evidence shown verbatim from Natural Medicines

Clinical research in adults with diarrhea-predominant IBS shows that taking crofelemer (SP-303), a purified constituent of sangre de grado, as 125 mg, 250 mg, or 500 mg twice daily for 12 weeks does not improve stool consistency, stool frequency, urgency, or pain when compared with placebo.

Also studied for 1 condition — evidence insufficient to rate
Insufficient Reliable Evidence To Rate Insect bite
Rating & evidence shown verbatim from Natural Medicines

Preliminary clinical research shows that applying a specific sangre de grado 1% balm (Zangrado Bug Bite Balm, Rainforest Phytoceuticals, LLC.) alleviates the symptoms of insect bites (fire ants, wasps, bees) and plant reactions. In a group of pest control workers, use of the sangre de grado balm relieved itching, pain, redness, swelling, and discomfort in 100% of cases, while application of a placebo balm relieved pain and redness in only 17% to 20% of cases, with no reports of improvement in itching, swelling, or discomfort.

Sources Ref 73086

Source & disclaimer. Effectiveness ratings and evidence summaries are provided by Natural Medicines (Therapeutic Research Center) and shown as licensed. Where Natural Medicines hasn’t rated a use, HelloPharmacist’s pharmacists may add their own reviewed rating and evidence (each such entry is labeled). This is educational information, not medical advice — talk with your pharmacist or doctor before starting, stopping, or changing a supplement.

Safety & precautions

Sangre de Grado has a long history of traditional use, and short-term use appears to be reasonably well tolerated by many people. Still, modern safety data for the supplement is limited, so caution is wise.

People with chronic health conditions, those taking other medicines, children, and older adults should talk with a healthcare provider before using it. If you have ongoing or severe diarrhea, do not rely on a supplement; see a doctor, because untreated diarrhea can cause dangerous dehydration.

Pregnancy and breastfeeding: There is not enough reliable safety information for these situations. Because the sap contains active compounds and safety is unclear, it is best to avoid Sangre de Grado if you are pregnant or breastfeeding.

Side effects

When taken by mouth, the sap may cause stomach upset, nausea, or an unpleasant taste. When used on the skin, it can stain the skin and clothing red and may cause irritation or an allergic reaction in some people.

Stop using it and seek medical care if you notice signs of an allergic reaction such as rash, itching, swelling, trouble breathing, or worsening symptoms. Because supplement quality and purity can vary, choosing products from reputable manufacturers is important.

Sangre De Grado: Reported Adverse Effects

Documented safety reports on Sangre De Grado from the evidence-graded Natural Medicines (TRC Healthcare) database, shown word-for-word from the licensed record.

Orally, crofelemer (SP-303), a purified constituent of sangre de grado, seems to be well tolerated. No serious adverse effects have been reported in clinical studies. Mild gastrointestinal adverse effects, bronchitis, and headache have been reported in clinical research with oral crofelemer (SP-303).

Topically, the sangre de grado constituent crofelemer can cause local pain and burning.

  1. Holodniy M, Koch J, Mistal M, et al. A double blind, randomized, placebo-controlled phase II study to assess the safety and efficacy of orally administered SP-303 for the symptomatic treatment of diarrhea in patients with AIDS. Am J Gastroenterol 1999;9
  2. Dicesare D, Dupont HL, Mathewson JJ, et al. A double-blind randomized, placebo-controlled study of SP-303 (Provir) in the symptomatic treatment of acute diarrhea among travelers to Mexico and Jamaica. Infectious Diseases Society of America Annual Meetin
  3. DiCesare, D., DuPont, H. L., Mathewson, J. J., Ashley, D., Martinez-Sandoval, F., Pennington, J. E., and Porter, S. B. A double blind, randomized, placebo-controlled study of SP-303 (Provir) in the symptomatic treatment of acute diarrhea among travelers
  4. MacArthur RD, Hawkins T, Brown SJ, et al. Efficacy and safety of crofelemer for noninfectious diarrhea in HIV-seropositive individuals (ADVENT trial): a randomized, double-blind, placebo-controlled, two-stage study. HIV Clin Trials 2013;14(6):261-73.
  5. Mangel AW, Chaturvedi P. Evaluation of crofelemer in the treatment of diarrhea-predominant irritable bowel syndrome patients. Digestion 2008;78(4):180-6.
  6. Nee J, Salley K, Ludwig AG, et al. Randomized clinical trial: crofelemer treatment in women with diarrhea-predominant irritable bowel syndrome. Clin Transl Gastroenterol. 2019;10(12):e00110.
  7. Safrin S, McKinley G, McKeough M, et al. Treatment of acyclovir-unresponsive cutaneous herpes simplex virus infection with topically applied SP-303. Antiviral Res 1994;25:185-92.
  8. Orozco-Topete R, Sierra-Madero J, Cano-Dominguez C, et al. Safety and efficacy of Virend for topical treatment of genital and anal herpes simplex lesions in patients with AIDS. Antiviral Res 1997;35:91-103.
Reports by condition
Acute bronchitis Pulmonary/Respiratory
Cluster headache Neurologic/CNS
Constipation Gastrointestinal

Orally, gastrointestinal adverse effects have been reported in some patients taking the sangre de grado constituent crofelemer (SP-303). In a clinical trial of patients with diarrhea-predominant irritable bowel syndrome, constipation, flatulence, or abdominal pain was reported in 5% to 7% of patients taking crofelemer compared to only 2% to 3% of patients taking placebo. In another clinical trial, flatulence was reported in 3.5% of patients taking crofelemer compared to only 1.1% of patients taking placebo.

  1. MacArthur RD, Hawkins T, Brown SJ, et al. Efficacy and safety of crofelemer for noninfectious diarrhea in HIV-seropositive individuals (ADVENT trial): a randomized, double-blind, placebo-controlled, two-stage study. HIV Clin Trials 2013;14(6):261-73.
  2. Mangel AW, Chaturvedi P. Evaluation of crofelemer in the treatment of diarrhea-predominant irritable bowel syndrome patients. Digestion 2008;78(4):180-6.
Pain Dermatologic
DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Adverse-effects data: Natural Medicines, Therapeutic Research Center

Dosing

There is no official, standardized dose for Sangre de Grado supplements. The right amount can depend on the form (liquid sap, tincture, gel, or capsule) and the concentration of the specific product.

If you choose to use it, follow the directions on the product label and do not exceed the recommended amount. Because doses are not well established, it is a good idea to ask a pharmacist or doctor before starting, and to keep them informed about any supplements you take.

Pregnancy & Breastfeeding

Sangre De Grado & Pregnancy

Insufficient reliable information

Insufficient reliable information available; avoid using.

Sangre De Grado & Breastfeeding

Insufficient reliable information

Insufficient reliable information available; avoid using.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

© 2026 Therapeutic Research Center

Pregnancy & lactation ratings: Natural Medicines, Therapeutic Research Center

References & further reading

The 9 references that drive our Sangre De Grado monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Holodniy M, Koch J, Mistal M, et al. A double blind, randomized, placebo-controlled phase II study to assess the safety and efficacy of orally administered SP-303 for the symptomatic treatment of diarrhea in patients with AIDS. Am J Gastroenterol 1999;9 PubMed
  2. Safrin S, McKinley G, McKeough M, et al. Treatment of acyclovir-unresponsive cutaneous herpes simplex virus infection with topically applied SP-303. Antiviral Res 1994;25:185-92. PubMed
  3. Orozco-Topete R, Sierra-Madero J, Cano-Dominguez C, et al. Safety and efficacy of Virend for topical treatment of genital and anal herpes simplex lesions in patients with AIDS. Antiviral Res 1997;35:91-103. PubMed
  4. Dicesare D, Dupont HL, Mathewson JJ, et al. A double-blind randomized, placebo-controlled study of SP-303 (Provir) in the symptomatic treatment of acute diarrhea among travelers to Mexico and Jamaica. Infectious Diseases Society of America Annual Meetin
  5. Miller, M. J., Vergnolle, N., McKnight, W., Musah, R. A., Davison, C. A., Trentacosti, A. M., Thompson, J. H., Sandoval, M., and Wallace, J. L. Inhibition of neurogenic inflammation by the Amazonian herbal medicine sangre de grado. J.Invest Dermatol. 200 PubMed
  6. DiCesare, D., DuPont, H. L., Mathewson, J. J., Ashley, D., Martinez-Sandoval, F., Pennington, J. E., and Porter, S. B. A double blind, randomized, placebo-controlled study of SP-303 (Provir) in the symptomatic treatment of acute diarrhea among travelers
  7. MacArthur RD, Hawkins T, Brown SJ, et al. Efficacy and safety of crofelemer for noninfectious diarrhea in HIV-seropositive individuals (ADVENT trial): a randomized, double-blind, placebo-controlled, two-stage study. HIV Clin Trials 2013;14(6):261-73. PubMed
  8. Mangel AW, Chaturvedi P. Evaluation of crofelemer in the treatment of diarrhea-predominant irritable bowel syndrome patients. Digestion 2008;78(4):180-6. PubMed
  9. Nee J, Salley K, Ludwig AG, et al. Randomized clinical trial: crofelemer treatment in women with diarrhea-predominant irritable bowel syndrome. Clin Transl Gastroenterol. 2019;10(12):e00110. PubMed
Keep reading

This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Product directory

Supplement products with Sangre De Grado

27 products in our database contain Sangre De Grado. Open any to see its full ingredient list and every drug interaction we check.

Aroma Resins by Herbal Terra Liquid 4 Fluid Ounce(s) · 120 mL View ingredients & interactions Aroma Resins by Herbal Terra Liquid 4 Fluid Ounce(s) · 120 mL View ingredients & interactions China Tung Hsueh Pills by Plum Flower Tablet Or Pill 100 Pill(s) · 0.88 Ounce(s) · 25 Gram(s) View ingredients & interactions Codizone by Amazon Therapeutics Liquid 2 Fluid Ounce(s) · 60 mL View ingredients & interactions Dragon's Blood by Herb Pharm Liquid 1 Fluid Ounce(s) · 30 Milliliter(s) View ingredients & interactions Dragon's Blood by Herb Pharm Liquid 4 fl. Oz. · 120 mL View ingredients & interactions Dragon's Blood 4:1 Extract Powder by TerraVita Premium Collection Powder 1 Ounce(s) View ingredients & interactions Dragon's Blood 4:1 Extract Powder by TerraVita Premium Collection Powder 4 Ounce(s) View ingredients & interactions Royal Dragon's Blood Liquid Herbal Extract by Whole World Botanicals Liquid 30 mL · 1 Ounce(s) View ingredients & interactions The Great Mender Teapills by Plum Flower Tablet Or Pill 1.2 Ounce(s) · 34 Gram(s) · 200 Pill(s) View ingredients & interactions Aroma Resins by Hawaii Pharm Liquid 4 Fluid Ounce(s) · 120 mL Off market View ingredients & interactions Aroma Resins Non-Alcohol by Hawaii Pharm Liquid 4 Fluid Ounce(s) · 120 mL Off market View ingredients & interactions China Tung Hsueh Pills by Plum Flower Tablet Or Pill 100 Pill(s) · 0.8 Oz(s) · 23 Gram(s) Off market View ingredients & interactions Dragon's Blood by Herb Pharm Liquid 4 fl. Oz. · 120 mL Off market View ingredients & interactions Dragon's Blood by Herb Pharm Liquid 1 fl. Oz. · 30 mL Off market View ingredients & interactions Dragon's Blood by Herb Pharm Liquid 1 fl. Oz. · 30 mL Off market View ingredients & interactions Dragon's Blood by Herb Pharm Liquid 4 fl. Oz. · 120 mL Off market View ingredients & interactions Dragon's Blood by Herb Pharm Liquid 1 fl. Oz. · 30 mL Off market View ingredients & interactions Dragon's Blood by Herb Pharm Liquid 1 fl. Oz. · 30 mL Off market View ingredients & interactions Dragon's Blood by Herb Pharm Liquid 4 fl. Oz. · 120 mL Off market View ingredients & interactions Dragon's Blood by Herb Pharm Liquid 1 fl. Oz. · 29.6 mL Off market View ingredients & interactions Dragon's Blood by Herb Pharm Liquid 4 fl. Oz. · 118.4 mL Off market View ingredients & interactions Dragon's Blood by Herb Pharm Liquid 1 fl. Oz. · 29.6 mL Off market View ingredients & interactions Organic Dragon's Blood by Amazon Therapeutics Liquid 1 Fluid Ounce(s) · 30 mL Off market View ingredients & interactions
Pharmacist Counseling Corner

Sangre De Grado: Common Questions

What is Sangre De Grado used for, and does it work?
People use Sangre De Grado for many reasons, but the evidence varies by use. According to the Natural Medicines database, there is at least some clinical evidence supporting Sangre De Grado for Genital herpes, HIV/AIDS-related diarrhea and Travelers' diarrhea. For most other uses it has been studied for, the evidence is currently insufficient to rate. See the graded list on this page, and always confirm with your pharmacist or doctor.
Does Sangre De Grado interact with prescription medications?
We do not currently list any known drug interactions for Sangre De Grado. This does not guarantee that none exist, so always confirm with your pharmacist before combining it with your medications.
How are Sangre De Grado interactions rated?
Each interaction is graded major, moderate, or minor based on how clinically significant it is and the strength of the evidence behind it. Major interactions are the most serious and are best avoided, or used only under close professional supervision.
Is it safe to take Sangre De Grado with my medications?
It depends on the specific medication. Some combinations are fine, while others call for monitoring, timing changes, or should be avoided. Check your exact drug above and confirm with your pharmacist or doctor before starting, stopping, or changing anything.
Where does this Sangre De Grado interaction information come from?
Our interaction data is built on the Natural Medicines database — an evidence-graded reference for vitamins, herbs, and supplements — and is reviewed by licensed HelloPharmacist pharmacists, who may add clinical context.
What is Sangre De Grado used for?
It is traditionally used for diarrhea, wound and skin healing, insect bites, and various stomach complaints. Most of these uses come from traditional practice and early research rather than strong human studies.
Is Sangre De Grado the same as the prescription drug crofelemer?
Not exactly. Crofelemer is a purified compound made from the same plant and is used in an approved medicine for diarrhea, but the raw sap or supplement is not the same product and is not regulated the same way.
Can I use Sangre De Grado if I am pregnant or breastfeeding?
It is best to avoid it. There is not enough safety information for pregnancy or breastfeeding, so the cautious choice is to skip it and ask your doctor about safer options.
Does Sangre De Grado have side effects?
It may cause stomach upset or nausea when taken by mouth and can stain or irritate the skin when applied topically. Allergic reactions are possible, so stop using it if you develop a rash, swelling, or trouble breathing.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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