Compound Monograph
Tetrandrine
Tetrandrine is a bis-benzylisoquinoline alkaloid from Stephania tetrandra (Han Fang Ji) and Abuta — a genuine calcium-channel blocker with decades of Chinese clinical use for hypertension and silicosis, notable P-glycoprotein and two-pore-channel activity, and real pulmonary-toxicity and herb-substitution safety concerns.
Sources · 4
Where Does It Come From?
Tetrandrine is a naturally occurring bis-benzylisoquinoline alkaloid, found in Stephania tetrandra, Abuta, Cyclea spp. and 1 other source. It is flagged as moderately toxic.
Concentration
Content by Source
Concentrations not reported. No percent-dry-weight or mg/g figures have been published for this compound in its source plants.
Tetrandrine at a Glance
Tetrandrine is a bis-benzylisoquinoline alkaloid from Stephania tetrandra (han fang ji) and abuta.
It is a genuine calcium-channel blocker — not a weak in-vitro one — with decades of Chinese clinical use in hypertension and, distinctively, in silicosis, the occupational lung fibrosis caused by inhaling silica dust, for which there is otherwise almost no drug treatment.
It also inhibits P-glycoprotein, giving it real drug-interaction potential, and it concentrates in lung tissue — the same property that underlies both its pulmonary use and its pulmonary toxicity.
Han Fang Ji vs. Guang Fang Ji
The most important thing to know about tetrandrine is not about tetrandrine. It is about what the herb it comes from might turn out to be.
In Chinese materia medica, “fang ji” is a category, not a species. Stephania tetrandra (Menispermaceae) is han fang ji, the tetrandrine source. Aristolochia fangchi (Aristolochiaceae) is guang fang ji — an entirely different plant, containing aristolochic acid, one of the most potent nephrotoxins and urothelial carcinogens known. The two have been confused and substituted for each other in trade for decades.
The consequence is documented. A Belgian weight-loss clinic dispensed a herbal preparation in which Aristolochia fangchi had replaced Stephania tetrandra; the result was a cluster of progressive interstitial renal fibrosis and, in the follow-up study, urothelial carcinoma in 18 of 39 patients who underwent prophylactic nephroureterectomy, with aristolochic-acid–DNA adducts found in the removed tissue 7Reference 7ObservationalUrothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi) — cohort studyView study →. The syndrome now carries the name aristolochic-acid nephropathy 8Reference 8ReviewNortier J, Pozdzik A, Roumeguere T, et al. (2015). [Aristolochic-acid nephropathy (“Chinese herb nephropathy”)] — review. Néphrologie & Thérapeutique. https://pubmed.ncbi.nlm.nih.gov/26515658/View study →.
Tetrandrine did not cause that. It is chemically unrelated to aristolochic acid, and it is not nephrotoxic or carcinogenic in that way. But the substitution risk is a property of the supply chain rather than of the molecule, so it attaches to any fang-ji-sourced material regardless of what the label says. Any such material has to be verified aristolochic-acid-free by analysis, not by name.
The Bisbenzylisoquinoline Class
Tetrandrine is a bisbenzylisoquinoline (bisBIQ) — two benzylisoquinoline units joined through diaryl ether bridges into a large, rigid macrocycle of 622.7 Da. The chemistry of the family, its biosynthesis and the pharmacology and toxicology its members share are set out on berbamine.
Two relationships are worth carrying here. Isotetrandrine is tetrandrine’s epimer — identical connectivity, opposite configuration at one benzylic carbon — and is itself the O-methyl ether of berbamine, so tetrandrine and berbamine are two small changes apart 18Reference 18A modular approach to the bisbenzylisoquinoline alkaloids tetrandrine and isotetrandrineView study →. And fangchinoline, the co-alkaloid that travels with tetrandrine in Stephania tetrandra root, is tetrandrine minus one methyl group, which is why the two are always measured together 22Reference 22Li YQ, Chen XG, Qi YX, et al. (2007). [Determination of tetrandrine and fangchinoline in Radix Stephaniae tetrandrae and its preparation by nonaqueous capillary chromatography]. Zhongguo Zhong Yao Za Zhi. https://pubmed.ncbi.nlm.nih.gov/18161288/View study →.
The class properties that matter clinically are all present in tetrandrine, and more strongly than in
its relatives: L-type calcium-channel blockade, P-glycoprotein inhibition, poor aqueous solubility with
low oral bioavailability, and metabolic activation to reactive intermediates 5,
What It's Used For
Tetrandrine is unusual among plant alkaloids in having genuine pharmacology and real clinical use. Its defining mechanism is non-selective L-type calcium-channel blockade, giving vasodilation and
smooth-muscle relaxation, and it has been used in China for hypertension and — for decades — for
silicosis as an antifibrotic 5,
Its more interesting mechanisms (two-pore-channel blockade, P-glycoprotein inhibition) are preclinical, and the anticancer concentrations far exceed anything a decoction delivers, so those results belong to the concentrated isolate.
Tetrandrine is a genuine non-selective L-type calcium-channel blocker producing vasodilation, negative inotropy/chronotropy and pulmonary-artery smooth-muscle relaxation, and it has been used in China as an antihypertensive and antianginal 5,
Gap: the clinical evidence is old, small, largely Chinese-language and below modern RCT standards, with no Western regulatory approval 5Reference 5Systematic reviewThirteen bisbenzylisoquinoline alkaloids in five Chinese medicinal plants: botany, traditional uses, phytochemistry, pharmacokinetics and toxicity — systematic reviewView study →.
Tetrandrine has decades of clinical use in China as an antifibrotic for silicosis, and a 2025 retrospective cohort reported slowed HRCT progression and lung-function decline in artificial-stone silicosis 4Reference 4ObservationalTetrandrine slows disease progression on high-resolution computed tomography and lung-function decline in artificial-stone-associated silicosis: a retrospective cohort study — observationalView study →.
It is also studied in connective-tissue-disease-associated interstitial lung disease 2Reference 2ReviewThe immunoregulatory function and therapeutic potential of tetrandrine in connective-tissue-disease-associated interstitial lung disease — reviewView study →.
The most rigorous recent study is a 2026 randomised, double-blind trial in 108 patients with stage II silicosis 17Reference 17RCTThe clinical efficacy of hydrogen combined with tetrandrine in the treatment of silicosis fibrosis: a randomised controlled intervention studyView study → — see Silicosis, and What the Trials Test for what it does and does not establish.
Gap: no trial has compared tetrandrine against placebo or no treatment. Its efficacy in silicosis is assumed, not demonstrated, and the same lung accumulation that may help fibrosis also drives pulmonary toxicity 4,
Tetrandrine suppresses articular inflammatory cytokines via NF-κB inactivation in rodent arthritis 14Reference 14AnimalTetrandrine suppresses the articular inflammatory response by inhibiting pro-inflammatory factors via NF-κB inactivation — animal in vivoView study → and downregulates IKK–IκBα–NF-κB signaling in human peripheral-blood T cells 13Reference 13In vitroPlant alkaloid tetrandrine downregulates the IκB-kinase–IκBα–NF-κB signalling pathway in human peripheral-blood T cells — in vitroView study →. A head-to-head comparison with berbamine found both alkaloids immunosuppressive, differing in potency rather than in kind 21Reference 21In vitroComparative immunopharmacology and toxicology of the bisbenzylisoquinoline alkaloids tetrandrine and berbamine — in vitroView study →.
Gap: there are no arthritis clinical trials of the isolated molecule — the human data are cell-level only 13Reference 13In vitroPlant alkaloid tetrandrine downregulates the IκB-kinase–IκBα–NF-κB signalling pathway in human peripheral-blood T cells — in vitroView study →.
Tetrandrine inhibits P-glycoprotein (ABCB1), re-sensitizing resistant leukemia and tumor cells to chemotherapy, and has been explored as a chemo-sensitizer 6Reference 6In vitroTetrandrine overcomes drug resistance mediated by the bone-marrow microenvironment by regulating P-glycoprotein expression in acute leukemia — in vitroView study →. Strong P-gp affinity is a property of the whole bisBIQ class, and tetrandrine is its most-studied example 5Reference 5Systematic reviewThirteen bisbenzylisoquinoline alkaloids in five Chinese medicinal plants: botany, traditional uses, phytochemistry, pharmacokinetics and toxicity — systematic reviewView study →.
Gap: mostly in-vitro and animal, with human oncology use still investigational 6Reference 6In vitroTetrandrine overcomes drug resistance mediated by the bone-marrow microenvironment by regulating P-glycoprotein expression in acute leukemia — in vitroView study →.
The best-developed of the preclinical stories. Landmark work identified the endolysosomal two-pore channel TPC2 as required for Ebola virus entry and blocked by tetrandrine 1Reference 1Two-pore channels control Ebola virus host cell entry and are drug targets for disease treatmentView study →.
Against SARS-CoV-2 the mechanism is the same: tetrandrine acts at the early-entry stage and blocks trafficking of virus from early endosomes to endolysosomes, with activity in three cell lines, reduced viral load and lung pathology in an adenovirus-hACE2 mouse model, and a large volume of distribution driving high tissue accumulation 16Reference 16AnimalAntiviral effects and tissue exposure of tetrandrine against SARS-CoV-2 infection and COVID-19 — animal in vivoView study →.
Physiologically based modelling then estimated the unbound lung concentration at the approved clinical dose at 1.67–1.74 µg/mL, above the in-vitro EC90 of 1.52 µg/mL 3Reference 3Quantitative pulmonary pharmacokinetics of tetrandrine for SARS-CoV-2 repurposing: a physiologically based pharmacokinetic modeling approachView study →.
Gap: no antiviral efficacy trial in humans for any virus. The exposure argument is a model, and reaching a threshold concentration is not the same as changing an outcome 3,
Tetrandrine modulates autophagy and induces ROS/ER-stress-mediated cell death — for example in melanoma via SIRT5 15Reference 15In vitroTetrandrine targeting SIRT5 exerts anti-melanoma properties via inducing ROS, ER stress and blocked autophagy — in vitroView study →.
Gap: cell-line pharmacology only, with the direction of the autophagy effect context-dependent 15Reference 15In vitroTetrandrine targeting SIRT5 exerts anti-melanoma properties via inducing ROS, ER stress and blocked autophagy — in vitroView study →.
Mechanisms
| Target / pathway | Effect | Relevant to |
|---|---|---|
| L-type voltage-gated Ca²⁺ channel (block) | vasodilation, negative inotropy, smooth-muscle relaxation | antihypertensive / antiarrhythmic |
| Two-pore channel TPC2 (endolysosomal Ca²⁺, block) | blocks viral escape from the endosome | antiviral (EbolaSARS-CoV-2; preclinical) |
| P-glycoprotein / ABCB1 (inhibition) | raises intracellular drug/co-drug levels | MDR reversal; drug interactions |
| IKK–IκBα–NF-κB (inhibition) | ↓ pro-inflammatory cytokines | anti-inflammatoryarthritisantifibrotic |
| Lysosomal trapping of the dibasic molecule | very large volume of distribution; heterogeneous tissue loading | lung/liver accumulation — use and toxicity |
| CYP-mediated bioactivation to reactive intermediates | covalent adduct formation | pulmonary and hepatic toxicity |
Pharmacokinetics
Load-bearing, and better characterised than for most alkaloids on this scale.
Tetrandrine has poor aqueous solubility and low, variable oral bioavailability — limitation enough that a
sizeable literature exists on nanocrystal and nanoparticle formulations to improve absorption 9Reference 9ReviewAdvances in nano-preparations for improving tetrandrine solubility and bioavailability — reviewView study →.
Systemic clearance is primarily hepatic metabolism, and metabolism includes activation to reactive
intermediates implicated in its organ toxicity 3,
The distinctive feature is distribution. Tetrandrine is a dibasic, lipophilic molecule that is trapped in lysosomes, and that trapping was identified as the pivotal driver of its very large volume of distribution and its markedly uneven tissue loading — it also modulates absorption in the gut 3Reference 3Quantitative pulmonary pharmacokinetics of tetrandrine for SARS-CoV-2 repurposing: a physiologically based pharmacokinetic modeling approachView study →. The practical result is high concentrations in lung and liver: modelling of the approved clinical dose put the unbound lung concentration at 1.67–1.74 µg/mL 3Reference 3Quantitative pulmonary pharmacokinetics of tetrandrine for SARS-CoV-2 repurposing: a physiologically based pharmacokinetic modeling approachView study →. That lung tropism is the pharmacokinetic basis for both the silicosis use and the pulmonary toxicity, and route matters — in mice, inhaled administration raised lung exposure while reducing exposure elsewhere 16Reference 16AnimalAntiviral effects and tissue exposure of tetrandrine against SARS-CoV-2 infection and COVID-19 — animal in vivoView study →.
Silicosis, and What the Trials Test
Silicosis is the indication that makes tetrandrine unusual: an irreversible fibrotic lung disease caused by inhaled crystalline silica, with essentially no approved pharmacotherapy anywhere, and a molecule used against it in one country for decades.
The evidence has never caught up with the use. The strongest observational data are a 2025 retrospective cohort in artificial-stone silicosis reporting slower HRCT progression and slower lung-function decline 4Reference 4ObservationalTetrandrine slows disease progression on high-resolution computed tomography and lung-function decline in artificial-stone-associated silicosis: a retrospective cohort study — observationalView study →. The strongest experimental data are a 2026 prospective, randomised, double-blind trial in 108 patients with stage II silicosis — and its design is the point. Both arms received tetrandrine; the randomisation was to added hydrogen inhalation or not 17Reference 17RCTThe clinical efficacy of hydrogen combined with tetrandrine in the treatment of silicosis fibrosis: a randomised controlled intervention studyView study →. It found that hydrogen plus tetrandrine improved carbon-monoxide diffusing capacity and lowered serum IL-6 relative to tetrandrine alone. That is a well-conducted trial of hydrogen, with tetrandrine as the assumed-effective background.
Which is the honest summary of the whole indication: tetrandrine’s silicosis efficacy is the premise of the trials rather than their finding. It is plausible — the antifibrotic mechanism is real, the lung concentrations are high, and the clinical tradition is long — and it has not been tested against no treatment in a modern randomised design.
Isolate vs. Plant Studies
Everything here is the isolate, and unusually the plant side barely exists.
Tetrandrine’s clinical use in China is as tetrandrine tablets — a purified single compound at a
defined milligram dose 5Reference 5Systematic reviewThirteen bisbenzylisoquinoline alkaloids in five Chinese medicinal plants: botany, traditional uses, phytochemistry, pharmacokinetics and toxicity — systematic reviewView study →. The silicosis cohort and trial used that product 4,
That gap is not academic. The concentrations at which tetrandrine is active far exceed what whole-plant material delivers, so a han fang ji decoction is not a low-dose version of the drug — it is a different exposure entirely, carrying the co-alkaloid fangchinoline and whatever else the root contains, and carrying the substitution risk described above. On the plant side, abuta and related Cissampelos/Abuta species are traditional medicines in which tetrandrine is one alkaloid among many, with no isolate-attributable human evidence at all.
Its Role in Plants
Tetrandrine’s biosynthesis was worked out by isotope feeding before any of the enzymes were cloned: labelled precursor studies established that the dimer is assembled from two benzylisoquinoline units through phenol coupling, in the pattern now known for the class 19Reference 19Biosynthesis of the bisbenzylisoquinoline alkaloid, tetrandrineView study →. The enzymology was later solved in a relative — berbamunine synthase, a cytochrome P450 from Berberis, couples two N-methylcoclaurine molecules and the stereochemistry of the pairing decides which dimer results 20Reference 20Molecular cloning and heterologous expression of a cDNA encoding berbamunine synthase, a C–O phenol-coupling cytochrome P450 from the higher plant Berberis stoloniferaView study →. That is why Stephania tetrandra root accumulates tetrandrine, its demethyl analogue fangchinoline and its epimer isotetrandrine together rather than one clean product.
These alkaloids sit in the tuberous root, the plant’s perennial storage organ — the tissue with the most to lose to a herbivore and the longest to defend.
Prevalence in Nature
Bisbenzylisoquinoline alkaloids occur mainly in the Menispermaceae, Berberidaceae, Monimiaceae and Ranunculaceae of tropical and subtropical regions 5Reference 5Systematic reviewThirteen bisbenzylisoquinoline alkaloids in five Chinese medicinal plants: botany, traditional uses, phytochemistry, pharmacokinetics and toxicity — systematic reviewView study →. Tetrandrine is a Menispermaceae alkaloid, and its commercial source is one species: the tuberous root of Stephania tetrandra, the Chinese drug han fang ji. It travels there with fangchinoline, its demethyl analogue, and the two are routinely quantified together as the pair that defines the drug’s identity and quality 22Reference 22Li YQ, Chen XG, Qi YX, et al. (2007). [Determination of tetrandrine and fangchinoline in Radix Stephaniae tetrandrae and its preparation by nonaqueous capillary chromatography]. Zhongguo Zhong Yao Za Zhi. https://pubmed.ncbi.nlm.nih.gov/18161288/View study →.
It has also been reported from Cyclea species and from the Menispermaceae used as abuta (Cissampelos/Abuta spp.), where it is one member of a complex bisbenzylisoquinoline mixture rather than a dominant constituent.
Quantitatively the plant figures are thin. Analytical methods for tetrandrine and fangchinoline in Stephania tetrandra root and in finished preparations are established 22Reference 22Li YQ, Chen XG, Qi YX, et al. (2007). [Determination of tetrandrine and fangchinoline in Radix Stephaniae tetrandrae and its preparation by nonaqueous capillary chromatography]. Zhongguo Zhong Yao Za Zhi. https://pubmed.ncbi.nlm.nih.gov/18161288/View study →, but no consistent percentage range has been published that could be compared across provenances — and because the therapeutic material is purified alkaloid, nobody has needed one.
Major Natural Sources
| Source | Part | Level | Note |
|---|---|---|---|
| Stephania tetrandra (han fang ji) | tuberous root | the commercial source; not published as a range | measured together with fangchinoline as the pair defining the drug’s identity 22Reference 22Li YQ, Chen XG, Qi YX, et al. (2007). [Determination of tetrandrine and fangchinoline in Radix Stephaniae tetrandrae and its preparation by nonaqueous capillary chromatography]. Zhongguo Zhong Yao Za Zhi. https://pubmed.ncbi.nlm.nih.gov/18161288/View study → |
| Cyclea spp. | root | not quantified | Menispermaceae, same tribe |
| Abuta (Cissampelos/Abuta spp.) | root, stem | not quantified | one member of a complex bisbenzylisoquinoline mixture, not a dominant constituent |
| Aristolochia fangchi (guang fang ji) | root | none | a different family entirely; contains aristolochic acid instead 7, |
Discovery & Synthesis
Tetrandrine is a long-established alkaloid of Stephania tetrandra, named for the species; a single first-isolation date is not reliably fixed in the accessible record. Its biosynthesis was traced in 1980 by precursor-feeding experiments 19Reference 19Biosynthesis of the bisbenzylisoquinoline alkaloid, tetrandrineView study →, and its clinical identity in China as a silicosis and antihypertensive drug dates from the middle of the twentieth century 5Reference 5Systematic reviewThirteen bisbenzylisoquinoline alkaloids in five Chinese medicinal plants: botany, traditional uses, phytochemistry, pharmacokinetics and toxicity — systematic reviewView study →.
The chemistry stayed difficult for a long time. Closing a macrocyclic bis-diaryl-ether while controlling two benzylic stereocentres is not easy, and the reference modern solution is a 2020 modular synthesis that reaches both tetrandrine and its epimer isotetrandrine from separately prepared halves — which is also the cleanest demonstration that the two epimers are a single connectivity with two configurations 18Reference 18A modular approach to the bisbenzylisoquinoline alkaloids tetrandrine and isotetrandrineView study →.
Supply is extraction, not synthesis. Tetrandrine tablets are made from Stephania tetrandra root,
and most modern pharmaceutical work on the molecule is formulation rather than manufacture —
nanocrystals, nanomicelles and inhaled preparations aimed at its poor solubility and its uneven tissue
distribution 9,
Patents: not yet researched (future patent-loop pass).
Toxicity & Safety
Tetrandrine has real, dose-dependent organ toxicity — but the bigger practical hazard is what you might actually be buying, since fang-ji material has historically been substituted with the aristolochic-acid-containing Aristolochia fangchi.
- Dose-related pulmonary toxicity. It accumulates in lung tissue and is metabolically activated to reactive species; chronic dosing raises phospholipidosis concerns.
- Dose-dependent liver toxicity at high exposure. Hepatic accumulation plus CYP-mediated bioactivation.
- Botanical-substitution hazard. Real-world fang-ji product may carry aristolochic acid — the cause of the Belgian slimming-clinic nephropathy, not tetrandrine itself.
- Avoid in pregnancy and lactation.
- P-glycoprotein and likely CYP inhibitor. Can raise blood levels of co-administered substrate drugs.
- Additive hypotension. Plausible alongside antihypertensives, given the calcium-channel blockade.
Full Safety & Interactions Detail
Tetrandrine carries real, dose-dependent toxicity plus a serious sourcing hazard. It accumulates in lung tissue and is metabolically activated to reactive species, and a controlled mouse study demonstrated dose-related pulmonary toxicity, with phospholipidosis-type concerns on chronic dosing — the same lung tropism that underlies its silicosis use 12Reference 12AnimalPulmonary toxicity and metabolic activation of tetrandrine in CD-1 mice — animal in vivoView study →.
Hepatic accumulation and CYP-mediated bioactivation confer a dose-dependent liver-toxicity risk at high exposure 5,
The load-bearing safety-context point is species confusion: han fang ji (Stephania tetrandra, the tetrandrine source) has historically been confused with or substituted by guang fang ji (Aristolochia fangchi), and the Belgian slimming-clinic nephropathy — aristolochic-acid nephropathy, including urothelial carcinoma — was caused by the Aristolochia substitution, not by tetrandrine 7,
As a P-glycoprotein (and likely CYP) inhibitor, tetrandrine can raise blood levels of co-administered P-gp and CYP-substrate drugs — this is the mechanism it is deliberately used for in multidrug-resistance reversal, so it is not speculative 5,
Dosage
There is no validated supplement dose, and nothing here is a recommendation.
| Context | Form | Dose |
|---|---|---|
| Silicosis, hypertension (Chinese medical practice) | tetrandrine tablets, oral | roughly 60–120 mg/day in divided doses 5Reference 5Systematic reviewThirteen bisbenzylisoquinoline alkaloids in five Chinese medicinal plants: botany, traditional uses, phytochemistry, pharmacokinetics and toxicity — systematic reviewView study → |
| Silicosis trial | tetrandrine tablets ± hydrogen inhalation | approved clinical dosage in both arms 17Reference 17RCTThe clinical efficacy of hydrogen combined with tetrandrine in the treatment of silicosis fibrosis: a randomised controlled intervention studyView study → |
| Antiviral, anticancer, MDR reversal | — | no human dose established; preclinical concentrations are substantially higher 1, |
Any fang-ji-sourced material must be verified free of aristolochic acid. These are doses studied in research and are not a personal recommendation.
References
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- Wang F, Dong L, Hu J, et al. (2024). Quantitative pulmonary pharmacokinetics of tetrandrine for SARS-CoV-2 repurposing: a physiologically based pharmacokinetic modeling approach. Frontiers in Pharmacology. https://pubmed.ncbi.nlm.nih.gov/39346557/
- Zhou S, Shi J, Chen Z, et al. (2025). Tetrandrine slows disease progression on high-resolution computed tomography and lung-function decline in artificial-stone-associated silicosis: a retrospective cohort study — observational. BMC Pulmonary Medicine. https://pubmed.ncbi.nlm.nih.gov/40684152/
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