Realgar/Indigo naturalis (RIF), also known as Compound Huangdai (), is a medication used to treat

acute promyelocytic leukemia Acute promyelocytic leukemia (APML, APL) is a subtype of acute myeloid leukemia (AML), a cancer of the white blood cells. In APL, there is an abnormal accumulation of immature granulocytes called promyelocytes. The disease is characterized by a ...

. Effectiveness appears similar to

arsenic trioxide Arsenic trioxide, sold under the brand name Trisenox among others, is an inorganic compound and medication. As an industrial chemical, whose major uses include in the manufacture of wood preservatives, pesticides, and glass. As a medication, i ...

. It is generally used together with

all-trans-retinoic acid Tretinoin, also known as all-''trans'' retinoic acid (ATRA), is a medication used for the treatment of acne and acute promyelocytic leukemia. For acne, it is applied to the skin as a cream, gel or ointment. For leukemia, it is taken by mouth f ...

(ATRA). It is taken

by mouth Oral administration is a route of administration where a substance is taken through the mouth. Per os abbreviated to P.O. is sometimes used as a direction for medication to be taken orally. Many medications are taken orally because they are i ...

. Side effects may include abdominal pain and rash. It is made up of a combination of

realgar Realgar ( ), also known as "ruby sulphur" or "ruby of arsenic", is an arsenic sulfide mineral with the chemical formula α-. It is a soft, sectile mineral occurring in monoclinic crystals, or in granular, compact, or powdery form, often in assoc ...

(tetra-arsenic tetra-sulfide), ''

Indigo naturalis Indirubin is a chemical compound most often produced as a byproduct of bacterial metabolism. For instance, it is one of the compounds responsible for the generally benign condition purple urine bag syndrome, resulting from bacteria metabolizing in ...

'', root of ''Salvia miltiorrhiza'', and root of ''Pseudostellaria heterophylla''. It works by breaking down the cancer protein

retinoic acid receptor alpha Retinoic acid receptor alpha (RAR-α), also known as NR1B1 (nuclear receptor subfamily 1, group B, member 1) is a nuclear receptor that in humans is encoded by the ''RARA'' gene. NR1B1 is a gene with a protein product and has a chromosomal locat ...

. The main active ingredients according to NCI are tetraarsenic tetrasulfide (realgar), indirubin (from the indigo) and

tanshinone Tanshinones are a class of chemical compounds. Examples include dihydrotanshinone, tanshinone I, or tanshinone IIA. These compounds are all naturally occurring and can all be isolated from ''Salvia miltiorrhiza''. Dihydrotanshinone I has been r ...

IIA (from the ''Salvia''). Realgar-Indigo naturalis was developed in the 1980s and approved for medical use in China in 2009. It is on the

World Health Organization's List of Essential Medicines The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health ...

. It is made in China and was originally a

herbal remedy Herbal medicine (also herbalism) is the study of pharmacognosy and the use of medicinal plants, which are a basis of traditional medicine. With worldwide research into pharmacology, some herbal medicines have been translated into modern remedies ...

. It is not approved in either the United States or Europe .

Composition

WHO data indicates that the medication is provided in units of 270 mg of the mixture, 30 mg of which is tetraarsenic tetrasulfide (As₄S₄). The 2004 Chinese patent for this medication indicates that it contains 12-18% realgar (90-95% As₄S₄), 25-42% ''Indigo naturalis'', 36-46% ''Salvia miltiorrhiza'' root (separately water-extracted), and 12-18% ''Pseudostellaria heterophylla'' root.

References

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