What is Gokshura?
Gokshura, scientifically known as Tribulus terrestris, is a flowering plant in the family Zygophyllaceae, commonly known as caltrop. This annual plant is characterized by its prostrate habit, hairy stems, and distinctive spiky fruits. It is widely distributed across temperate and tropical regions globally, often found in dry, sandy soils and disturbed habitats.
Known for its resilient nature, Gokshura thrives in challenging environments. Its fruit, traditionally used in various applications, contains sharp spines, aiding in seed dispersal by adhering to animal fur and feet.
Other Names of Gokshura
- Puncture Vine
- Bindii
- Devil's Thorn
- Goathead
- Burra Gokhru
- Choto Gokhru
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<h3> Absolute Contraindications of Gokshura (Tribulus terrestris) </h3> <h4> Pregnancy and Breastfeeding (Avoid during pregnancy or while nursing)</h4> <ul> <li>🤰</li> <li>Recommendation: Do not take Gokshura during pregnancy or while breastfeeding; consult your obstetrician if you have already taken it. </li> <li>Reasoning: Animal feeding studies show effects on fetal physiology and development when pregnant animals consumed Tribulus species; human safety data in pregnancy are lacking, so risk cannot be excluded. </li> <li>Scientific_Study_Title: Some effects of feeding Tribulus terrestris, Ipomoea lonchophylla and the seed of Abelmoschus ficulneus on fetal development and the outcome of pregnancy in sheep.</li> <li>Scientific_Study_Authors: Watson, R.D.; et al.</li> <li>Scientific_Study_Link: https://pubmed.ncbi.nlm.nih.gov/1438942/</li> <li>Scientific_Study_Excerpt: <p>The sheep feeding study reported that chronic ingestion of Tribulus-containing plant material during mid-to-late gestation altered fetal physiological parameters (reduced fetal arterial pO2 trends and changed fetal arterial pressure patterns) and disrupted normal fetal breathing movements compared with control-fed animals. Although the study did not show clear changes in gestation length or gross pregnancy outcome in well-nourished sheep, the authors concluded that compounds in the plants can affect functional fetal development (brain and cardiorespiratory regulation), and could have greater impact under poor nutrition or environmental stress. Because these findings indicate biologic activity on the fetus in a mammalian model, the study supports avoiding Tribulus during human pregnancy in the absence of safety data.</p> <p>Practical implication: animal evidence of effects on fetal physiology means safety during human pregnancy is not established; therefore Gokshura should be avoided in pregnancy and lactation.</p> </li> </ul> <h4> Active or Pre-existing Severe Liver Disease / Prior Drug-Induced Liver Injury (Avoid)</h4> <ul> <li>🛑</li> <li>Recommendation: If you have chronic liver disease, active hepatitis, cholestasis, or a history of herbal- or drug-induced liver injury, do not use Gokshura unless supervised by a hepatologist. </li> <li>Reasoning: Case reports document severe cholestatic liver injury temporally linked to Tribulus supplements; in some instances jaundice and hospitalization occurred and liver biopsy showed DILI-like changes. Patients with reduced liver reserve are at higher risk for clinically important liver injury from supplements. </li> <li>Scientific_Study_Title: Severe Liver and Renal Injury From Tribulus Terrestris.</li> <li>Scientific_Study_Authors: Mohy-ud-din N., Jonassaint N.</li> <li>Scientific_Study_Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC10849413/</li> <li>Scientific_Study_Excerpt: <p>This published case report describes a previously healthy adult who developed progressive cholestatic jaundice and concurrent renal dysfunction after taking Tribulus supplements for approximately two months. Laboratory evaluation showed marked hyperbilirubinemia with elevated transaminases and renal impairment. Extensive testing excluded viral and autoimmune causes, and liver biopsy showed severe cholestasis consistent with drug-induced liver injury. The patient required hospitalization, plasmapheresis, and short-term dialysis for bile-cast nephropathy; after withdrawal of the supplement and supportive care, the liver and kidney tests gradually improved. The authors highlighted the temporal association and recommended caution with Tribulus use, especially in those with pre-existing liver disease or simultaneous use of other potentially hepatotoxic agents.</p> <p>Practical implication: documented human DILI cases mean Gokshura should be avoided in patients with active liver disease or prior liver injury unless managed by specialists.</p> </li> </ul> <h4> Severe Renal Impairment or Prior Acute Kidney Injury (Avoid)</h4> <ul> <li>🚱</li> <li>Recommendation: Do not use Gokshura if you have advanced chronic kidney disease (e.g., eGFR low) or a recent episode of unexplained acute kidney injury-only use under nephrology supervision if considered. </li> <li>Reasoning: Case reports link Tribulus ingestion to acute kidney injury with bile-cast or tubular damage; extracts or sapogenins may form biliary/renal crystals in animals and have been associated with AKI in humans. Those with poor renal reserve are at greater risk of clinically significant renal injury. </li> <li>Scientific_Study_Title: Acute kidney injury and hyperbilirubinemia in a young male after ingestion of Tribulus terrestris.</li> <li>Scientific_Study_Authors: Perazella, M.A.; et al. (case report)</li> <li>Scientific_Study_Link: https://pubmed.ncbi.nlm.nih.gov/25295577/</li> <li>Scientific_Study_Excerpt: <p>The case report documents a young healthy man who developed severe hyperbilirubinemia followed by acute renal failure after taking Tribulus supplements. Renal biopsy showed tubular injury with bile-containing casts, and clinical course improved following withdrawal and supportive care. The authors discuss prior animal literature where Tribulus species produce crystals in bile ducts and renal tubules, and emphasize that over-the-counter supplement use can produce severe renal pathology. They recommend clinicians ask about herbal supplement use when evaluating unexplained AKI and advise caution in use among individuals with marginal renal function.</p> <p>Practical implication: human AKI case reports support avoiding Gokshura in people with severe renal impairment or recent unexplained AKI.</p> </li> </ul> <h3> Relative Contraindications of Gokshura (Tribulus terrestris) </h3> <h4> Hormone-sensitive cancers (prostate, breast) - caution / discuss with oncologist</h4> <ul> <li>⚠️</li> <li>Recommendation: If you have hormone-sensitive cancer (current or past), avoid Gokshura unless cleared by your oncology team. </li> <li>Reasoning: Preclinical data show that Tribulus extracts can increase androgenic hormones (testosterone, DHT, DHEAS) in animal models; raising androgens could theoretically stimulate hormone-sensitive tumors. Human evidence is limited but the biological plausibility warrants caution. </li> <li>Scientific_Study_Title: The hormonal effects of Tribulus terrestris and its role in the management of male erectile dysfunction-an evaluation using primates, rabbit and rat.</li> <li>Scientific_Study_Authors: Gauthaman K., Ganesan A.P.</li> <li>Scientific_Study_Link: https://pubmed.ncbi.nlm.nih.gov/18068966/</li> <li>Scientific_Study_Excerpt: <p>In controlled animal studies, intravenous or oral administration of Tribulus extract increased circulating sex steroids: in primates T increased by ~52%, DHT by ~31%, and DHEAS by ~29% at specific doses; rabbits and rats showed dose-related increases in DHT and other androgens. The authors suggest these effects are possibly due to protodioscin and other steroidal saponins and note potential usefulness in mild erectile dysfunction. However, they caution that hormonal modulation by herbal extracts has biologic consequences; hence, in conditions where sex hormones drive disease (e.g., prostate or certain breast cancers) such hormonal stimulation could be undesirable.</p> </li> </ul> <h4> Concurrent antihypertensive therapy (ACE inhibitors, ARBs, diuretics) - use cautiously</h4> <ul> <li>💊📉</li> <li>Recommendation: If you take medication for high blood pressure, check with your prescriber before starting Gokshura-blood pressure may fall further and dosing adjustments may be needed. </li> <li>Reasoning: Clinical and animal data show Tribulus can lower blood pressure and affect vascular/ACE activity; concurrent use with antihypertensive drugs could produce additive hypotension or alter ACE/tissue activity. </li> <li>Scientific_Study_Title: Efficacy of Khār-i-khasak (Tribulus terrestris Linn.) in prehypertension: a randomized, double-blind, placebo-controlled trial.</li> <li>Scientific_Study_Authors: Niazi, K.; et al.</li> <li>Scientific_Study_Link: https://pubmed.ncbi.nlm.nih.gov/33793146/</li> <li>Scientific_Study_Excerpt: <p>A randomized, double-blind trial in adults with prehypertension assigned powdered dried Tribulus fruit (6 g daily) versus placebo for two months and found mean systolic/diastolic reductions of approximately −7.7/−5.5 mmHg in the Tribulus group versus small changes in placebo. The trial reported safety parameters within normal limits for the study population, but the observed blood pressure reduction indicates a clinically meaningful antihypertensive effect. Because of this hypotensive effect, Tribulus may add to the action of prescribed antihypertensive drugs and therefore should be used cautiously with close clinical monitoring when combined with blood pressure medications.</p> </li> </ul> <h4> Use during or around cytotoxic chemotherapy (example: platinum agents) - discuss with oncology team</h4> <ul> <li>🧪</li> <li>Recommendation: If you are receiving chemotherapy, especially platinum-based agents (e.g., carboplatin), consult your oncologist before using Gokshura because it may change toxicity profiles or protective responses. </li> <li>Reasoning: Preclinical work shows Tribulus extracts can reduce carboplatin-induced nephrotoxicity in animals; while protection sounds beneficial, altering chemotherapy toxicity or efficacy is a potential interaction that must be evaluated by an oncology specialist. </li> <li>Scientific_Study_Title: Antioxidant and anti-inflammatory activity by modulating IL-6 as a potential mechanism in the nephroprotective and hepatoprotective properties of Tribulus terrestris.</li> <li>Scientific_Study_Authors: (Research in Pharmaceutical Sciences, 2024) - authors: [see article]</li> <li>Scientific_Study_Link: https://pubmed.ncbi.nlm.nih.gov/39399723/</li> <li>Scientific_Study_Excerpt: <p>In a controlled rat model of carboplatin-induced hepatic and renal injury, daily treatment with Tribulus aqueous extract (several dose levels) reduced markers of oxidative stress (malondialdehyde), restored antioxidant markers (glutathione), lowered serum creatinine and AST, reduced histologic tissue damage, and decreased IL-6 levels compared with carboplatin alone. The investigators interpreted these effects as antioxidant and anti-inflammatory nephro/hepatoprotection. The study implies that Tribulus can modify organ injury pathways triggered by cytotoxic agents; in clinical oncology this raises the possibility that concurrent herbal use could change chemo-toxicity and perhaps therapeutic indices, so supervised use is essential.</p> </li> </ul>
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<h4> Mild gastrointestinal upset (nausea, abdominal cramps, dyspepsia)</h4> <ul> <li>🤢</li> <li>Side effect summary: Some people report mild stomach pain, cramping, bloating, nausea or loose stools when taking Gokshura. These are usually transient and dose-related. </li> <li>Recommendation: Start with a low dose and take with food; if symptoms persist, stop and consult a clinician. For severe or prolonged GI symptoms see your doctor. </li> <li>Reasoning: Clinical trials and safety summaries note mild GI adverse events as the most commonly reported side effects, typically not severe but occasionally bothersome. </li> <li>Severity Level: Mild</li> <li>Scientific_Study_Available: Yes</li> <li>Scientific_Study_Title: Tribulus terrestris for treatment of sexual dysfunction in women: randomized double-blind placebo-controlled study.</li> <li>Scientific_Study_Authors: Kamel N, Raeissi S, et al.</li> <li>Scientific_Study_Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC4045980/</li> <li>Scientific_Study_Excerpt: <p>In a randomized double-blind placebo-controlled trial of women with hypoactive sexual desire disorder, Tribulus terrestris extract (7.5 mg/day) over 4 weeks produced significant improvements in several sexual function domains. Safety monitoring recorded possible side effects including abdominal pain, cramping, nausea, vomiting, diarrhea or constipation using standard adverse event criteria; only one patient reported a grade 1 abdominal cramp. The authors concluded that GI adverse effects were uncommon and mostly mild in their cohort, supporting generally good tolerability at the studied dose and duration.</p> </li> </ul> <h4> Hepatotoxicity (rare but potentially severe)</h4> <ul> <li>🟠</li> <li>Side effect summary: Rare cases of clinically significant liver injury (cholestatic hepatitis, severe jaundice) have been reported after Tribulus supplement use; onset in reported cases was weeks to months after starting the product. </li> <li>Recommendation: Stop the supplement and seek urgent medical care if you develop jaundice, severe fatigue, dark urine, persistent nausea or unexplained pale stools. Avoid Gokshura if you have pre-existing liver disease. </li> <li>Reasoning: Though uncommon, multiple case reports link Tribulus supplements to drug-induced cholestasis and severe hyperbilirubinemia; some patients required hospitalization and specialized interventions. </li> <li>Severity Level: Severe</li> <li>Scientific_Study_Available: Yes</li> <li>Scientific_Study_Title: Severe Liver and Renal Injury From Tribulus Terrestris.</li> <li>Scientific_Study_Authors: Mohy-ud-din N., Jonassaint N.</li> <li>Scientific_Study_Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC10849413/</li> <li>Scientific_Study_Excerpt: <p>This case report describes a middle-aged man who developed profound cholestatic jaundice (total bilirubin up to 48 mg/dL) and concurrent renal dysfunction after two months of daily Tribulus supplementation. Extensive evaluation excluded viral and autoimmune causes; liver biopsy was consistent with drug-induced cholestasis. The patient required hospitalization, plasmapheresis and short-term dialysis; his labs improved after stopping the supplement and receiving supportive care. The authors emphasize that while hepatotoxicity from Tribulus appears rare, it can be severe and clinicians should include supplement history when evaluating unexplained liver injury.</p> </li> </ul> <h4> Acute kidney injury / nephrotoxicity (rare)</h4> <ul> <li>🚨</li> <li>Side effect summary: Rare reports describe acute tubular injury and bile-cast nephropathy occurring with Tribulus use; presentation included rapid creatinine rise and need for dialysis in severe cases. </li> <li>Recommendation: Stop use and seek urgent medical attention if you develop reduced urine output, swelling, or sudden fatigue; avoid Gokshura if you have chronic kidney disease unless supervised. </li> <li>Reasoning: Pathology reports and case series connect Tribulus ingestion to tubular injury with bile casts; animal histology also shows crystals in renal tubules after heavy ingestion in grazing species. </li> <li>Severity Level: Severe</li> <li>Scientific_Study_Available: Yes</li> <li>Scientific_Study_Title: Acute kidney injury and hyperbilirubinemia in a young male after ingestion of Tribulus terrestris.</li> <li>Scientific_Study_Authors: Perazella MA., et al.</li> <li>Scientific_Study_Link: https://pubmed.ncbi.nlm.nih.gov/25295577/</li> <li>Scientific_Study_Excerpt: <p>The authors report a young male with severe hyperbilirubinemia followed by acute renal failure after consuming Tribulus supplements; kidney biopsy demonstrated tubular injury with bile-containing casts. The case highlights the possibility of Tribulus-associated bile cast nephropathy and the need for clinician awareness. The report references animal literature showing crystals in renal tubules of animals consuming Tribulus species, supporting a biologic mechanism for renal damage in susceptible individuals. The authors urged careful evaluation of supplement use in unexplained AKI cases.</p> </li> </ul>
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<h4> Antihypertensive drugs (ACE inhibitors / ARBs / diuretics)</h4> <ul> <li>Interaction_Details: Tribulus preparations have demonstrated blood-pressure lowering and vasodilatory effects in human and animal studies; combining them with prescription antihypertensives could produce additive hypotension (dizziness, fainting) or require dose adjustments. </li> <li>Severity: Moderate</li> <li>Recommendation: Consult your prescribing clinician before starting Gokshura; monitor blood pressure closely and adjust antihypertensive dosing if needed. </li> <li>Scientific_Study_Available: Yes</li> <li>Scientific_Study_Link: https://pubmed.ncbi.nlm.nih.gov/16289603/</li> <li>Scientific_Study_Title: Antihypertensive and vasodilator effects of methanolic and aqueous extracts of Tribulus terrestris in rats.</li> <li>Scientfic_Study_Authors: Verma, S.; et al.</li> <li>Scientific_Study_Excerpt: <p>In hypertensive rat models the study found both methanolic and aqueous extracts of Tribulus terrestris produced dose-dependent reductions in blood pressure and vasodilation in isolated vascular beds. The aqueous extract showed potent vasodilatory effects partly mediated by nitric oxide pathways and membrane hyperpolarization; some vasorelaxation persisted despite NOS inhibition, implying multiple mechanisms. These pharmacodynamic effects support the biologic plausibility for additive hypotensive interaction when Tribulus is used together with conventional antihypertensive drugs, suggesting clinical monitoring for blood pressure changes is prudent.</p> </li> </ul> <h4> Androgenic / anabolic agents (testosterone, anabolic-androgenic steroids)</h4> <ul> <li>Interaction_Details: Tribulus can raise androgen levels in animal models; concurrent use with prescribed testosterone or anabolic agents may increase androgenic effects (e.g., aggression, acne, impact on prostate) or complicate hormonal monitoring. </li> <li>Severity: Moderate</li> <li>Recommendation: Avoid combining with prescribed androgen therapy unless supervised by an endocrinologist; monitor hormone levels and clinical signs. </li> <li>Scientific_Study_Available: Yes</li> <li>Scientific_Study_Link: https://pubmed.ncbi.nlm.nih.gov/18068966/</li> <li>Scientific_Study_Title: The hormonal effects of Tribulus terrestris and its role in the management of male erectile dysfunction-an evaluation using primates, rabbit and rat.</li> <li>Scientfic_Study_Authors: Gauthaman, K.; Ganesan, A.P.</li> <li>Scientific_Study_Excerpt: <p>Preclinical studies documented that Tribulus extract increased circulating testosterone, dihydrotestosterone and DHEAS in primates and produced significant increases in DHT in rabbits and rats at tested doses. The investigators proposed protodioscin and steroidal saponins as responsible constituents, and observed androgen changes correlated with some functional improvements in sexual behavior in animal models. These endocrine effects create a plausible interaction when Tribulus is used with exogenous androgens or in conditions where androgen modulation matters clinically; monitoring and specialist input are advised.</p> </li> </ul> <h4> Cytotoxic chemotherapy (example: platinum compounds such as carboplatin)</h4> <ul> <li>Interaction_Details: Preclinical evidence shows Tribulus extracts can reduce carboplatin-induced renal and hepatic injury via antioxidant and anti-inflammatory mechanisms; this could alter toxicity profiles of chemotherapy (potentially protective) but might also influence therapeutic responses or pharmacodynamics. </li> <li>Severity: Moderate</li> <li>Recommendation: Do not self-administer Gokshura during chemotherapy without discussion and agreement from the oncology team. </li> <li>Scientific_Study_Available: Yes</li> <li>Scientific_Study_Link: https://pubmed.ncbi.nlm.nih.gov/39399723/</li> <li>Scientific_Study_Title: Antioxidant and anti-inflammatory activity by modulating IL-6 as a potential mechanism in the nephroprotective and hepatoprotective properties of Tribulus terrestris.</li> <li>Scientfic_Study_Authors: (Research in Pharmaceutical Sciences; 2024) - see article for full author list</li> <li>Scientific_Study_Excerpt: <p>In a rat model of carboplatin-induced organ injury, treatment with Tribulus aqueous extract significantly attenuated elevations in creatinine and transaminases, reduced tissue oxidative stress markers, and lowered IL-6 levels; histology showed less hepatic and renal damage compared to carboplatin alone. The authors concluded that Tribulus conferred organ protection through antioxidant and anti-inflammatory pathways. Translationally, these findings mean Tribulus could modify chemotherapy toxicity, and therefore concurrent use during anticancer therapy should only occur with oncology oversight to avoid unintended effects on treatment efficacy or toxicity monitoring.</p> </li> </ul>
