Conessine, a steroidal alkaloid from Holarrhena antidysenterica: Ethnomedical roots, pharmacological insights, and formulation strategies for modern drug development.

Holarrhena antidysenterica preparations have been used traditionally since ancient times for the treatment of gastrointestinal disorders, parasitic infections, and inflammatory conditions. Conessine is the main steroidal alkaloid of Holarrhena antidysenterica, which is commonly associated with its reported biological activities. Current research demonstrates that conessine exhibits antimicrobial activity and inhibits some multidrug efflux pumps responsible for conventional antibiotic resistance. Experimental and computational studies have also reported antiviral, antiplasmodial, anti-inflammatory and neuroprotective activities of conessine. Despite its compelling pharmacological profile, the development of conessine-based therapeutic preparations is limited by challenges related to extraction, formulation, and safety. Overcoming these limitations requires optimization of extraction methods, application of advanced delivery systems, and complementary in silico studies. This review critically explores conessine's ethnomedical background, chemical and biosynthetic insights, analytical methods, pharmacological actions, and formulation approaches to clarify its current scientific status and identify priorities for future research.