The butterbur plant (Petasites hybridus) is a shrub found throughout Europe as well as parts of Asia and North America. Butterbur that has been used medicinally for centuries to treat cough, asthma, and inflammatory diseases. The butterbur plant can grow to a height of three feet and is usually found in wet, marshy ground, in damp forests, and adjacent to rivers or streams.
Active ingredients in
butterbur
extract
Petasin, a kind of sesquiterpene ester, appears to be a major active compound of
butterbur
extract. It has inhibitory activities on leukotriene generation in
eosinophils and neutrophils. This indicates that it may have anti-inflammatory and
anti-allergy properties although butterbur does not seem to be effective in
blocking histamine release.
Butterbur
also helps reduce smooth muscle spasm.
Butterbur
safety and side effects, risks, toxicity
Butterbur
has not been studied extensively enough to determine its side effects
or toxicity profile,
but there appears to be some early concerns that would cautions me from
recommending its use for more than 2 weeks at a time without a break.
Safety of a patented special butterbur root extract for migraine prevention.
Headache. 2003.
To report on the safety of a patented special butterbur root extract
used for migraine prevention. Two placebo-controlled clinical trials have been
conducted supporting the beneficial use in humans. The patented special butterbur root extract is safe for
treatment in humans.
Q. I have been doing some of my own research
on Butterbur (Petasites hybridus). I have also come across numerous warnings
from websites in the UK that butterbur can seriously harm your liver and even
cause cancer. Since 2012 the UK has warned people not to take it. Even when the
PA ( dangerous ingredient) has been taken out the report says :"Butterbur
products have been associated with cases of liver toxicity; 40 cases have been
reported in the literature. Of these cases, nine were of acute hepatitis and two
of the nine cases resulted in liver failure requiring transplantation. The cases
of liver toxicity appear to have occurred with extracts of butterbur where the
PAs had been removed and only small amounts remained. There is some evidence
that other constituents found in butterbur such as the sesquiterpene
constituents for example petasin may be implicated in the liver toxicity. This
is what it says, "Butterbur contains pyrrolizidine alkaloids (PAs) which studies
have shown can result in serious liver damage and organ failure. PAs have also
been shown to lead to cancer in animals. Butterbur is most commonly used to
treat migraine and hayfever. Butterbur products have been associated with cases
of liver toxicity; 40 cases have been reported in the literature. Of these
cases, nine were of acute hepatitis and two of the nine cases resulted in liver
failure requiring transplantation. The cases of liver toxicity appear to have
occurred with extracts of butterbur where the PAs had been removed and only
small amounts remained. There is some evidence that other constituents found in
butterbur such as the sesquiterpene constituents for example petasin may be
implicated in the liver toxicity."
A. There have been such reports in the medical literature.
Forsch Komplementarmed Klass Naturheilkd. 2003. The common butterbur (Petasites hybridus)--portrait of a medicinal herb]. For hundreds of years butterbur (Petasites hybridus) has been used against many diseases. Modern indications are the prophylaxis of migraine, tension headache, spasms of the urogenital tract, gastro-intestinal tract and bile duct and hopefully hay fever and asthma in the near future. The petasines, the main components of butterbur, inhibit the synthesis of leucotrienes and decrease the intracellular concentration of calcium which explains the anti-inflammatory and spasmolytic properties of extracts of butterbur. Thanks to extraction with supercritical CO(2) the concentrations of the potentially hepatotoxic and carcinogenic pyrrolizidine alkaloids lie below the detection limits. Until now four cases of a reversible cholestatic hepatitis have been probably associated with long-term administration of butterbur (incidence of 1:175.000). It is unknown which components of butterbur are responsible for the long-term hepatotoxicity. Further side effects involve the gastrointestinal tract and are usually mild.
Butterbur
Dosage
and recommended use
Typically, extracts are standardized to contain a minimum of 7.5 mg of
petasin and isopetasin. The adult dosage ranges from 50-100 mg twice daily with meals.
Medical uses
Allergies and Allergic Rhinitis
Butterbur
may be helpful for
allergic rhinitis
although the research thus far with butterbur leading to relief of
allergies has
not been consistent. Most, but not all, studies support the use of butterbur for allergic
rhinitis. See allergy for
more information.
Butterbur was found to be no more effective than placebo at relieving symptoms of intermittent allergic rhinitis, more commonly known as hay fever. However, lead author Dr. Brian J. Lipworth of the University of Dundee in Scotland found that the herb was more effective than placebo and as effective as the allergy drug Allegra (fexofenadine) at treating year-round allergic rhinitis. Petasin has been shown to block leukotrienes, substances that are thought to play a role in lung inflammation. Petasin has also been shown to inhibit compounds called histamines that are released by the immune system during allergic reactions. Dr. Brian Lipworth compared butterbur to placebo in 35 men and women with seasonal allergies to grass pollen for 2 weeks. Symptoms did not improve significantly in people taking butterbur or the placebo. There were also no significant differences in quality of life or nasal air flow. Despite the lack of a significant effect, the researchers did detect signs that butterbur may have been more helpful than placebo for people with the most severe symptoms. Lipworth's team speculates that the herb may have real benefits for people with severe allergy symptoms. Neither treatment caused serious side effects. Annals of Allergy, Asthma and Immunology, 2004.
Treating intermittent allergic rhinitis: a prospective, randomized,
placebo and antihistamine-controlled study of Butterbur extract Ze 339.
Phytotherapy Research. 2005.
Butterbur extract (Ze 339; 8 mg total
petasine; one tablet thrice-daily), fexofenadine (Telfast 180, one tablet
once-daily) and placebo was given to 330 patients. Both
active treatments were individually significantly superior to placebo in
improving symptoms of allergic rhinitis, while there were no differences between
the two active treatments. Butterbur and Fexofenadine are comparably
efficacious relative to placebo.
Butterbur Ze339 for the treatment of
intermittent allergic rhinitis: dose-dependent efficacy in a prospective,
randomized, double-blind, placebo-controlled study.
Arch Otolaryngol Head Neck Surg. 2004.
One hundred eighty-six patients were randomized (Butterbur Ze339 high
dose, 60; low dose, 65; and placebo, 61 patients). Established diagnostic
criteria for intermittent allergic rhinitis were confirmed by skin allergy tests
in all patients. High-dose butterbur group, 1 tablet 3 times
daily; low-dose group, 1 tablet twice daily; or matching placebo. All groups
were treated for 2 consecutive weeks.
Butterbur Ze339 is an effective treatment for intermittent allergic
rhinitis symptoms and is well tolerated.
Effects of butterbur treatment in intermittent allergic rhinitis: a
placebo-controlled evaluation.
Ann Allergy Asthma Immunology. 2004.
Petasites hybridus contains the active ingredient petasin,
which exhibits antileukotriene and antihistamine activity. Previous
studies of intermittent allergic rhinitis have demonstrated a comparable
response to butterbur compared with a histamine H1-receptor antagonist on the
36-Item Short-Form Health Survey quality-of-life score. In our study, there was no significant clinical efficacy of butterbur use vs placebo use
on objective and subjective outcomes in intermittent allergic rhinitis. Further studies are now
indicated to investigate the use of butterbur in persistent allergic
rhinitis.
A placebo-controlled evaluation of butterbur
and fexofenadine on objective and subjective outcomes in perennial allergic
rhinitis.
Clinical Exp Allergy. 2004.
Sixteen patients with perennial allergic rhinitis and house dust mite
sensitization were randomized in double-blind cross-over fashion to receive for
1 week either Butterbur
50 mg twice daily, FEX 180 mg once daily and
placebo once daily, or placebo twice daily. Butterbur and FEX, in comparison to
placebo,
were equally effective in attenuating the nasal response to AMP and in improving
nasal symptoms, highlighting a potential role for butterbur in the treatment of
allergic rhinitis.
Petasites hybridus root extract in the treatment of asthma - an open
trial.
Danesch UC.
Alternative Medicine Reviews. 2004.
The efficacy and tolerability of a butterbur root extract (Petadolex) for the
treatment of asthma was analyzed.
Subjects included 64 adults and 16 children / adolescents treated for two months
with the extract, followed by two months during which the intake of the extract
was optional. Concomitant asthma medication was permitted. The number, duration,
and severity of asthma attacks decreased, while peak flow, forced expiratory
volume (FEV1), and all measured symptoms improved during therapy. In addition,
more than 40 percent of patients using asthma medications at baseline reduced
intake of these medications by the end of the study.
Asthma benefit
Butterbur, a herbal remedy, confers complementary anti-inflammatory
activity in asthmatic patients receiving inhaled corticosteroids.
Clin Exp Allergy. 2004.
We
evaluated the effects of butterbur, given as add-on therapy patients with
asthma maintained on inhaled corticosteroids, assessing adenosine monophosphate bronchoprovocation along
with other surrogate inflammatory markers such as serum eosinophil cationic protein and peripheral blood eosinophil count.
Chronic dosing conferred complementary
anti-inflammatory activity in atopic asthmatic patients maintained on
inhaled corticosteroids.
Asthma / bronchitis
Various parts of the
butterbur
plant have been used for centuries to treat
bronchial
asthma and
whooping cough. Butterbur's
possible effectiveness in treating respiratory disorders such as asthma and bronchitis is
attributed to the antispasmodic and anti-inflammatory properties of the petasin
constituent.
Migraine Headache
Complement Ther Clin Pract. 2014. Butterbur extract: Prophylactic treatment
for childhood migraines. In order to decrease the impact of the condition on the
child and the family, prophylactic treatment is recommended if the child is
experiencing disabling migraines. The medications currently prescribed for the
prevention of pediatric migraines often have significant side effects and are of
questionable therapeutic value. For those patients and parents who are
interested in alternative therapies and natural remedies for preventive
treatment of pediatric migraines, butterbur extract derived from the butterbur
plant, Petasites hybridus, has emerged as a promising treatment.
Two clinical studies using 50 mg and 75 mg of a standardized
butterbur
extract twice daily for 12 weeks demonstrated its effectiveness as a
prophylactic treatment for migraines. When used to treat migraines, administration is
prophylactic and supplementation should be carried out daily for a few weeks and then
tapered until migraine incidence begins to increase.
Butterbur
may work by preventing
peptidoleukotriene biosynthesis.
An article published in the December 2004 issue of Neurology reports a
study that compared butterbur with an inactive
placebo. Researchers compared the effectiveness of two different doses of
butterbur extract in about 230 migraine patients who had experienced two to six attacks per month for the 3 months prior
to the study. The number of migraine headache attacks per month was
reduced by 45 percent in the group that took 75 milligrams of butterbur
twice daily, compared with a reduction of 28 percent in the placebo group
during the 16-week trial. A group that took 50 milligrams of butterbur
twice daily experienced a 32 percent decrease, not significantly different
from placebo.
The butterbur extract was well tolerated, the team reports, with burping
as the only adverse event occurring more frequently in the active
treatment groups. There were no changes in blood pressure, heart rate, or
routine laboratory tests.
My comments: As with many herbs and medicines, it is likely that some users
will find butterbur reduces the severity or frequency of their migraine
headache, whereas others may not find it to be helpful. How butterbur
interacts with standard pharmaceutical medicines -- such as beta blockers
or triptans -- used for prevention or treatment of migraines is currently
not known.
Petasites hybridus root is an effective
preventive treatment for migraine.
Neurology. 2004.
This is
a three-arm, parallel-group, randomized trial comparing butterbur extract 75 mg
bid, 50 mg bid, or placebo bid in 245 patients with migraine.
Eligible patients met International Headache Over 4 months of treatment, migraine
attack frequency was reduced by 48% for butterbur extract 75 mg bid, 36% for
50 mg bid, and 26% for the placebo group. The most frequently reported adverse reactions
considered possibly related to treatment were mild gastrointestinal events,
predominantly burping. Butterbur 50 mg PO bid was
not significantly more effective than placebo on the primary study endpoints.
In children
Complement Ther Clin Pract. 2014. Butterbur extract: prophylactic treatment for
childhood migraines. The incidence of migraine headaches in childhood is
increasing. Migraines are often difficult to diagnose in pediatrics and even
more difficult to treat and prevent. In order to decrease the impact of the
condition on the child and the family, prophylactic treatment is recommended if
the child is experiencing disabling migraines. The medications currently
prescribed for the prevention of pediatric migraines often have significant side
effects and are of questionable therapeutic value. For those patients and
parents who are interested in alternative therapies and natural remedies for
preventive treatment of pediatric migraines, butterbur extract derived from the
butterbur plant, Petasites hybridus, has emerged as a promising treatment.
Testimonial
Dr. Sahelian, I would like to thank you. I was having migraines several
times a month, some lasting days, and nothing I took helped
substantially, including feverfew, 5HTP, and Imitrex. I have now been
taking butterbur for two months, and I had had only two mild headaches
in the first month (I don't think either lasted more than 1 or 2 hours)
and none in the last month. I am going to taper my dose a bit, as is
recommended, since I've been taking the highest dose. It has been a
lifesaver. I am taking Solaray, Butterbur Extract, 50 mg, 60 Veggie
Caps.
Gastrointestinal Disorders
A German study found extracts of
butterbur
blocked ethanol-induced gastric damage and reduced ulcerations of the small
intestine caused by indomethacin, an anti-inflammatory drug used to treat arthritic
conditions. The results of this study were attributed to inhibition of lipoxygenase
activity and leukotriene biosynthesis.
Interactions with medications
Could you tell me if butterbur pills interfere with warfarin also
known as Coumadin used for
blood thinning?
I have not seen such combination studies, so I don't know.
Warfarin is a potentially dangerous medication and one has to be careful
when combining it with other medications and supplements.
Buy Butterbur supplement
extract
Supplement Facts
Purple Butterbur (Petasites hybridus) 50 mg
pill
(Petadolex brand) Root Extract standardized to contain 7.5 mg petasins
Enzymatic Therapy, Petadolex, Pro-Active, 60 Softgels
Buy Butterbur extract -
Enzymatic Therapy
Buy Butterbur extract, Studies demonstrate patented
Petadolex is safe and well tolerated.
| Supplement Facts | ||
| Serving Size: 1 softgel | ||
| Amount per softgel | % DV | |
| Purple Butterbur (Petasites hybridus) (Petadolex brand) Root Extract standardized to contain 7.5 mg petasins and to be free of harmful levels of pyrrolizidine alkaloids (PAs) |
50 mg | ** |
| **Daily Value not established. | ||
Recommendations: One butterbur softgel three times daily, or 2 softgels 2 times daily for the first four weeks. Thereafter, one softgel twice daily.
Petadolex contains the patented extract of Petasites hybridus, that supports healthy blood vessel tone in the brain, as well as normal blood flow in the brain. Butterbur has been the subject of several placebo-controlled clinical studies.
Petadolex is standardized to contain 15% of butterbur's key ingredient, petasin. It's also guaranteed to be pyrrolizidine alkaloid free, so you can use it with confidence. Pyrrolizidine alkaloids are toxic compounds that can harm the liver.