Butterbur
Butterbur/Drug Interactions:
Analgesic agentsAnalgesic agents: According to literature review and some clinical research, treatment with butterbur reduced the frequency and number of migraines and increased the percentage of participants who responded to treatment (17; 18; 33; 16; 34; 19; 26; 4; 5; 6; 7; 3; 20). However, in other research, arthralgia, limb, and other pain complaints have occurred in some patients treated with butterbur (3). Anti-asthmatic agentsAnti-asthmatic agents: In animal study, butterbur reduced inflammation of the airway and mucus (38). In clinical research, treatment with butterbur resulted in significant beneficial effects on adenosine monophosphate broncho-provocation, exhaled nitric oxide, serum eosinophil cationic protein, and peripheral blood eosinophil count compared to placebo in patients with asthma (39). In other clinical research, butterbur improved peak flow, FEV1, and symptoms of asthma patients (32). Anticholinergic agentsAnticholinergic agents: According to literature review, butterbur may potentiate the effects of anticholinergics; concomitant treatment may lead to increased liver enzyme levels (40). AntihistaminesAntihistamines: In human study, treatment with butterbur significantly decreased histamine levels (28). Anti-inflammatoriesAnti-inflammatories: Laboratory study reported anti-inflammatory properties of butterbur (1; 41). Inhibition of COX-2 and PGE2 has also been reported in animal research (42). In laboratory study, butterbur extract inhibited interleukin (IL)-2, IL-4, IL-5, IL-13, and TNF-alpha release, and blocked expression of IL-6 (38). In animal research, butterbur reduced inflammation of the airway, eosinophil infiltration, and IL-5 levels in bronchoalveolar lavage (BAL) fluid (38). Antineoplastic agentsAntineoplastic agents: According to secondary sources, animal studies report carcinogenicity of pyrrolizidine alkaloids. However, in laboratory study, the extract of butterbur exhibited anticarcinogenic effects (11). Anxiolytic agentsAnxiolytic agents: In clinical research, treatment with butterbur significantly improved symptoms of anxiety and depression in patients with somatoform disorders (22). BronchodilatorsBronchodilators: According to secondary sources, when taken orally, butterbur may cause difficulty breathing. In human research, flu-like symptoms, symptoms of the common cold, and wheezing were reported, although it is unclear if these events were attributable to butterbur (9; 15; 22). Dermatologic agentsDermatologic agents: According to secondary sources, butterbur may cause skin discoloration or pruritus. In human research, rash and hot flushes have been reported (9; 15). Gastrointestinal agentsGastrointestinal agents: Reviews and clinical research have reported that burping occurred with butterbur treatment (16; 17; 18; 19; 20). Other gastrointestinal complaints reported in clinical research have included abdominal pain or upset stomach, bitter taste, nausea, diarrhea, regurgitation, indigestion, constipation, flatulence, and throat tightness, although often these events were reported in the control groups as well (3; 9; 15; 21; 22). According to secondary sources, when taken orally, butterbur may also cause discoloration of stool and dysphagia. Hepatotoxic agentsHepatotoxic agents: In animal and laboratory study, butterbur at high doses (e.g. 200-fold greater than therapeutic doses) caused increased bilirubin and liver transaminases (24). According to secondary sources, raw, unprocessed butterbur plant should be avoided due to the potential hepatotoxicity of pyrrolizidine alkaloids with long-term use. Neurologic agentsNeurologic agents: When taken orally, butterbur has been associated with headache, drowsiness, dizziness, and/or fatigue (15; 3). Ophthalmologic agentsOphthalmologic agents: According to secondary sources, when taken orally, butterbur may cause itchy eyes or eye discoloration.SedativesSedatives: When taken orally, butterbur has been associated with drowsiness, dizziness, and/or fatigue (15; 3). VasoconstrictorsVasoconstrictors: The active constituents of Petasites hybridus have been reported to possess smooth muscle relaxant activity on vascular walls with a particular affinity for cerebral blood vessels (1; 2; 41). VasodilatorsVasodilators: The active constituents of Petasites hybridus have been reported to possess smooth muscle relaxant activity on vascular walls with a particular affinity for cerebral blood vessels (1; 2; 41). Butterbur/Herb/Supplement Interactions:
AnalgesicsAnalgesics: According to literature review and some clinical research, treatment with butterbur reduced the frequency and number of migraines and increased the percentage of participants who responded to treatment (17; 18; 33; 16; 34; 19; 26; 4; 5; 6; 7; 3; 20). However, in other research, arthralgia, limb, and other pain complaints have occurred in some patients treated with butterbur (3). Anti-asthmatic herbs and supplementsAnti-asthmatic herbs and supplements: In animal study, butterbur reduced inflammation of the airway and mucus (38). In clinical research, treatment with butterbur resulted in significant beneficial effects on adenosine monophosphate broncho-provocation, exhaled nitric oxide, serum eosinophil cationic protein, and peripheral blood eosinophil count compared to placebo in patients with asthma (39). In other clinical research, butterbur improved peak flow, FEV1, and symptoms of asthma patients (32). Anticholinergic herbs and supplementsAnticholinergic herbs and supplements: According to literature review, butterbur may potentiate the effects of anticholinergics; concomitant treatment may lead to increased liver enzyme levels (40). Examples of anticholinergic herbs include belladonna, bittersweet (Solanum dulcamara), henbane (Hyoscyamus niger), and Jimson weed (Datura stramonium). AntihistaminesAntihistamines: In human study, treatment with butterbur significantly decreased histamine levels (28). Anti-inflammatory herbs and supplementsAnti-inflammatory herbs and supplements: Laboratory study reported anti-inflammatory properties of butterbur (1; 41). Inhibition of COX-2 and PGE2 has also been reported in animal research (42). In laboratory study, butterbur extract inhibited interleukin (IL)-2, IL-4, IL-5, IL-13, and TNF-alpha release, and blocked expression of IL-6 (38). In animal research, butterbur reduced inflammation of the airway, eosinophil infiltration, and IL-5 levels in bronchoalveolar lavage (BAL) fluid (38). Antineoplastic herbs and supplementsAntineoplastic herbs and supplements: According to secondary sources, animal studies report carcinogenicity of pyrrolizidine alkaloids. However, in laboratory study, the extract of butterbur exhibited anticarcinogenic effects (11). AntioxidantsAntioxidants: In animal study, butterbur decreased mortality from kainic acid, a pro-oxidant (43), and scavenged reactive oxygen species in bronchoalveolar lavage fluid cells (38). AnxiolyticsAnxiolytics: In clinical research, treatment with butterbur significantly improved symptoms of anxiety and depression in patients with somatoform disorders (22). BronchodilatorsBronchodilators: According to secondary sources, when taken orally, butterbur may cause difficulty breathing. In human research, flu-like symptoms, symptoms of the common cold, and wheezing were reported, although it is unclear if these events were attributable to butterbur (9; 15; 22). Dermatologic herbs and supplementsDermatologic herbs and supplements: According to secondary sources, butterbur may cause skin discoloration or pruritus. In human research, rash and hot flushes have been reported (9; 15). Gastrointestinal herbs and supplementsGastrointestinal herbs and supplements: Reviews and clinical research have reported that burping occurred with butterbur treatment (16; 17; 18; 19; 20). Other gastrointestinal complaints reported in clinical research have included abdominal pain or upset stomach, bitter taste, nausea, diarrhea, regurgitation, indigestion, constipation, flatulence, and throat tightness, although often these events were reported in the control groups as well (3; 9; 15; 21; 22). According to secondary sources, when taken orally, butterbur may also cause discoloration of stool and dysphagia. HepatotoxinsHepatotoxins: In animal and laboratory study, butterbur at high doses (e.g. 200-fold greater than therapeutic doses) caused increased bilirubin and liver transaminases (24). According to secondary sources, raw, unprocessed butterbur plant should be avoided due to the potential hepatotoxicity of pyrrolizidine alkaloids with long-term use. Neurologic herbs and supplementsNeurologic herbs and supplements: When taken orally, butterbur has been associated with headache, drowsiness, dizziness, and/or fatigue (15; 3). Pyrrolizidine alkaloid-containing herbsPyrrolizidine alkaloid-containing herbs: According to secondary sources, raw, unprocessed butterbur may contain toxic pyrrolizidine alkaloids, although commercially available products should be free of pyrrolizidine alkaloids. Nonetheless, concomitant use of other agents containing pyrrolizidine alkaloids should be avoided due to the potential for additive toxicity. The following herbs may contain unsaturated pyrrolizidine alkaloids: alkanna, borage, gravel root, hemp agrimony, hound's tongue, comfrey, coltsfoot, and the Senecio species plants; dusty miller, alpine ragwort, groundsel, golden ragwort, and tansy ragwort. SedativesSedatives: When taken orally, butterbur has been associated with drowsiness, dizziness, and/or fatigue (15; 3). VasoconstrictorsVasoconstrictors: The active constituents of Petasites hybridus have been reported to possess smooth muscle relaxant activity on vascular walls with a particular affinity for cerebral blood vessels (1; 2; 41). VasodilatorsVasodilators: The active constituents of Petasites hybridus have been reported to possess smooth muscle relaxant activity on vascular walls with a particular affinity for cerebral blood vessels (1; 2; 41). Butterbur/Food Interactions:
Insufficient available evidence.Butterbur/Laboratory Interactions
CytokinesCytokines: In laboratory study, butterbur extract inhibited interleukin (IL)-2, IL-4, IL-5, IL-13, and TNF-alpha release, and blocked expression of IL-6 (38). In animal study, butterbur reduced IL-5 levels in bronchoalveolar lavage (BAL) fluid (38). In human study, treatment with butterbur significantly decreased leukotriene levels (28). HistamineHistamine: In human study, treatment with butterbur significantly decreased histamine levels (28). Liver function tests (LFTs)Liver function tests (LFTs): According to human research, butterbur caused mild elevations in liver enzyme levels (23; 3). In animal and laboratory study, butterbur at high doses (200-fold greater than therapeutic doses) caused increased bilirubin and liver transaminases (24). Oxidation markersOxidation markers: In an animal study, butterbur improved the levels of glutathione and thiobarbituric acid-reactive substance (TBARS) (43).