Horse chestnut

Horse chestnut/Drug Interactions:

  • AntiangiogenicsAntiangiogenics: HCSE has been shown to increase venous tone, improve venous return, and reduce vascular permeability (48; 49; 50; 51; 52; 53).
  • Anticoagulants, antiplatelet agents, NSAIDsAnticoagulants, antiplatelet agents, NSAIDs: Horse chestnut theoretically may increase bleeding risk due to the hydroxycoumarin content of esculin (13; 14; 15). Properly extracted HCSE should not contain esculin and therefore, should not carry this risk. Life-threatening, acute hemorrhage from renal angiomyolipoma after use of HCSE for venous insufficiency has been noted in a case report (29). The authors suggested caution in patients taking anticoagulants concomitantly with HCSE due to potential HCSE-induced anticoagulation.
  • Antidiabetic agentsAntidiabetic agents: In animal research, HCSE inhibited the normal increase of serum glucose levels after glucose-loading (24).
  • Anti inflammatory agentsAnti inflammatory agents: Purified escin has been shown to decrease chemically-induced inflammation in rats (52; 53; 49).
  • Dermatologic agentsDermatologic agents: In human research, escin by mouth has caused pruritus (11), and when used topically, has caused contact dermatitis (25).
  • Fertility agentsFertility agents: In human research, escin supplementation improved sperm density and the diameter of the spermatic vein in males with varicocele-associated infertility (12).
  • Gastrointestinal agentsGastrointestinal agents: In human research, escin taken by mouth resulted in nausea, dyspepsia, vomiting, diarrhea, dry mouth, and constipation (10; 11; 12; 26; 12).
  • HepatotoxinsHepatotoxins: A 69 year-old woman who was taking Venocapsan?, which contained horse chestnut leaf, experienced hepatotoxicity that resolved after discontinuing the product (31).
  • Highly protein bound agentsHighly protein bound agents: Escin may theoretically interfere with highly protein-bound drugs, such as phenytoin, warfarin, or amiodarone, although there is a lack of reported cases in the available literature.
  • Musculoskeletal agentsMusculoskeletal agents: In human research, a small percentage of patients reported calf spasm after taking HCSE (28).
  • Neurologic agentsNeurologic agents: Theoretically, horse chestnut may interact with neurologic agents. In human research, headache, dizziness, and fatigue have been reported with HCSE (11; 10; 12).
  • Renal agentsRenal agents: In human research, high parenteral doses of escin resulted in nephrotoxicity (17; 18).
  • VasodilatorsVasodilators: HCSE has been shown to increase venous tone, improve venous return, and reduce vascular permeability (48; 49; 50; 51; 52; 53). HCSE has been found to dose-dependently contract canine (49) and human (50) isolated saphenous veins in vitro, possibly due to preferential formation of the vasoconstrictive eicosanoid, PGF 2-alpha (51). In human research, escin increased relaxation in the endothelium of varicose veins (54).

    • Horse chestnut/Herb/Supplement Interactions:

  • AntiangiogenicsAntiangiogenics: HCSE has been shown to increase venous tone, improve venous return, and reduce vascular permeability (48; 49; 50; 51; 52; 53).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Horse chestnut theoretically may increase bleeding risk due to the hydroxycoumarin content of esculin (13; 14; 15). Properly extracted HCSE should not contain esculin and therefore, should not carry this risk. Life-threatening, acute hemorrhage from renal angiomyolipoma after use of HCSE for venous insufficiency has been noted in a case report (29). The authors suggested caution in patients taking anticoagulants concomitantly with HCSE due to potential HCSE-induced anticoagulation.
  • Anti inflammatoriesAnti inflammatories: Purified escin has been shown to decrease chemically-induced inflammation in rats (52; 53; 49).
  • AntioxidantsAntioxidants: HCSE extract has been reported to have antioxidant effects (49; 55).
  • Dermatologic agentsDermatologic agents: In human research, escin by mouth has caused pruritus (11), and when used topically, has caused contact dermatitis (25).
  • Fertility agentsFertility agents: In human research, escin supplementation improved sperm density and the diameter of the spermatic vein in males with varicocele-associated infertility (12).
  • Gastrointestinal agentsGastrointestinal agents: In human studies, escin taken by mouth resulted in nausea, dyspepsia, vomiting, diarrhea, dry mouth, and constipation (10; 11; 12; 26; 12).
  • HepatotoxinsHepatotoxins: A 69 year-old woman who was taking Venocapsan?, which contained horse chestnut leaf, experienced hepatotoxicity that resolved after discontinuing the product (31).
  • Highly protein bound agentsHighly protein bound agents: Escin may theoretically interfere with highly protein-bound agents, although there is a lack of reported cases in the available literature.
  • HypoglycemicsHypoglycemics: In animal research, HCSE inhibited the normal increase of serum glucose levels after glucose-loading (24).
  • Musculoskeletal agentsMusculoskeletal agents: In human research, a small percentage of patients reported calf spasm after taking HCSE (28).
  • Neurologic agentsNeurologic agents: Theoretically, horse chestnut may interact with neurologic herbs and supplements. In human research, headache, dizziness, and fatigue have been reported with HCSE (11; 10; 12).
  • Renal agentsRenal agents: In human research, high parenteral doses of escin resulted in nephrotoxicity (17; 18).
  • VasodilatorsVasodilators: HCSE has been shown to increase venous tone, improve venous return, and reduce vascular permeability (48; 49; 50; 51; 52; 53). HCSE has been found to dose-dependently contract canine (49) and human (50) isolated saphenous veins in vitro, possibly due to preferential formation of the vasoconstrictive eicosanoid, PGF 2-alpha (51). In human research, escin increased relaxation in the endothelium of varicose veins (54).

    • Horse chestnut/Food Interactions:

  • Insufficient available evidence.

    • Horse chestnut/Lab Interactions:

  • Coagulation panelCoagulation panel: Horse chestnut theoretically may increase bleeding risk due to the hydroxycoumarin content of esculin (13; 14; 15). Properly extracted HCSE should not contain esculin and therefore, should not carry this risk. Life-threatening, acute hemorrhage from renal angiomyolipoma after use of HCSE for venous insufficiency has been noted in a case report (29). The authors suggested caution in patients taking anticoagulants concomitantly with HCSE due to potential HCSE-induced anticoagulation.
  • Serum glucoseSerum glucose: HCSE has been noted to inhibit the normal increase of serum glucose levels in glucose-loaded rats (24).