- What other names is Butterbur known by?
- What is Butterbur?
- How does Butterbur work?
- Are there safety concerns?
- Are there any interactions with medications?
- Dosing considerations for Butterbur.
Blatterdock, Bog Rhubarb, Bogshorns, Butter Bur, Butter-Dock, Butterfly Dock, Capdockin, Chapelière, Common Butterbur, Contre-Peste, Exwort, Feuille de Pétasite, Flapperdock, Fleur de Pétasite, Grand Bonnet, Herbe à la Peste, Herbe aux Teigneux, Langwort, Pestwurz, Pétasite, Pétasite Hybride, Pétasite Officinal, Pétasite Vulgaire, Petasites, Petasites hybridus, Petasites officinalis, Petasites Vulgaris, Petasitidis Folium, Petasitidis Hybridus, Petasitidis Rhizoma, Plague Root, Purple Butterbur, Racine de Pétasite, Rhizome de Pétasite, Tussilago hybrida, Umbrella Leaves.
Butterbur is a shrub that is found throughout Europe as well as mild parts of Asia. It also now grows in parts of the US. The name "butterbur" developed because the large leaves of the shrub are used to wrap butter during warm weather.
People take butterbur by mouth for pain, upset stomach, stomach ulcers, migraine and other headaches, ongoing cough, chills, anxiety, plague, fever, trouble sleeping (insomnia), whooping cough, asthma, a lung disease called chronic obstructive bronchitis, hay fever (allergic rhinitis), eczema, mental illnesses that cause symptoms in the body (somatoform disorders), and for irritable bladder and urinary tract spasms. Butterbur is also taken by mouth to stimulate the appetite.
Some people apply butterbur to the skin to improve wound healing.
Possibly Effective for...
- Hay fever caused by grass pollen. Taking a specific butterbur leaf extract called Ze 339 (Tesalin, Zeller AG) seems to decrease nose discomfort in people with hay fever. Some evidence also suggests that this extract might be as effective as 10 mg daily of cetirizine (Zyrtec) or 180 mg daily of fexofenadine (Allegra). But this extract does not seem to improve airflow, nasal and eye symptoms, or quality of life when taken for 2 weeks.
- Migraine headaches. Taking butterbur by mouth seems to prevent migraine headache. Using a specific extract from the butterbur root (Petadolex, Weber & Weber, GmbH & Co, Germany) over 16 weeks can reduce the number and severity of migraine headaches and the length of time they last. This butterbur extract seems to reduce the number of migraine headaches by almost half. Doses of at least 75 mg twice daily seem to be necessary for best results. Lower doses of 50 mg twice daily may not be effective in adults. There is also some evidence that this butterbur extract can decrease the frequency of migraine headaches in children aged 6-17 years.
- Mental illnesses that cause physical pain (somatoform disorders). Research shows that taking a product called Ze185 that contains butterbur, valerian root, lemon balm leaf, and passionflower (Relaxane, Max Zeller Söhne AG, Switzerland) reduces anxiety and depression in people with physical pain.
Possibly Ineffective for...
- Itchy and inflamed skin (eczema). Some research shows that taking butterbur extract (Petaforce, Bioforce Ltd, Irvine, UK) twice daily for one week does not reduce skin inflammation caused by allergies.
Insufficient Evidence to Rate Effectiveness for...
- Asthma. Early research suggests that butterbur might be helpful for treating asthma and chronic bronchitis.
- Chronic obstructive bronchitis. Early research suggests that butterbur might be helpful for treating chronic obstructive bronchitis.
- Irritable bladder.
- Stomach ulcers.
- Upset stomach.
- Urinary tract spasms.
- Other conditions.
Butterbur contains chemicals that might relieve spasms and decrease swelling (inflammation).
Pyrrolizidine alkaloid (PA)-free butterbur products are POSSIBLY SAFE when taken by mouth appropriately for up to 16 weeks. Some butterbur products may contain PAs, and that's the major safety concern. PAs can damage the liver, lungs, and blood circulation, and possibly cause cancer. Butterbur products that contain PAs are LIKELY UNSAFE when taken by mouth or applied to broken skin. Broken skin allows chemicals to be absorbed into the body. Do not use butterbur products unless they are certified and labeled as free of PAs.
Not enough is known about the safety of using PA-free butterbur products on unbroken skin. Don't use it.
PA-free butterbur is generally well tolerated. It can cause belching, headache, itchy eyes, diarrhea, asthma, upset stomach, fatigue, and drowsiness. However, it seems to cause less drowsiness and fatigue than cetirizine (Zyrtec). Butterbur products might cause allergic reactions in people who are allergic to ragweed, marigolds, daisies, and other related herbs.
Special Precautions & Warnings:Children: Pyrrolizidine alkaloid (PA)-free butterbur is POSSIBLY SAFE when taken by mouth appropriately. There is some evidence that a specific PA-free butterbur rhizome extract (Petadolex, Weber & Weber, GmbH & Co, Germany) can be safely used in children aged 6-17 years for up to 4 months.
Pregnancy and breast-feeding: Taking butterbur by mouth is LIKELY UNSAFE while pregnant or breast-feeding. Butterbur preparations containing pyrrolizidine alkaloids (PAs) might cause birth defects and liver damage. Not enough is known about the safety of using butterbur products that do not contain PAs during pregnancy or breast-feeding. Don't use it.
Allergy to ragweed and related plants: Butterbur may cause an allergic reaction in people who are sensitive to the Asteraceae/Compositae family. Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many others. If you have allergies, be sure to check with your healthcare provider before taking butterbur.
Liver disease: There is some concern that butterbur might make liver disease worse. Don't take it.
Medications that increase breakdown of other medications by the liver (Cytochrome P450 3A4 (CYP3A4) inducers)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Butterbur is broken down by the liver. Some chemicals that form when the liver breaks down butterbur can be harmful. Medications that cause the liver to break down butterbur might enhance the toxic effects of chemicals contained in butterbur.
The following doses have been studied in scientific research:
- For hay fever (allergic rhinitis): Up to 6 tablets of a specific butterbur leaf extract called Ze 339 (Tesalin, Zeller AG), has been taken daily in up to three divided doses for 1-2 weeks. 50 mg of a specific whole butterbur root extract (Petaforce, Bioforce) has been taken twice daily for 2 weeks.
- For migraine headache: 75-150 mg of a specific butterbur rhizome extract (Petadolex, Weber & Weber, GmbH & Co, Germany) has been taken daily in up to two divided doses for up to 4 months.
- For mental illnesses that cause physical pain (somatoform disorders): A specific product called Ze185 (Relaxane, Max Zeller Söhne AG, Switzerland) containing 90 mg of dry extracts of butterbur root, 90 mg of valerian root, 90 mg of passionflower herb, and 60 mg of lemon balm leaf, has been taken three times daily for 2 weeks.
- For migraine headache: 50-75 mg of a specific butterbur rhizome extract (Petadolex, Weber & Weber, GmbH & Co, Germany) has been taken daily in two or three divided doses for children 8-9 years-old, and in doses of 100-150 mg daily in two or three divided doses for children 10-17 years-old, for up to 4 months.
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).
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Agosti, R., Duke, R. K., Chrubasik, J. E., and Chrubasik, S. Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review. Phytomedicine. 2006;13(9-10):743-746. View abstract.
Aydin, A. A., Zerbes, V., Parlar, H., and Letzel, T. The medical plant butterbur (Petasites): analytical and physiological (re)view. J Pharm Biomed.Anal. 3-5-2013;75:220-229. View abstract.
Bickel, D., Roder, T., Bestmann, H. J., and Brune, K. Identification and characterization of inhibitors of peptido-leukotriene-synthesis from Petasites hybridus. Planta Med. 1994;60(4):318-322. View abstract.
Brune, K., Bickel, D., and Peskar, B. A. Gastro-protective effects by extracts of Petasites hybridus: the role of inhibition of peptido-leukotriene synthesis. Planta Med. 1993;59(6):494-496. View abstract.
Debrunner, B. and Meier, B. Petasites hybridus: a tool for interdisciplinary research in phytotherapy. Pharm.Acta Helv. 1998;72(6):359-362. View abstract.
Degenring FH and Bommer S. Prevention de la migraine par Petadolor H (Petaforce
Diener, H. C. [Migraine prevention with Petasites]. Med Monatsschr.Pharm 2006;29(1):40. View abstract.
Evans, R. W. and Taylor, F. R. "Natural" or alternative medications for migraine prevention. Headache 2006;46(6):1012-1018. View abstract.
Evers, S. Treatment of migraine with prophylactic drugs. Expert.Opin.Pharmacother. 2008;9(15):2565-2573. View abstract.
Evers, S., Afra, J., Frese, A., Goadsby, P. J., Linde, M., May, A., and Sandor, P. S. EFNS guideline on the drug treatment of migraine - report of an EFNS task force. Eur J Neurol. 2006;13(6):560-572. View abstract.
Evers, S., Afra, J., Frese, A., Goadsby, P. J., Linde, M., May, A., and Sandor, P. S. EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force. Eur J Neurol. 2009;16(9):968-981. View abstract.
Fiebich, B. L., Grozdeva, M., Hess, S., Hull, M., Danesch, U., Bodensieck, A., and Bauer, R. Petasites hybridus extracts in vitro inhibit COX-2 and PGE2 release by direct interaction with the enzyme and by preventing p42/44 MAP kinase activation in rat primary microglial cells. Planta Med 2005;71(1):12-19. View abstract.
Grossman, W. and Schmidramsl, H. An extract of Petasites hybridus is effective in the prophylaxis of migraine. Altern.Med.Rev. 2001;6(3):303-310. View abstract.
Guo, R., Pittler, M. H., and Ernst, E. Herbal medicines for the treatment of allergic rhinitis: a systematic review. Ann Allergy Asthma Immunol. 2007;99(6):483-495. View abstract.
Lee, J. S., Yang, E. J., Yun, C. Y., Kim, D. H., and Kim, I. S. Suppressive effect of Petasites japonicus extract on ovalbumin-induced airway inflammation in an asthmatic mouse model. J Ethnopharmacol. 1-27-2011;133(2):551-557. View abstract.
Leimgruber, A. [Allergo-immunology]. Rev.Med Suisse 1-11-2006;2(48):89-92. View abstract.
Levin, M. Herbal treatment of headache. Headache 2012;52 Suppl 2:76-80. View abstract.
Lovell, B. V. and Marmura, M. J. New therapeutic developments in chronic migraine. Curr Opin.Neurol. 2010;23(3):254-258. View abstract.
Man, L. X. Complementary and alternative medicine for allergic rhinitis. Curr Opin.Otolaryngol.Head Neck Surg. 2009;17(3):226-231. View abstract.
Mauskop, A. Nonmedication, alternative, and complementary treatments for migraine. Continuum (Minneap.Minn.) 2012;18(4):796-806. View abstract.
Moyad, M. A. Conventional, complementary, and alternative options for seasonal allergies. Urol.Nurs. 2008;28(3):227-228. View abstract.
Ross, S. M. Clinical applications of integrative therapies for prevention and treatment of migraine headaches. Holist.Nurs.Pract. 2011;25(1):49-52. View abstract.
Sadler, C., Vanderjagt, L., and Vohra, S. Complementary, holistic, and integrative medicine: butterbur. Pediatr.Rev. 2007;28(6):235-238. View abstract.
Schiapparelli, P., Allais, G., Castagnoli, Gabellari, I, Rolando, S., Terzi, M. G., and Benedetto, C. Non-pharmacological approach to migraine prophylaxis: part II. Neurol.Sci. 2010;31 Suppl 1:S137-S139. View abstract.
Shukla, R. and Sinh, M. Migraine: prophylactic treatment. J Assoc.Physicians India 2010;58 Suppl:26-29. View abstract.
Sun-Edelstein, C. and Mauskop, A. Alternative headache treatments: nutraceuticals, behavioral and physical treatments. Headache 2011;51(3):469-483. View abstract.
Sun-Edelstein, C. and Mauskop, A. Foods and supplements in the management of migraine headaches. Clin J Pain 2009;25(5):446-452. View abstract.
Sutherland, A. and Sweet, B. V. Butterbur: an alternative therapy for migraine prevention. Am J Health Syst.Pharm 5-1-2010;67(9):705-711. View abstract.
Taylor, F. R. Nutraceuticals and headache: the biological basis. Headache 2011;51(3):484-501. View abstract.
Tepper, S. J. Complementary and alternative treatments for childhood headaches. Curr Pain Headache Rep. 2008;12(5):379-383. View abstract.
Anderson N, Meier T, and Borlak J. Toxicogenomics applied to cultures of human hepatocytes enabled an identification of novel petasites hybridus extracts for the treatment of migraine with improved hepatobiliary safety. Toxicol.Sci 2009;112:507-20. View abstract.
Anon. Petasites hybridus. Altern Med Rev 2001;6:207-9. View abstract.
Chojkier M. Hepatic sinusoidal-obstruction syndrome: toxicity of pyrrolizidine alkaloids. J Hepatol 2003;39:437-46. View abstract.
Danesch U, Rittinghausen R. Safety of a patented special butterbur root extract for migraine prevention. Headache 2003;43:76-8.. View abstract.
Danesch UC. Petasites hybridus (Butterbur root) extract in the treatment of asthma--an open trial. Altern.Med.Rev. 2004;9:54-62. View abstract.
Diener HC, Rahlfs VW, Danesch U. The first placebo-controlled trial of a special butterbur root extract for the prevention of migraine: reanalysis of efficacy criteria. Eur Neurol 2004;51:89-97. View abstract.
Food and Drug Administration. FDA Advises Dietary Supplement Manufacturers to Remove Comfrey Products From the Market. July 6, 2001. Available at: http://www.cfsan.fda.gov/~dms/dspltr06.html.
Gex-Collet C, Imhof L, Brattstrom A, et al. The butterbur extract petasin has no effect on skin test reactivity induced by different stimuli: a randomized, double-blind crossover study using histamine, codeine, methacholine, and aeroallergen solutions. J Investig.Allergol.Clin Immunol. 2006;16:156-61. View abstract.
Gray RD, Haggart K, Lee DK, Cull S, Lipworth BJ. Effects of butterbur treatment in intermittent allergic rhinitis: a placebo-controlled evaluation. Ann Allergy Asthma Immunol 2004;93:56-60. View abstract.
Grossmann WM, Schmidramsl H. An extract of Petasites hybridus is effective in the prophylaxis of migraine. Int J Clin Pharmacol Ther 2000;38:430-5.
Holland S, Silberstein SD, Freitag F, et al. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 2012;78:1346-53. View abstract.
Jackson CM, Lee DK, and Lipworth BJ. The effects of butterbur on the histamine and allergen cutaneous response. Ann.Allergy Asthma Immunol. 2004;92:250-54. View abstract.
Kaufeler R, Polasek W, Brattstrom A, et al. Efficacy and safety of butterbur herbal extract Ze 339 in seasonal allergic rhinitis: postmarketing surveillance study. Adv.Ther 2006;23:373-84. View abstract.
Lee DK, Carstairs IJ, Haggart K, et al. Butterbur, a herbal remedy, attenuates adenosine monophosphate induced nasal responsiveness in seasonal allergic rhinitis. Clin Exp Allergy 2003;33:882-6.. View abstract.
Lee DK, Gray RD, Robb FM, et al. A placebo-controlled evaluation of butterbur and fexofenadine on objective and subjective outcomes in perennial allergic rhinitis. Clin Exp Allergy 2004;34:646-9. . View abstract.
Lee DK, Haggart K, Robb F M, and Lipworth BJ. Butterbur, a herbal remedy, confers complementary anti-inflammatory activity in asthmatic patients receiving inhaled corticosteroids. Clin.Exp.Allergy 2004;34:110-14. View abstract.
Lipton RB, Gobel H, Einhaupl KM, et al. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology 2004;63:2240-4. View abstract.
Mauz C, Candrian U, Luthy J, et al. [Method for the reduction of pyrrolizidine alkaloids from medicinal plant extracts]. Pharm Acta Helv 1985;60:256-9.
Melzer J, Schrader E, Brattström A, et al. Fixed herbal drug combination with and without butterbur (Ze 185) for the treatment of patients with somatoform disorders: randomized, placebo-controlled pharmaco-clinical trial. Phytother Res. 2009 Sep;23:1303-8. View abstract.
Oelkers-Ax R, Leins A, Parzer P, et al. Butterbur root extract and music therapy in the prevention of childhood migraine: an explorative study. Eur J Pain 2008;12:301-13. View abstract.
Ozarowski M, Przystanowicz J, Adamczak A. Phytochemical, pharmacological and clinical studies of Petasites hybridus (L.) P. Gaertn., B. Mey. & Scherb. A review. Herba Polonica. 2013;59(4):108-128.
Pothmann R, Danesch U. Migraine Prevention in Children and Adolescents: Results of an Open Study With a Special Butterbur Root Extract. Headache 2005;45:196-203.. View abstract.
Pringsheim T, Davenport W, Mackie G, et al. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol.Sci 2012;39:S1-59. View abstract.
Roeder E. Medicinal plants in Europe containing pyrrolizidine alkaloids. Pharmazie 1995;50:83-98.
Schapowal A, Study Group. Treating intermittent allergic rhinitis: a prospective, randomized, placebo and antihistamine-controlled study of Butterbur extract Ze 339. Phytother Res 2005;19:530-37. View abstract.
Schapowal A. Petasites Study Group. Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ 2002;324:144-6. View abstract.
Schapowal A. 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;130:1381-86. View abstract.
Scheidegger C, Dahinden C, Wiesmann U. Effects of extracts and of individual components from Petasites on prostaglandin synthesis in cultured skin fibroblasts and on leucotriene synthesis in isolated human peripheral leucocytes. Pharm Acta Helv 1998;72:376-8. View abstract.
Thomet OA, Schapowal A, Heinisch IV, et al. Anti-inflammatory activity of an extract of Petasites hybridus in allergic rhinitis. Int Immunopharmacol 2002;2:997-1006.. View abstract.
Wang YP, Yan J, Fu PP, Chou MW. Human liver microsomal reduction of pyrrolizidine alkaloid N-oxides to form the corresponding carcinogenic parent alkaloid. Toxicol Lett 2005;155:411-20. View abstract.
WHO working group. Pyrrolizidine alkaloids. Environmental Health Criteria, 80. WHO: Geneva, 1988.
Ziolo G, Samochowiec L. Study on clinical properties and mechanisms of action of Petasites in bronchial asthma and chronic obstructive bronchitis. Pharm Acta Helv 1998;72:378-80. View abstract.