Butterbur Supplement Uses, Benefits, Dosages & Side Effects

Butterbur is a shrub that is native to Europe and temperate parts of Asia. It has been used as a food and in traditional medicine for hundreds of years.

Traditionally it was used for fevers, asthma, cough colds, menstrual issues, as a cardiac stimulant, and for skin wounds. [2, 4, 5]

Butterbur supplements are commonly used to prevent migraines. It has been shown to work in multiple clinical trials with most patients reporting some degree of benefit in prevention of symptoms. [3]

Prescription drugs used for migraine headache can cause significant side effects. Butterbur is a natural product and seems to be safe for most people when used orally and properly. [3]

This medicinal herb is also purported to have benefits for reducing inflammation, relaxing blood vessels, and asthma and coughs. [1, 2]

This article will review what butterbur is, how this supplement works inside the body, common uses, dosages, safety, side effects, and possible drug interactions.

Butterbur

Herbal Supplement

Headache

Infla-mmation<

Breathing

How It Works:

• Shown to prevent migraine headaches
• Natural anti-inflammatory properties
• May improve allergic rhinitis

Dosage:

Between 550-1000 mg per day

Safety:

Rated Possibly Safe

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Butterbur Plant Description

Butterbur’s botanical name is Petasites hybridus. It is also known as Petasites officinalis and Tussilago hybrida. [3]

It is a member of the Asteraceae/Compositae family, which contains over 32,000 known plant species. Other members of this family include ragweed, dandelion, marigold, daisy, chamomile, and zinnia. [3]

The name butterbur comes from its large leaves, which were traditionally used to wrap butter to protect it from heat. [2, 3]

Some other common names include Bog Rhubarb, Devil’s Hat, Plague Root, Bogshorns, Umbrella Leaf/Plant, Exwort, Langwort, Butterfly Dock, and Pestilence Wort. [3]

The National Center for Complementary and Integrative Health (NCCIH) states that butterbur grows in regions in Asia, Europe, North Africa, and North America. It is typically found in marshy areas. [2]

According to Nature Gate, it is a perennial herbaceous shrub that develops rhizomes (horizontal roots with lateral shoots). The plants grow more than two feet tall with flower spikes up to 5 feet in height. [4]

It has red/brown/purple stems, large kidney-shaped leaves up to 28 inches in width, and usually grows purple flowers. It is a dioecious plant, meaning male and female flowers develop on different plants. [4]

It develops a flowering stem before it produces leaves in the springtime. It produces yellow/brown achene fruit that are tipped with unbranched hairs. [4]

Butterbur is considered to be a harmful invasive plant species. It grows well in fields, road banks, lake shores, wastelands, river banks, and woodland margins. [1]

Common Uses for Butterbur

Butterbur extract was originally used in the Middle Ages for reducing fever. It was grown as a medicinal herb because the strong smelling roots were thought to give immunity from the plague. [4]

In the 17th century, it was used as a treatment for cough, skin wounds, allergies, and asthma. [2]

Nicholas Culpeper – a noted English herbalist and botanist – recommended some of the following uses for this plant in the 1600s:

• Clearing skin blemishes
• Brightening mood
• Improving breathing
• Increasing urine production (diuresis)
• Reducing fever
• Resisting poisons
• Stimulating and toning the heart [5]

Herbalists would dry and grind butterbur rhizome (root) into powder and then make a decoction with wine.

In the 1600s, Culpeper recommended the decoction be consumed by the glassful, consistently throughout the day. [5]

The Natural Medicines Comprehensive Database (NMCD) reports that some people use butterbur supplements orally for:

• Asthma
• Allergic rhinitis (hayfever)
• Chronic obstructive bronchitis
• Cough and whooping cough
• Eczema (atopic dermatitis)
• Headaches including migraine headaches
• Irritable bladder
• Stomach upset and gastric ulcers
• Urinary tract spasms [3]

This plant extract is also used orally for pain, chills, anxiety, fever and sleeplessness. It is also sometimes taken by mouth for somatoform disorders, a group of psychological conditions that cause body pain with no discernable causes. [3]

Butterbur is also used orally as an appetite stimulant and antispasmodic to ease cramping and muscle spasms. [3]

It is used topically (applied to skin) for improving minor wound healing. [3]

How Does Butterbur Work Inside the Body?

The Cleveland Clinic (CC) states that butterbur addresses the two primary biological causes for migraine headache by reducing inflammation and relaxing blood vessels (vasodilation). [1]

According to the CC, “In one trial, 70% of patients who used butterbur reduced the frequency of their migraines by about half within four months.” [1]

Researchers believe that a sesquiterpene chemical found in this herb called petasin is responsible for its anti-allergy and anti-inflammatory effects.

The Memorial Sloan Kettering Cancer Center (MSKCC) states that petasin (C20H28O3) slows down the activity of histamine and leukotriene (inflammatory markers produced by white blood cells). [6]

In research, petasin has also demonstrated calcium channel blocking effects. This is thought to make it an effective prophylactic (preventative) for migraines. [6]

Butterbur has also shown dose-dependent inhibitory effects on the inflammatory mediators cyclooxygenase-2 (COX-2) and prostaglandin E2.

These effects are not believed to be caused by petasin. At this time researchers have not determined which compound(s) are responsible for these effects. [6]

Butterbur Health Benefits

NMCD rates the effectiveness of herbs and supplements in specific health conditions based on evidence from clinical research in humans.

The NMCD rates Butterbur as Possibly Effective for:

• Allergic rhinitis (hayfever)
• Migraine headaches
• Somatoform disorder [3]

Preliminary clinical research has shown that butterbur may improve asthma and chronic obstructive bronchitis. [3] However, more research is needed to confirm initial findings and determine the therapeutic efficacy for these and other conditions.

Butterbur is regulated as a dietary supplement and the FDA has not approved it as a drug to prevent or treat any medical conditions.

If you are interested in taking this supplement to address a specific health concern, it is recommended that you speak with your doctor before beginning use.

Butterbur for Migraine Headaches

The NMCD states that using butterbur orally seems to prevent migraine headaches from developing.

In research trials it was seen that a German-made butterbur rhizome extract called Petadolex could, “reduce the frequency, intensity, and duration of migraine headache when used over a period of 16 weeks in adults.” [3]

Petadolex is manufactured by Weber & Weber, GmbH & Co. It is standardized to contain 15% total petasin and isopetasin. It seems to reduce migraine frequency by approximately 48% in clinical trials. [3]

According to research studies, daily doses of at least 75 mg are needed to induce significant anti-migraine effects in adults. It has been observed that 50 mg/day doses are not as effective in adult patients. [3]

However, in young children lower dosages may be effective. One study found that dosages between 50-75 mg in 8-9-year old subjects and between 100-150 mg in 10-12-year old subjects reduced migraine frequency compared to placebo.

Treatment was found to be equivalent to music therapy in reducing migraine frequency. [3]

Another study in children between 6-17 years of age found that Petadolex dosages between 50-150 mg per day decreased migraine frequency by at least half in 77% of patients. [3]

Butterbur for Hay Fever

The NMCD reports that a specific butterbur leaf extract can decrease symptoms and nasal inflammation mediators in in patients diagnosed with allergic rhinitis (hay fever). [3]

This extract is called Ze 339 (Tesalin, Zeller AG) and it is standardized to contain 8 mg total petasin.

Some clinical evidence suggests that Ze 339 is as effective for allergic rhinitis as using 10 mg/day Zyrtec (cetirizine), or 180 mg/day Allegra (fexofenadine). [3]

A specific butterbur root extract, called Petaforce, appears to reduce “response to adenosine monophosphate challenge in patients with allergic rhinitis compared to placebo.” [3]

However, in one trial lasting for two weeks, Petaforce did not improve eye or nasal symptoms of hayfever, quality of life, or peak nasal inspiratory flow (the fastest flow rate when breathing in). [3]

More research is needed to determine the therapeutic efficacy of butterbur for improving symptoms of allergic rhinitis.

Somatoform Disorders

Using a specific butterbur-containing product, called Ze 185, has been observed to improve depression and anxiety in those with somatoform disorders.

This extract was used 2-3 times daily for two weeks in 90 mg doses along with passionflower, lemon balm leaf, and valerian root. It was compared to taking another supplement containing passionflower, lemon balm leaf, and valerian root alone. [3]

It was observed that the patients taking the passionflower, lemon balm leaf, and valerian root as well as the Ze 185 has improved anxiety and depression scores compared to the other supplement group.

Research using butterbur alone for anxiety or depression is lacking. More research is needed to determine what effects butterbur may have on symptoms of somatoform disorders.

Butterbur Supplements

The NCCIH states that dietary supplements containing butterbur rhizome, root and leaf are available. However, consuming raw, unprocessed butterbur might be dangerous. [2]

This plant contain compounds called pyrrolizidine alkaloids (PA) that can damage the liver when taken in large amounts or repeatedly over time. Users are advised to only buy and use natural health products that are certified to be PA-free. [2]

The NMCD reports that there are over 70 different butterbur dietary supplement products available on the market. [3]

Some products contain this plant extract alone. Other supplements are formulated for specific uses (i.e. migraines) and combine butterbur with various other herbs, vitamins, and minerals.

Most supplements contain either 50 mg or 75 mg of this herbal per dosage. Most 75 mg supplements are recommended to be taken once daily, while 50 mg supplements are formulated to be taken once or twice per day.

Supplements are typically standardized to 15% sesquiterpenes as petasin content.

It is recommended to choose organic, non-GMO, PA-free supplements for efficacy and safety.

Butterbur Dosage

The suggested dosage is dependent on several factors including age, weight, sex, health status and the reason for taking a supplement.

It is recommended to follow dosing instructions on the label of the specific products you are purchasing. Consult with a doctor to determine the right dosage for you before beginning to take a supplement.

The NMCD reports the following adult oral doses of butterbur have been used in research studies: [3]

• 25 mg Petaforce, twice daily for a week for asthma
• 50 mg Petaforce, twice daily for 2 weeks for hayfever
• 75-150 mg/day Petadolex, for up to 4 months for preventing migraines
• 150 mg/day Petadolex, in 3 divided doses, for 2-4 months for asthma
• 600 mg/day powdered rhizome for 2 weeks for asthma
• 600 mg/day powdered rhizome for 2 weeks for chronic obstructive bronchitis
• Up to 6 tablets Ze 339 daily, in divided doses, for 1-2 weeks for hayfever

In children between 6-17 years of age, 50-150 mg/day Petadolex has been used for 2-4 months for asthma. [3]

The Cleveland Clinic recommends using 50-75 mg twice daily doses of a quality extract for up to 4 months. They recommend that consumers, “Look for a ‘pyrrolizidine-free’ butterbur rhizome extract with 7.5 mg of petasin and isopetasin in each 50 mg tablet, such as in Petadolex®.” [1]

Safety and Side Effects

The NMCD rates certified PA-free butterbur rhizome and leaf extracts as Possibly Safe when used in appropriate oral doses for up to sixteen weeks. [3]

Products that contain hepatotoxic pyrrolizidine alkaloids are rated as Likely Unsafe for oral use.

According to the NMCD, consuming high amounts of PA or repeated exposure to low amounts can cause severe veno-occlusive liver disease. This is a disease where the veins in the liver become obstructed. [3]

It is believed that PAs may also be carcinogenic (cancer causing) and mutagenic (cause mutations). [3]

PA-containing butterbur products are also rated as Likely Unsafe when applied topically, especially on broken skin. There is insufficient information available to rate the safety of topical use of PA-free products on unbroken or broken skin. [3]

PA-free butterbur is rated as Possibly Safe when used orally and appropriately in children between 6-17 years of age. [3]

However, it is recommended that butterbur only be given to children by a qualified healthcare professional. [2]

The NCCIH states, “PAs can cause liver damage and can result in serious illness. Only butterbur products that have been processed to remove PAs and are labeled or certified as PA-free should be used.” [2]

Several studies suggest that PA-free butterbur products are well-tolerated and generally safe for most people, for up to 16 weeks, when taken orally in recommended doses. The safety of long-term use has not been determined. [2]

Butterbur supplements that are PA-free are generally well tolerated in most users. Some mild side effects have been reported including belching, diarrhea, itchy eyes, headache, breathing difficulty, drowsiness, and fatigue. [2]

Do not use this supplement if you are allergic to other members of the Asteraceae plant family, as allergic reactions are possible. [2]

Drug and Supplement Interactions

The pyrrolizidine alkaloids in butterbur plants are substrates of the Cytochrome P450 3A4 enzyme system. In theory, some drugs and herbs that induce CYP3A4 might increase conversion of PAs to other hepatotoxic compounds. [3]

Drugs in this class include phenobarbital, phenytoin (Dilantin), carbamazepine (Tegretol), and rifampin. Herbs that induce Cytochrome P450 3A4 include Echinacea, garlic, and St. John’s wort. [3]

Be careful mixing butterbur supplements with other herbs that may contain pyrrolizidine alkaloids. Some of these include borage, coltsfoot, comfrey, hemp agrimony, golden ragwort, and tansy ragwort. [3]

This plant extract may increase liver enzyme activity and affect results of laboratory tests that measure liver function. Talk to your doctor before using this supplement if you have liver disease. [3]

Stop using butterbur at least 2 weeks prior to scheduled surgeries. [3]

If you are interested in taking a butterbur supplement it is recommended that you speak with your doctor before beginning use. Your doctor will be able to determine if this supplement is right for your needs.

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