BUTTERBUR
Place in Therapy
Place in Therapy
Butterbur can be used as an alternative to antihistamines in the treatment of allergic rhinitis. When compared to placebo it was found to be superior and compared to H1 antihistamines it was found to have equal efficacy. It was beneficial in reducing nasal and ocular symptoms as well as sneezing and itchiness. There were some studies that found no benefit so evidence for its use is mixed. It does have a benign adverse effect profile with patients reporting mild GI upset (burping was common), headaches, pruritus and fatigue. There is a concern due to the potential hepatotoxicity and carcinogenicity of unprocessed butterbur and therefore commercially available products should only be used. No long-term data exists to evaluate its safety and it has not been studied in pregnancy and breastfeeding. There have been no documented drug interactions but there is a theoretic interaction with calcium channel antagonists, inotropic and anticholinergic medicines, and inducers of CYP3A4 causing an increase in toxic metabolites. If patients prefer a natural product, butterbur could be used as an alternative to antihistamines but should not be used first line in allergic rhinitis.
References
1. Natural Standard. Butterbur Professional Monograph. Available at: https://naturalmedicines-therapeuticresearch-com.proxy.lib.uwaterloo.ca/databases/food,-herbs-supplements/b/butterbur/professional.aspx. Accessed on July 12, 2014.
2. Lexicomp. Butterbur (Natural Products Database). Available at: http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/fc_rnp2/3750072. Accessed on July 12, 2014.
3. Kaufeler R, Polasek W, Brattstrom A, Koetter U. Efficacy and safety of butterbur herbal extract Ze 339 in seasonal allergic rhinitis: postmarketing surveillance study. Adv Ther. 2006;23(2):373-384.
4. Brozek JL, Bousquet J, Baena-Cagnani CE et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466-476.
Butterbur can be used as an alternative to antihistamines in the treatment of allergic rhinitis. When compared to placebo it was found to be superior and compared to H1 antihistamines it was found to have equal efficacy. It was beneficial in reducing nasal and ocular symptoms as well as sneezing and itchiness. There were some studies that found no benefit so evidence for its use is mixed. It does have a benign adverse effect profile with patients reporting mild GI upset (burping was common), headaches, pruritus and fatigue. There is a concern due to the potential hepatotoxicity and carcinogenicity of unprocessed butterbur and therefore commercially available products should only be used. No long-term data exists to evaluate its safety and it has not been studied in pregnancy and breastfeeding. There have been no documented drug interactions but there is a theoretic interaction with calcium channel antagonists, inotropic and anticholinergic medicines, and inducers of CYP3A4 causing an increase in toxic metabolites. If patients prefer a natural product, butterbur could be used as an alternative to antihistamines but should not be used first line in allergic rhinitis.
References
1. Natural Standard. Butterbur Professional Monograph. Available at: https://naturalmedicines-therapeuticresearch-com.proxy.lib.uwaterloo.ca/databases/food,-herbs-supplements/b/butterbur/professional.aspx. Accessed on July 12, 2014.
2. Lexicomp. Butterbur (Natural Products Database). Available at: http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/fc_rnp2/3750072. Accessed on July 12, 2014.
3. Kaufeler R, Polasek W, Brattstrom A, Koetter U. Efficacy and safety of butterbur herbal extract Ze 339 in seasonal allergic rhinitis: postmarketing surveillance study. Adv Ther. 2006;23(2):373-384.
4. Brozek JL, Bousquet J, Baena-Cagnani CE et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466-476.