Devil's Claw (Harpagophytum procumbens DC)

Devil's Claw (Harpagophytum procumbens DC)

Background

The medicinal ingredient of Devil's claw ( Harpagophytum procumbens ) is extracted from the dried out tuberous roots of the plant which originates from the Kalahari and Savannah desert regions of South and Southeast Africa. In these parts of the world, it has historically been used to treat a wide range of conditions including fever, malaria and indigestion.

Currently, the major clinical uses of Devil's claw are as an anti-inflammatory and analgesic (pain reliever) in joint diseases, back pain and headache. The initial evidence from scientific studies in animals and humans has been popularized, and has resulted in widespread use of standardized Devil's claw as a mild analgesic for joint pain in Europe. Scientific evaluation is lacking regarding its effectiveness as an appetite stimulant or liver tonic, but it is widely used for these purposes as well.

Potential side effects include gastrointestinal upset, hypotension (low blood pressure) and arrhythmic (abnormal heart beat) effects. Devil's claw may have chronotropic (increased heart rate) and inotropic (increased heart squeezing) effects.

Traditionally, it has been recommended to avoid using devil's claw in patients with gastric or duodenal ulcers, or in people using anticoagulant ("blood thinner") therapy. Clinical data to substantiate these recommendations are insufficient.

Synonyms

Algophytum®, Arthrosetten H®, Arthrotabsm®, Artigel®, Artosan®, Defencid®, Devil's Claw Capsule®, Devil's Claw Secondary Root®, Devil's Claw Vegicaps®, Doloteffin®, Duiwelsklou (Afrikaans) , Fitokey Harpagophytum®Ã,¸Grapple plant, griffe du diable (French), Harpadol®, Hariosen®, HarpagoMega®, Harpagon®, Harpagophyti radix (Latin ) , Harpagophytum zeyher, Jucurba N®, Pedaliaceae (family), 'Rheuma-Sern®, Rheuma-Tee®, Salus®, Sengaparile (Senegalese), Sudafrikanische, Teufelskralle, Trampelklette (German), Venustorn ( Danish), Windhoek's root, Wood spider .

Multi-Ingredient Preparations Containing Devil's Claw Root : Arktophytum, Arthritic Pain Herbal Formula, Devil's Claw Plus, Lifesystem Herbal Formula 1 Arthritic Aid, Lifesystem Herbal Formula 12 Willowbark, Prost-1, Green Lipped Mussel (FM), Harpagophytum.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidenceGrade*Osteoarthritis
A small amount of research reports that devil's claw may be effective for treating pain and for improving mobility in individuals with osteoarthritis (particularly affecting the hip or knee). These studies suggest that the use of devil's claw may allow the dose of pain medications to be reduced. However, there are problems with the design and reporting of these trials, and better research is needed before a firm conclusion can be drawn.

B

Low back pain
There are several human studies of devil's claw for low back pain. The results of these trials do not all agree with each other, and additional research is needed to provide clearer answers.

C

* Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Allergies, anti-inflammatory, antioxidant, appetite stimulant, arrhythmias, atherosclerosis (clogged arteries), bitter tonic, blood diseases, boils (used topically), childbirth difficulties, choleretic (bile secretion), constipation, diabetes, diarrhea, diuretic, dyspepsia, edema, fever, fibromyalgia, flatulence (gas), gastrointestinal disorders, gout, headache, heartburn, high cholesterol, hip pain, indigestion, irregular heartbeat, knee pain, liver and gallbladder tonic, loss of appetite, malaria, menopausal symptoms, menstrual cramps, migraines, muscle pain, nerve pain, nicotine poisoning, pain, rheumatoid arthritis, sedative, skin cancer (used topically), skin ulcers (used topically), spasmolytic, sores (used topically), tendonitis, urinary tract infections, wound healing for skin injuries (used topically).

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Standardization

Devil's claw products may be standardized to contain a specific amount of harpagoside, and often contain greater than 1-2% harpagoside. Some studies have used a special preparation called WS 1531, which contains 8.5% harpagoside.

Adults (18 years and older)

Tablets: A dose of 600 to 1,200 milligrams (standardized to contain 50 to 100 milligrams of harpagoside) by mouth three times per day has been used in some research for joint and muscle problems.

Dried root: Doses of 0.5 to 1.5 grams by mouth three times per day in an aqueous (water-based) solution have been used traditionally for appetite loss or stomach discomfort.

Tincture: Doses of 0.2 to one milliliter (1:5 in 25 percent alcohol) by mouth three times per day have been used traditionally. Doses of three milliliters (1:10 in 25 percent alcohol) by mouth three times per day have also been used traditionally.

Fluid extract: Doses of 0.25 to 1.5 milliliters (1:1 in 25 percent alcohol) by mouth three times per day have been used traditionally.

Children (younger than 18 years)

The dosing and safety of devil's claw have not been studied thoroughly in children, and safety is not established.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

People with allergies to Harpagophytum procumbens should avoid devil's claw products.

Side Effects and Warnings

At recommended doses, devil's claw is traditionally believed to be well tolerated. However, there are published reports of headache, ringing in the ears, loss of taste and appetite, and diarrhea in those taking this herb. Whether use of devil's claw for longer than 3-4 months is safe or effective is unknown.

Devil's claw may change the rate and force of heartbeats (chronotropic and inotropic effects). Individuals with heart disease or arrhythmias (abnormal heart rhythms) should consult their cardiologist or primary care physician before taking devil's claw. Devil's claw may affect levels of acid in the gastrointestinal tract and should be avoided by people with gastric (stomach) or duodenal (intestinal) ulcers. Devils claw should be used cautiously in patients with gallstones.

In theory, devil's claw may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.

In theory, devil's claw may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. Patients may need to stop taking devil's claw before some surgeries, and should discuss this with their primary healthcare provider.

Devil's claw products may be contaminated with other herbs, pesticides, herbicides, heavy metals, or drugs.

Pregnancy and Breastfeeding

Devil's claw may stimulate contractions of the uterus and cannot be recommended during pregnancy and breast-feeding. Patients should be aware that many tinctures contain high levels of alcohol and should be avoided during pregnancy.

References

1. Chantre P, Cappelaere A, Leblan D, et al. Efficacy and tolerance of versus diacerhein in treatment of osteoarthritis. Phytomedicine 2000;7(3):177-183.

2. Chrubasik S, Zimpfer C, Schutt U, et al. Effectiveness of Harpagophytum procumbens in treatment of acute low back pain. Phytomedicine 1996;3(1):1-10.

3. Chrubasik S, Junck H, Conradt C, et al. Effectiveness of oral harpagophytum extract WS 1531 in treating low back pain [abstract]. Arthr Rheum 1998;41 (Suppl 9) :S261.

4. Chrubasik S, Junck H, Breitschwerdt H, et al. Effectiveness of extract WS 1531 in the treatment of exacerbation of low back pain: a randomized, placebo-controlled, double- blind study. Eur J Anaesthesiol 1999;16(2):118-129.

5. Chrubasik S, Junck H, Breitschwerdt H, et al. Effectiveness of Harpagophytum extract WS 1531 in the treatment of exacerbation of low back pain: a randomized, placebo-controlled, double- blind study. Eur J Anaesthesiol 1999;16(2):118-129.

6. Chrubasik S, Sporer F, Dillmann-Marschner R, et al. Physicochemical properties of harpagoside and its in vitro release from Harpagophytum procumbens extract tablets. Phytomedicine 2000;6(6):469-473.

7. Chrubasik S, Künzel O, Thanner J, et al. A short-term follow-up after a randomised double-blind pilot study comparing Doloteffin vs Rofecoxib for low back pain. 9th Annual Symposium on Complementary Health Care, Exeter UK 2002.

8. Chrubasik S, Model A, Ullmann H, et al. DoloteffinR vs VioxxR for low back pain--a randomized, double-blind pilot study. Focus on Alternative and Complementary Therapies 2002;7:90.

9. Chrubasik S, Fiebich B, Black A, et al. Treating low back pain with an extract of Harpagophytum procumbens that inhibits cytokine release. Eur J Anaesthesiol 2002;19:209.

10. Chrubasik S, Pollak S, Black A. Effectiveness of devil's claw for osteoarthritis. Rheumatology (Oxford) 2002;41(11):1332-1333.

11. Chrubasik S, Thanner J, Kunzel O, et al. Comparison of outcome measures during treatment with the proprietary Harpagophytum extract doloteffin in patients with pain in the lower back, knee or hip. Phytomedicine 2002;9(3):181-194.

12. Chrubasik S, Pollak S. [In Process Citation]. Wien Med Wochenschr 2002;152(7-8):198-203.

13. Ernst E, Chrubasik S. Phyto-anti-inflammatories: a systematic review of randomized, placebo-controlled, double-blind trials. Rheum Dis Clin North Am 2000;26(1):13-27.

14. Grahame R, Robinson BV. Devils's claw (Harpagophytum procumbens): pharmacological and clinical studies. Ann Rheum Dis 1981;40(6):632.

15. Guyader M. Les plantes antirhumatismales. Etude historique et pharmacologique, et etude clinique du nebulisat d'Harpagohytum procumbens DC chez 50 patients arthrosiques suivis en service hospitalier [Dissertation]. Universite Pierre et Marie Curie 1984.

16. Leblan D, Chantre P, Fournie B. in the treatment of knee and hip osteoarthritis: four-month results of a prospective, multicenter, double-blind trial versus diacerhein. Joint Bone Spine 2000;67(5):462-467.

17. Lecomte A, Costa JP. Harpagophytum dans l'arthrose: Etude en double insu contre placebo. Le Magazine 1992;15:27-30.

18. Munkombwe NM. Acetylated phenolic glycosides from Harpagophytum procumbens. Phytochemistry. 2003 Apr;62(8):1231-4.

January 01, 2004