Feverfew (Tanacetum parthenium L. Schultz-Bip.)

Feverfew (Tanacetum parthenium L. Schultz-Bip.)

Background

Feverfew is an herb that has been used traditionally as an antipyretic, as its name denotes, although this effect has not been well studied.

Feverfew is most commonly used orally for the prevention of migraine headache. There is a biochemical basis for this use in pre-clinical studies reporting anti-inflammatory and vascular (inhibition of vasoconstriction) effects. Several controlled human trials have been conducted with mixed results. Overall, these studies suggest that feverfew taken daily as dried leaf capsules may reduce the incidence of headache attacks in patients who experience chronic migraines. However, this research has been poorly designed and reported. Evidence from an adequately powered randomized trial comparing feverfew to placebo and other migraine therapies is warranted before a strong recommendation can be made.

There is currently inconclusive evidence regarding the use of feverfew for symptoms associated with rheumatoid arthritis.

Feverfew appears to be well tolerated in clinical trials, with a mild and reversible side effects profile. The most common adverse effect appears to be mouth ulceration and inflammation with direct exposure to leaves. Pre-clinical reports of platelet aggregation inhibition suggest a theoretical increased risk of bleeding.

Synonyms

Altamisa, bachelor's button, camomille grande, crysanthemum parthenium, featherfew, featherfoil, febrifuge plant, federfoy, flirtwort, Leucanthemum parthenium , Matricaria capensis , matricaria eximia hort, Matricaria parthenium L., midsummer daisy, mother herb, mutterkraut, nosebleed, parthenolide, Pyrenthrum parthenium L., santa maria, wild chamomile, wild quinine.

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*Migraine headache prevention
Feverfew is often taken by mouth for the prevention of migraine headaches. Laboratory studies show that feverfew can reduce inflammation and prevent blood vessel constriction (squeezing) that may lead to headaches. Most of the available human studies are not high quality, and report mixed results. However, overall they do suggest that feverfew may reduce the number of headaches that occur in people with frequent migraines. A large, well-designed study comparing feverfew to placebo and other migraine treatments is needed before a strong recommendation can be made.

B

Rheumatoid arthritis
It is not clear if feverfew if helpful for treating rheumatoid arthritis symptoms such as joint stiffness or pain.

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.

Abdominal pain, anemia, anti-inflammatory, asthma, blood vessel dilation (relaxation), cancer, central nervous system diseases, colds, constipation, diarrhea, digestion, dizziness, fever, joint pain, induction of labor/abortion, heart muscle injury, insect bites, insect repellant, leukemia, menstrual cramps, neurological complications of malaria, promotion of menstruation, rash, ringing in the ears, toothache, tranquilizer, uterine disorders.

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

The active agent in feverfew is thought to be parthenolide, although this has been questioned recently. The amount of parthenolide may vary depending on the origin of the plant or the parts of the plant included in a feverfew product. Recent research reports that different products sold in stores may contain very different amounts of parthenolide. In England and Canada, feverfew products are standardized to contain at least 0.2 percent parthenolide. In France, products contain at least 0.1 percent parthenolide. There are no standard or well-studied doses of feverfew, and many different doses are used traditionally.

Adults (18 years and older)

Migraine headache prevention : Traditional doses by mouth include 2 to 3 dried leaves (approximately 60 milligrams) taken daily, or 50 to 250 milligrams of a dried leaf preparation taken daily, standardized to 0.2% parthenolide (a common dose is 125 milligrams daily). Human studies have used 50 to 114 milligrams of feverfew powdered leaves daily, packed into capsules, standardized to 0.2% parthenolide, or 0.50 milligrams of parthenolide daily.

Rheumatoid arthritis : Doses of 70 to 86 milligrams of dried chopped feverfew leaves in capsules, taken once daily, have been used.

Children (younger than 18 years)

There is not enough scientific information to safely recommend feverfew for use in children.

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

Feverfew may cause allergy in people allergic to chrysanthemums, daisies, marigolds, or other members of the Compositae family, including ragweed. There are multiple reports of allergic skin rashes after contact with feverfew.

Side Effects and Warnings

Few side effects are reported in human studies of feverfew. The side effects that do occur are usually mild and reversible. The most common complaints are inflammation and ulcers of the mouth and bleeding of the gums, which usually occur after direct contact of the mouth with the leaves, although some people report burning after swallowing a capsule containing dried leaf. Swelling of the lips and loss of taste have also been noted. Photosensitivity (sensitivity to sunlight or sunlamps) has been reported with other herbs in the Compositae plant family, and may be possible with feverfew as well. Indigestion, nausea, flatulence, constipation, diarrhea, abdominal bloating, and heartburn have been reported rarely in human studies. Gardeners may develop skin irritation at sites of contact with feverfew plants. Feverfew can also cause allergic rashes. One small study reported increased heart rate in some patients.

Long-term feverfew users who stop treatment suddenly may experience feverfew withdrawal symptoms, including rebound headaches, anxiety, difficulty sleeping, muscle stiffness, and joint pain.

Laboratory tests suggest that feverfew affects blood platelets, and in theory may increase the risk of bleeding. However, this has not been clearly shown in humans. Nonetheless, caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. Use caution prior to some surgeries or dental procedures, due to a theoretical increase in bleeding risk.

Pregnancy and Breastfeeding

There is not enough information about safety to recommend feverfew during pregnancy or breastfeeding. Traditional experience suggests that feverfew may stimulate menstrual flow and induce abortion, and therefore should be avoided.

References

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January 01, 2004