Horse Chestnut (Aesculus hippocastanum L.)
  
Horse Chestnut (Aesculus hippocastanum L.)
Background
Horse chestnut seed extract (HCSE) is widely used in Europe for chronic venous insufficiency (CVI), a syndrome that may include leg swelling, varicose veins, leg pain, itching, and skin ulcers. Although traditionally recommended for a variety of medical conditions, CVI is the only condition for which there is strong supportive scientific evidence.
Side effects from HCSE have been similar to placebo in clinical trials. However, due an increased risk of low blood sugars, caution is advised in children and people with diabetes.
Horse chestnut flower, branch bark, and leaf have not been shown effective for any indication, and it is strongly advised that they be avoided due to known toxicity.
Synonyms
Aescin, aescine, aescule, buckeye, bongay, chestnut, conkers, Conquerors, eschilo, escin, escine, fish poison, graine de marronier d'Inde, H. vulgare Gaertnhestekastanje, Hippocastabi folium, Hippocastani semen, horsechestnut, horse chestnut seed extract, HCSE, Marron Europeen, Marronier, NV-101, Rokastaniensamen, rosskastanie, Spanish chestnut, Venastat®, Venoplant®, Venostasin®.
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*Chronic venous insufficiency
Chronic venous insufficiency is a condition that is more commonly diagnosed in Europe than in the United States, and may include leg swelling, varicose veins, leg pain, itching, and skin ulcers. There is evidence from laboratory, animal, and human research that horse chestnut seed extract (HCSE) may be beneficial to patients with this condition. Studies report significant decreases in leg size, leg pain, itchiness, fatigue and "tenseness." There is preliminary evidence that HCSE may be as effective as compression stockings.
A
* 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.
Benign prostatic hypertrophy (BPH), fluid in the lungs (pulmonary edema), gall bladder pain (colic), gall bladder infection (cholecystitis), gall bladder stones (cholelithiasis), bladder disorders (incontinence, cystitis), bruising, cough, vein clots (deep venous thrombosis), diarrhea, dizziness, fever, hemorrhoids, kidney diseases, leg cramps, liver congestion, lung blood clots (pulmonary embolism), menstrual pain, nerve pain, osteoarthritis, pancreatitis, rectal complaints, "rheumatism," rheumatoid arthritis, skin conditions, post-operative/post-traumatic soft tissue swelling, ringing in the ears (tinnitus), ulcers, whooping cough.
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
Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients. Horse chestnut seed extract (HCSE) products are often standardized to contain 16% to 20% triterpene glycosides calculated as escin (aescin) content.
Adults (18 years and older)
Oral (by mouth) : A range of doses for horse chestnut seed extract (HCSE) taken by mouth have been used. Studies suggest a standardized product containing 50 to 75 milligrams of escin every 12 hours taken by mouth. This often results in an HCSE product total dose of 300 milligrams twice daily.
Topical (on the skin) : A gel preparation of horse chestnut applied to the skin has been studied for bruising, without clear benefits.
Intravenous (through a vein)/intramuscular (injected into a muscle) : Severe allergic reaction (anaphylactic shock) has been reported with intravenous use. Horse chestnut leaf has been associated with liver inflammation (hepatitis) after injection into muscle.
Children (younger than 18 years)
There is not enough scientific evidence to recommend use of horse chestnut in children. Deaths have been reported in children who ate raw horse chestnut seeds or tea made from horse chestnut leaves and twigs.
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
Horse chestnut seed extract (HCSE) may cause an allergic reaction in patients with known allergy to horse chestnuts, esculin, or any of its ingredients (flavonoids, biosides, trisides of quertins, and oligosacharides including 1-ketose and 2-ketose). Anaphylactic shock (severe allergic reaction) has been reported with intravenous (through the vein) use.
Side Effects and Warnings
Unprocessed horse chestnut seeds, leaves, bark, and flowers contain esculin, which has been associated with significant toxicity and death. Symptoms found with horse chestnut poisoning may include vomiting, diarrhea, headache, confusion, weakness, muscle twitching, poor coordination, coma or paralysis. Horse chestnut seed extract (HCSE) standardized to escin content should not contain significant levels of esculin, and should not have the same risks.
Standardized HCSE is generally considered to be safe in adults at recommended doses for short periods of time. Stomach upset, muscular (calf) spasm, headache, dizziness, nausea and itching have been reported. Contact skin irritation (dermatitis) has been reported following application of HCSE to the skin.
Based on animal study, HCSE may cause lowered blood sugar. 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 qualified healthcare provider, and medication adjustments may be necessary.
In theory, horse chestnut may increase the risk of bleeding due to the hydroxycoumarin content of esculin. Properly extracted HCSE should not contain esculin, and therefore should not carry this risk. However, caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Monitoring is recommended and dosing adjustments may be necessary. There is a case report of liver toxicity with horse chestnut leaf product that resolved after discontinuing the product, and case reports of kidney toxicity when high doses of escin were injected. Aflatoxins, considered to be cancer-causing agents, have been identified in commercial skin products containing horse chestnut, but not in HCSE.
Pregnancy and Breastfeeding
There is not enough scientific research to recommend the safe use of horse chestnut or HCSE during pregnancy and lactation. One small study of pregnant women treated with HCSE did not report serious adverse effects after two weeks.
References
1. Alter H. Zur medikamentosen therapie der varikosis. Z Allg Med 1973;49 (17) :1301-1304.
2. Bisler H, Pfeifer R, Kluken N, et al. [Effects of horse-chestnut seed extract on transcapillary filtration in chronic venous insufficiency]. Dtsch Med Wochenschr 1986;111(35):1321-1329.
3. Diehm C, Trampisch HJ, Lange S, et al. Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency. Lancet 1996;347(8997):292-294.
4. Diehm C, Vollbrecht D, Amendt K, et al. Medical edema protection--clinical benefit in patients with chronic deep vein incompetence. A placebo controlled double blind study. Vasa 1992;21(2):188-192.
5. Erdlen F. Klinische wirksamkeit von Venostasin retard im Doppelblindversuch. Med Welt 1989;40:994-996.
6. Erler M. Rokastaniensamenextrakt bei der therapie peripherer venoser odeme: ein klinischer therapievergleich. Med Welt 1991;43:593-596.
7. Friederich HC, Vogelsberg H, Neiss A. [Evaluation of internally effective venous drugs]. Z Hautkr 1978;53(11):369-374.
8. Kalbfleisch W, Pfalzgraf H. Odemprotektiva: aquipotente dosierung: rokastaniensamenextrakt und O -beta- hydroxyethylrutoside im vergleich. Therapiewoche 1989;39:3703-3707.
9. Koch R. Comparative study of Venostasin and Pycnogenol in chronic venous insufficiency. Phytother Res 2002;16 Suppl 1:S1-5.
10. Lohr E, Garanin P, Jesau P, et al. [Anti-edemic therapy in chronic venous insufficiency with tendency to formation of edema]. Munch Med Wochenschr 1986;128:579-581.
11. Neiss A, Bohm C. [Demonstration of the effectiveness of the horse-chestnut-seed extract in the varicose syndrome complex]. MMW Munch Med Wochenschr 1976;118(7):213-216.
12. Pilz E. Odeme bei venenerkrankungen. Med Welt 1990;40:1143-1144.
13. Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous insufficiency: a criteria-based systematic review. Arch Dermatol 1998;134(11):1356-1360.
14. Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev. 2002;(1):CD003230.
15. Siebert U, Brach M, Sroczynski G, et al. Efficacy, routine effectiveness, and safety of horsechestnut seed extract in the treatment of chronic venous insufficiency. A meta-analysis of randomized controlled trials and large observational studies. Int Angiol 2002;21(4):305-315.
16. Simini B. Horse-chestnut seed extract for chronic venous insufficiency. Lancet 1996;337(9009):1182-1183.
17. Tiffany N, Ulbricht C, Bent S, Basch E. Horse chestnut: a multidisciplinary clinical review. J Herbal Pharmacother 2002;2(1):71-85.
18. Vayssairat M, Debure C, Maurel A, et al. Horse-chestnut seed extract for chronic venous insufficiency. Lancet 1996;347(9009):1182.
19. Rehn D, Unkauf M, Klein P, et al. Comparative clinical efficacy and tolerability of oxerutins and horse chestnut extract in patients with chronic venous insufficiency. Arzneimittelforschung 1996;46(5):483-487.
20. Rudofsky G, et al. Odemprotektive wirkung und klinische wirksamkeit von ro kastaniensamenextrakt im doppeltblindversuch. Phleb Prokto 1986;15:47-54.
21. Steiner M. Untersuchungen zur odemvermindernden und odemportektiven wirking von ro kastaniensamenextrakt. Phlebol Prokto 1990;19:239-242.
January 01, 2004 
|
