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Information about Butterbur

Butterbur is a popular herbal preparation that is used to treat migraine headaches, allergic rhinitis and respiratory illnesses.  Butterbur is an extract of the roots of the butterbur bush and the extract has to be processed carefully to eliminate harmful pyrrolizidine alkaloids that occur naturally in the plant. 

Liver safety of Butterbur

Butterbur preparations processed to remove pyrrolizidine alkaloids do not appear to cause liver injury, either in the form of serum enzyme elevations during treatment or clinically apparent acute liver injury.  However, recent cases of clinically apparent liver injury have been reported with use of several commercial preparations of butterbur, suspected to be due to residual pyrrolizidine alkaloid contamination.

Mechanism of action of Butterbur

Butterbur is a popular herbal product derived from the rhizomes and stems of the perennial butterbur bush (Petasites hybridus), a plant native to Europe.  Butterbur is so named because its large leaves were used to wrap butter for storage.  Butterbur extracts have been used for centuries in traditional medicine and purported uses were for plague, asthma, gastrointestinal and respiratory illnesses and cancer.  Chemical components of butterbur extracts include sesquiterpene alcohol esters (petasitine, neopetasitine and isopetasitine), volatile oils, flavonoids and tannins.  Extracts from butterbur leaves and stems can contain pyrrolizidine alkaloids (senecionine, integerrimine), which are toxic molecules capable of causing sinusoidal obstruction syndrome in animals as well as humans.  Butterbur herbal products for oral use must be specially processed to remove any traces of pyrrolizidine alkaloids. 

Clinical use of Butterbur

Some evidence suggests that butterbur is effective in the treatment of migraine headaches and allergic rhinitis, but its long term efficacy and safety have not been established, and it is not specifically approved for these uses in the United States. 

Dosage and administration for Butterbur

Butterbur is available in a variety of formulations and the typical oral dosage is 100 to 150 mg per day in 2 to 3 divided doses.  Side effects of butterbur are uncommon and mild, and include gastrointestinal upset, eructation, nausea, diarrhea, headache, dizziness, increased bleeding tendency and rash.  In clinical trials, both serious and common side effects were often no more frequent with butterbur than placebo.

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