HERBAL
MEDICINAL
PLANT
Borago
officinalis L. (Boraginaceae) +
RETTODWIKART THENU
BORAGE
(baw’rij)
Borago officinalis L.
(Boraginaceae) +
SUMMARY AND PHARMACEUTICAL COMMENT
Limited
information is available on the constituents of borage. No documented pharmacological
data were located to support the traditional uses, although the mucilage
content supports the use of borage as a demulcent. Interest has focused on the
volatile oil as a source of gamolenic acid.
Borage
contains known toxic pyrrolizidine alkaloids, although at concentrations
considerably lower than those found in comfrey for which human toxicity has
been documented.
However,
it would seem wise to avoid excessive or prolonged ingestion of borage. It is
unclear whether borage oil, currently available in food supplements, contains
any pyrrolizidine alkaloids.
Figure 1. Borage (Borago officinalis).
DESCRIPTION
Medicinal
Parts: The medicinal parts are the dried Borage
flowers and the dried or fresh foliage, stems and leaves.
Flower
and Fruit: The flowers are in separate, terminal, erect,
leafy racemes. The calyx is divided almost to the base into 5 rough-haired
tips. The 1.5 to 2.5 cm wide corolla is usually sky blue (occasionally white)
and has a short tube. The scales of the
tube are white. The 5 stamens have a broadened filament and a violet, spur-like
appendage. The anthers are black-violet. The style is thread-like with a headlike
stigma. The ovary is divided into 4 valves. The small nut js elongate-ovate,
about 7 to 10 mm long, light brown, keeled, ribbed, warty and rough.
Leaves,
Stem and Root: Borage is an annual, succulent, bristly-haired
herb, 15 to 60 cm high. The erect, vertically grooved stems are covered in
rough, whitish hairs. The leaves are alternate, clasping, solitary,
entire-margined and hairy. They are also folded, curved in at the margins,
green on
top and whitish on the underside. The leaves are 3 to 10 cm long and elliptoid
to ovate.
Characteristics:
Borage
has a taste similar to cucumber.
Habitat: Borage
originated in the Mediterranean region, but is now found all over Europe and
the U.S.
Production: Borage oil is
the fatty oil of the seeds of Borago officinalis. Borage leaves are the dried
leaves and inflorescence of Borago officinalis. The herb most often grows wild,
but is cultivated on a small scale in Yugoslavia, Rumania, Bulgaria and Turkey.
Borage is harvested during the flowering period. Due to the plant's very high
water content, it should be artificially dried at 40°C.
Not to be
Confused With: The
herb can be confused with Echium vulgare.
OTHER COMMON NAMES
Beebread, common borage, common
bugloss, cool tankard, ox’s tongue, starfl ower
ORIGIN
Borage is an annual found in
North America and Europe.
PHARMACOPOEIAL AND OTHER MONOGRAPHS
BP 2007(G84)
Martindale 35th edition(G85)
Ph Eur 2007(G81)
LEGAL CATEGORY (LICENSED PRODUCT)
Borage is not included in the GSL.(G37)
USES
Borage is used to treat arthritis, hypertension, the
common cold, and bronchitis. It has been used primarily as a galactagogue but
should not be used during breastfeeding until research confi rms or denies the
presence of pyrrolizidine alkaloids. Borage is also used for menopause,
depression, adrenal replenishment, and as a tonic.
INVESTIGATIONAL
USES
Borage may decrease body fat accumulation.
FOOD USE
Borage
is occasionally used in salads and soups.
HERBAL USE
Borage
is stated to possess diaphoretic, expectorant, tonic, antiinflammatory and
galactogogue properties.(3) Traditionally, borage has been used to treat many
ailments including fevers, coughs and depression.(3,G42, G64) Borage is also
reputed to act as a restorative agent on the adrenal cortex.(3) Borage oil
(starflower oil) is used as an alternative source to evening primrose oil for gamolenic
acid.
BORAGE OIL
Unproven Uses: The oil is used
for neurodermatitis and as a food supplement.
BORAGE LEAF
Unproven Uses: In folk
medicine, Borage is used as a sequestering and mucilaginous agent for coughs
and throat illnesses and as a bronchial treatment. It is also used as an anti-inflammatory
agent for kidney and bladder disorders, as an astringent and to treat
rheumatism.
Preparations
using Borage are also used for blood purification and dehydration; the
prevention of chest and peritoneal inflammation and rheumatism of the joints;
as a pain-relieving, cardiotonic, sedative, sudorific; as a performance-enhancing
agent; and for phlebitis and menopausal complaints.
Figure 2. Borage – dried drug substance (herb).
CONSTITUENTS
The
following is compiled from several sources, including General References G22
and G64.
Alkaloids Pyrrolizidine-type.
Lycopsamine, intermedine, acetyllycopsamine, acetylintermedine, amabiline,
supinine and thesinine (unsaturated).(1, 2) Concentrations reported as 0.01%
and 2– 10 ppm for commercial dried samples. Alkaloid concentrations reportedly
the same for fresh and dried samples; fresh samples revealed alkaloids as the
free base in the roots and mainly as Noxides in the leaves.
Mucilages 11.1%.
Yielding glucose, galactose and arabinose.
Oil Rich in fatty
acids, in particular gamolenic acid.
Other constituents Acids (acetic, lactic,
malic, silicic), cyanogenetic compounds and tannins (up to 3%).
ACTIONS-ACTIVITIES
Activities
(Borage)
Adrenocorticostimulant
(f; APA; CAN); Analgesic (f; PHR; PH2); Antiinflammatory (1; APA; CAN; FAD;
PH2); Antipyretic (f; CRC; EFS; FAD; WO2); Antispasmodic (f; EFS); Aperient (f;
CRC); Astringent (1; APA; PHR; PH2); Carcinogenic (1; APA; CAN); Cardiotonic
(f; PHR; PH2); Collyrium (f; JFM); Demulcent (1; CAN; CRC; EFS); Depurative (f;
CRC; EFS; PH2); Diaphoretic (f; CAN; CRC; EFS; JFM; PHR; PH2); Diuretic (1;
APA; FAD; PNC); Emollient (f; CRC; EFA; HHB; PNC); Expectorant (f; CAN);
Genotoxic (1; CAN); Hepatocarcinogenic (1; APA; PHR); Hepatotoxic (1; CRC;
PHR); Hypotensive (1; CAN); Lactagogue (f; APA; CAN; CRC); Laxative (f; CRC;
EFS; WO2); Nervine (f; CRC; EFS; WO2); Pectoral (f; CRC); Sedative (f; PHR;
PH2); Tonic (f; CAN; CRC).
Antiinflammatory
Action
Several studies have demonstrated the benefi cial effects
of borage oil for treating rheumatoid conditions. Diets high in arachidonic acid
have been shown to increase the formation of pros ta glan din and leukotriene
with proinfl ammatory action (Zurier et al, 1996). Two studies have shown that
doses of 1.1 to 1.4 g gammalinolenic
acid in borage seed oil reduces joint infl ammation
signifi cantly (Leventhal et al, 1993; Pullman-Mooar et al, 1990). A study
using a combination of evening primrose oil and borage oil showed positive results
in rheumatologic conditions (Belch et al, 2000). However, not all studies have
shown positive results.
Antihypertensive
Action
One study has shown that the high levels of gamma-linolenic
acid in borage oil are responsible for its ability to decrease hypertension.
The decrease in blood pressure occurred in response to two factors: (1) a
reduction in the affi nity to angiotensin II receptors in cells that produce
aldosterone and (2) a reduction in the aldosterone/ renin ratio (Engler et al,
1998).
In vitro and animal studies
Borage
oil has been reported to attenuate cardiovascular reactivity to stress in rats.(4)
CLINICAL STUDIES
The
effect of borage seed oil on the cardiovascular reactivity of humans to acute
stress has been studied in 10 individuals, who each received a total daily dose
of 1.3 g for 28 days.(4) The individuals were required to undertake an acute
psychological task requiring sensory intake and vigilance (Stroop colour test).
Borage oil was found to attenuate cardiovascular reactivity to stress, indicated
by a reduction in systolic blood pressure and heart rate and by increased task
performance. The specific mechanisms by which borage exerts this effect were
unknown, but a central mechanism of action of the fatty acids was suggested in
view of the simultaneous reduction in heart rate and blood pressure.(4)
Other Actions
A borage oil study has shown a decrease in body fat accumulation
in rats. Rats were fed a low-fat diet containing borage oil. The result was a
decrease in body fat mass (Takahashi et al, 2000). Rosmarinic acid may be responsible
for the antioxidant action in borage (Bandoniene, 2002). Borage extract revealed
in the lab the presence of several radial scavenging components.
PRODUCT AVAILABILITY
Capsules: 240, 500, 1300 mg;
seed oil
Plant
Parts Used: Leaves, seeds, stems
DOSAGES
Joint
Infl ammation
Adult
PO seed oil: 1.1-1.4 g gamma-linolenic acid daily (Leventhal et al, 1993; Pullman-Mooar
et al, 1990)
Dosage
Dosages
for oral administration (adults) for traditional uses recommended in older and
contemporary standard herbal reference texts are given below.
Infusion Two 5-mL spoonfuls of dried herb to one cup
boiling water three times daily.(3)
Tincture 1–4mL three times daily.(3)
Dosages
(Borage) —
2–4
ml liquid leaf extract (APA; PNC); 1 (300 mg) softgel containing 24% GLA (APA);
2 (5 ml) spoonfuls dry herb/cup water 3 ×/day (CAN); 1–4 ml tincture 3 ×/day
(CAN); 10 g leaf and/or flower/liter water for bronchosis and fever (JFM).
DOSAGE
BORAGE OIL
Mode of
Administration: In
capsules, sometimes in combination with vitamins.
How Supplied:
Capsules —
500mg, 1000 mg
BORAGE LEAF
Storage: The drug should
be protected from light and moisture.
INDICATIONS
Alactea
(f; APA; CAN); Alcoholism (1; LAF); Arthrosis (1; APA; PHR; PH2); Bladder Stone
(f; CRC); Bronchosis (f; APA; CRC; PHR; PH2); Cancer, breast (f; CRC); Cancer,
face (f; CRC); Cardiopathy (1; APA; CRC; JFM; LAF; PHR); Catarrh (f; CRC);
Cholecystosis (f; PHR); Cold (1; APA); Conjunctivosis (f; CRC; JFM);
Constipation (f; CRC; EFS; WO2); Corn (f; APA; CRC; JLH); Cough (f; CAN; CRC;
HHB; JFM; PH2); Cramp (f; CRC; EFS); Cut (f; CRC); Cystosis (f; PH2);
Dehydration (f; PH2); Depression (f; CAN); Dermatosis (1; APA; PH2); Diabetes
(1; LAF); Diarrhea (1; APA; CRC; JFM); Eczema (f; CRC; LAF); Edema (f; CRC; JFM);
Fever (f; CAN; CRC; EFS; FAD; JFM; PHR; PH2; WO2); Gas (f; JFM); Hepatosis (f; JFM);
High Blood Pressure (1; CAN); Inflammation (1; APA; CAN; FAD; LAF; PH2);
Insomnia (f; EFS; PHR; PH2); Itch (f; CRC); Jaundice (f; CRC; FAD); Kidney Stone
(f; APA; CRC); Lethargy (f; CAN); Menopause (1; PHR; PH2); Nephrosis (f; CRC;
PHR; PH2); Nervousness (f; PHR; PH2); Neurodermatosis (f; APA; PHR; PH2); Pain
(f; CRC; PHR; PH2); Peritonosis (f; PH2); Pharyngosis (f; PH2); Phlebitis (f;
PHR; PH2); PMS (1; APA; JAD; LAF; PHR); Pulmonosis (f; PH2); Rheumatism (1;
APA; FAD; PHR; PH2); Ringworm (f; CRC); Sclerosis (f; CRC; JLH); Snakebite (f; CRC);
Sore Throat (f; CRC; HHB; PHR; PH2); Stress (1; CAN); Stroke (1; LAF); Swelling
(f; CRC; HHB); Syndrome-X (1; SYN); Tuberculosis (f; CRC); Tumor (f; CRC);
Ulcer, mouth (f; CRC); Ulcer, throat (f;
CRC); Water Retention (1; APA; FAD; PNC); Wound (f; FAD).
CONTRAINDICATIONS
Class 2a/2b/2c herb.
Until
more research is available, borage should not be used during pregnancy and breastfeeding
because of the possible presence of pyrrolizidine alkaloids. It should not be
given to children.
CONTRA-INDICATIONS, WARNINGS
Evening
primrose oil is recommended to be used with caution in epileptic patients,
especially in those with schizophrenia and/or those taking phenothiazines (see Evening
Primrose); on the basis that borage oil, like evening primrose oil, also
contains high concentrations of gamolenic acid, borage oil should also be used with
caution in these patient groups. In view of the known toxic pyrrolizidine
alkaloid constituents, excessive or prolonged ingestion of borage should be
avoided. In particular, infusions (e.g. herbal teas) containing borage should
be avoided.
Drug interactions None documented. However,
the potential for preparations of borage to interact with other medicines administered
concurrently, particularly those with similar or opposing effects, should be
considered.
Pregnancy and lactation In view of the documented pyrrolizidine constituents and
lack of toxicity data, borage should not be used during pregnancy or lactation.
SIDE EFFECTS/ADVERSE REACTIONS
GI:
Hepatotoxicity
Side-effects,
Toxicity
None
documented. However, borage contains low concentrations of unsaturated
pyrrolizidine alkaloids, which are known to be hepatotoxic in both animals and
humans (see Comfrey).(5)
INTERACTIONS
Drug
Anticoagulants,
antiplatelets, salicylates: Borage
may increase the risk for bleeding.
Anticonvulsants:
Bogbean may decrease the effect
of this product.
INTERACTIONS—CONT’D
Hepatotoxic
drugs: Borage when given with
hepatotoxic drugs, may lead to increased hepatotoxicity (Jellin et al, 2008).
Herb
Eucalyptus: Use with borage may increase unsaturated pyrrolizidine
alkaloid (UPA) (Jellin et al, 2008).
Lab Test
AST, ALT,
alkaline phosphatase, PT, INR: Borage
may increase these levels.
CONTRAINDICATIONS, INTERACTIONS, AND SIDE EFFECTS (BORAGE)
Class
2a, 2b, 2c, 2d. Long-term use is not recommended (AHP). Not approved (KOM).
“Hazards and/or side effects not known for proper therapeutic dosages” (PH2).
Commission E reports borage contains hepatotoxic and carcinogenic pyrrolizidine
alkaloids (AEH). “Effective July 1996, the AHP Board of Trustees recommends that
all products with botanical ingredient(s) which contain toxic pyrrolizidine
alkaloids, including Borago officinalis, display the following
cautionary statement on the label: For external use only. Do not
apply to broken or abraded skin. Do not use when nursing.” (AHP).
Pyrrolizidine alkaloids (PAs) have genotoxic, carcinogenic, and hepatotoxic
activity (CAN). Because of the PAs, its use in pregnancy and lactation is to be
avoided. Animal studies document placental transfer and secretion into breast
milk of unsaturated PAs (CAN). Swiss researchers report at least seven PAs from
the herb, at levels above those permitted in Germany (>1 ppm). Seeds
reportedly contain even higher quantities of alkaloids (De Smet et al., 1993).
Tannins have astringent activities (PHR). Mucilage acts as a sequestering agent
(PHR). The GLA in the seed oil may have been positive effects if divorced from
the potential of PA toxicity.
CLIENT CONSIDERATIONS
Assess
·
Assess for hepatotoxicity
(jaundice, increased liver function test levels, claycolored stools, right
upper-quadrant pain). If these occur, use of borage should be discontinued.
·
If the client is using borage
to treat joint conditions, assess for pain and infl ammation (location,
duration, intensity), including aggravating and alleviating factors.
·
Assess blood pressure and pulse
if borage is being used to treat hypertension.
·
Assess body weight if using to
decrease body fat accumulation.
Administer
·
Instruct the client to use
borage oil that contains 20% to 26% gamma-linolenic acid.
PREPARATIONS
Proprietary single-ingredient preparations Chile: Dexol.
Proprietary multi-ingredient
preparations Chile:
Celltech Gold. Italy: Sclerovis H. New Zealand: Mr Nits. USA: Borage Oil;
Omega-3 Complex; Omega-3 Glucosamine.
REFERENCE
Barnes, J.,
Anderson, L. A., and Phillipson, J. D. 2007. Herbal Medicines Third
Edition. Pharmaceutical Press. Auckland and London.
Duke, J. A. with
Mary Jo Bogenschutz-Godwin, Judi duCellier, Peggy-Ann K. Duke. 2002. Handbook
of Medicinal Herbs 2nd Ed. CRC Press LLC. USA.
Gruenwald, J.,
Brendler, T., Jaenicke, Ch. 2000. PDR
for Herbal Medicines. Medical Economics Company, Inc. at
Montvale, NJ 07645-1742. USA
Linda S-Roth.
2010. Mosby’s Handbook Of Herbs & Natural Supplements, Fourth Edition.
Mosby Elsevier. USA.
