HERBAL
MEDICINAL
PLANT
COWSLIP
Primula veris L. (Primulaceae)
++
BY
RETTODWIKART THENU
(kow’slip)
Primula
veris L. (Primulaceae) ++
SUMMARY AND PHARMACEUTICAL COMMENT
The
chemistry of cowslip is not well-documented and it is unclear whether saponins reported
as constituents of the underground plant parts are also present in the flowers.
Little pharmacological information has been documented to justify the herbal
uses of cowslip. In view of the lack of toxicity data, excessive use of cowslip
should be avoided.
TRADE NAMES
Comfrey
(available from numerous manufacturers)
OTHER COMMON NAMES
Artetyke, Arthritica, Buckles, Crewel, Drelip, Fairy
Cup, May Blob, Our Lady’s Keys, Paigle, Password, Peagle, Petty Mulleins,
Plumrocks
Oxlip, True Cowslip,
English Cowslip, Butter Rose, Herb Peter Paigle, Key Flower, Key of Heaven,
Fairy Caps. Palsywort, Plumrocks, Mayflower. Primrose.
DESCRIPTION
MEDICINAL PARTS: The medicinal
parts are the roots and flowers.
FLOWER AND FRUIT: The flowers are
in richly blossomed umbels with a short peduncle. The flowers are turned to one
side and grow in clusters (up to 25) from the center of the leaf rosette. The
calyx is cylindrical and appressed with a green margin. The remaining part of
the calyx is yellow and it is 12 to 15 cm long. The corolla is odorless,
usually sulfur yellow and has a tube with 5 triangular, orange spots. The fruit
is an oval capsule with 1.5 to 2.5 mm-long brown, warty seeds.
LEAVES, STEM AND ROOT: This 10 cm high
plant is a herbaceous perennial with a short sturdy rhizome. The green plant
parts are covered in 2 mm long segmented hairs. The leaves are revolute in the
bud. They are wrinkled, ovate or ovate oblong and are rounded at the base. They
narrow quickly to the winged stems. During the flowering season they are
irregularly dentate with blunt teeth. They are 3 to 6 cm long during the
flowering season, but grow larger later. The upper side of the leaf is glabrous.
HABITAT: The plant is
indigenous to all of Central Europe as far as the Southern European mountains.
There are many subspecies.
PRODUCTION: Cowslip flower
consists of the dried, whole flowers with calyx of Primula veris and/or Primula
elatior as well as their preparations. Cowslip root consists of the dried rhizome with roots of Primula veris and/or
Primula elatior as well as their preparations. Cowslip root is harvested at
best in the third year of growth.
SPECIES (FAMILY)
Primula
veris L. (Primulaceae)
SYNONYM(S)
Paigle, Peagle, Primula, Primula officinalis (L.) Hill.
ORIGIN
Cowslip is found in the western
region of the United States, Europe, and western Asia.
PHARMACOPODIAL AND OTHER MONOGRAPHS
BHP 1983(G7)
Complete German Commission E (Primrose flower)(G3)
ESCOP 1997(G52)
Martindale 35th edition(G85)
LEGAL CATEGORY (LICENSED PRODUCTS)
GSL (external use
only)(G37)
CONSTITUENTS
The
following is compiled from several sources, including General References G2 and
G59.
Carbohydrates Arabinose,
galactose, galacturonic acid, glucose, rhamnose, xylose and water-soluble
polysaccharide (6.2–6.6%).
Flavonoids Apigenin,
gossypetin, isorhamnetin, kaempferol, luteolin and quercetin.(1)
Phenols Glycosides
primulaveroside (primulaverin) and primveroside.
Quinones Primin
and other quinone compounds.
Saponins Primula
acid in sepals but saponins absent from other parts of the flower.
Tannins Condensed
(e.g. proanthocyanidin B2), pseudotannins (e.g. epicatechin, epigallocatechin).(1)
Other Constituents Silicic acid and volatile
oil (0.1–0.25%).
Other Plant Parts Saponins have been documented for the underground parts.(1) 'Primulic
acid' is a collective term for the saponin mixture.(2) Primulic acid A
glycoside (5–10%) yields primulagenin A as aglycone together with arabinose,
galactose, glucose, glucuronic acid, rhamnose and xylose.(3, 4) The saponin content
of the roots is stated to peak at two years.(5) After five years of storage the
saponin content was reported to have decreased by 45%.
CHEMICAL COMPONENTS
COMPOUNDS: COWSLIP FLOWER
Flavonoids (3%):
including
rutin, kaempferol-3-O-rutinoside, isorhamnetin-3-O-glucoside; isorhamnetin
rhamnosyl robinoside, isorhamnetin robinoside, isorhamnetin rutinoside, kaempferol
robinoside, limocitrin-3-O-glucoside. Quercetin gentiobioside, quercetin-3-O-glucoside,
quercetin robinoside
Primine
Triterpene
saponins
COMPOUNDS: COWSLIP ROOT
Phenol
glycosides (0.2 to 2.3%, high values in the Spring): primulaverin (3%,
2-hydroxy-5-methoxy- benzoic acid methyl ester-O-xyloglucoside) changing
over during dehydration into the characteristic-smelling
5-methoxy-methyl salicylate
Triterpene
saponins (5 to 10%): chief
components primulic acid A (chief aglycone protoprimulagenin)
USES
USES
Cowslip is used to treat insomnia, anxiety, restlessness,
and nervousness. The root is used for chronic cough.
FOOD USE
Cowslip
is not commonly used in foods. A related species,
Primula
eliator, is listed by the Council of Europe as a natural source of food
flavouring (category N2). This category indicates that Primula eliator can be
added to foodstuffs, provided that the concentration of coumarin does not
exceed 2 mg/kg.(G16) Coumarins, however, are not documented as constituents of Primula
veris, the subject of this monograph.
HERBAL USE
Cowslip is stated to possess sedative, antispasmodic, hypnotic, mild diuretic, expectorant and mild aperient properties. It has been used for insomnia, nervous excitability, hysteria and specifically for anxiety states associated with restlessness and irritability.(G2, G7,G64)
Figure 1. Cowslip (Primula veris).
Figure 2. Cowslip – dried drug
substance (flowerhead).
ACTIONS
Respiratory
Action
One
study conducted in Europe evaluated the effect of pharmacotherapeutic options and
herbal remedies for bronchitis. The herbal remedy Primula veris showed an effect equal to that of pharmacologic
treatments (Ernst et al, 1997), as did several other combination herbal
products with oil of eucalyptus, peppermint, anise, and ivy extract.
Other Actions
Older
studies have identifi ed both hypotensive and hypertensive effects of saponins,
chemical components in Primula veris. The
saponin may be responsible for this action. Two fl avonoids, quercetin and
apigenin, are responsible for the antiinfl ammatory and antispasmodic effects
of cowslip. These effects are common in all herbs with these chemical
components.
PHARMACOLOGICAL ACTIONS
IN VITRO AND ANIMAL STUDIES
The
saponin fraction has been reported to cause an initial hypotension followed by
a long-lasting hypertension in anaesthetised animals.(6) In vitro, the saponins
have been documented to inhibit prostaglandin (PG) synthetase, but to a lesser
extent than aspirin because of insignificant protein binding; to exhibit a
slight antiinflammatory effect against carrageenan rat paw oedema; to contract
isolated rabbit ileum; and to possess analgesic and antigranulation activity.(6)
Flavonoid and tannin constituents have been documented for cowslip. A variety
of activities has been reported for flavonoids including anti-inflammatory and
antispasmodic effects. The tannins are known to be astringent.
CLINICAL STUDIES
There
is a lack of clinical research assessing the effects of cowslip and rigorous
randomised controlled clinical trials are required.
ACTIVITIES
Allergenic (1; PH2); Analgesic (1; APA; CAN);
Antigranulation (1; APA; CAN); Antihistaminic (1; PNC); Antiinflammatory (1;
APA; CAN); Antioxidant (1; PNC); Antiradicular (1; PNC); Antispasmodic (1; APA;
CAN; HH2); Aperient (f; PNC); Astringent (1; APA; CAN); Candidicide (1; HH2);
Cardiotonic (f; APA; HH2); Decongestant (1; APA); Diuretic (1; APA; HH2; PH2;
PNC); Expectorant (2; HH2; KOM; PH2; PIP); Fungicide (1; HH2); Hemolytic (1;
CAN); Hypertensive (1; APA; CAN); Hypnotic (f; CAN); Hypotensive (1; APA; CAN);
Laxative (1; APA; HH2); Narcotic (f; MAD); Nervine (f; HH2); Neurotonic (f;
PH2); Piscicide (1; HH2); Secretolytic (2; KOM; PIP); Sedative (f; APA; HH2; PNC);
Vulnerary (1; APA).
INDICATIONS
Adenopathy (f; MAD); Anxiety (f; APA; CAN; PH2);
Apoplexy (f; MAD); Arthrosis (f; HH2; MAD; PH2); Asthma (f; APA; MAD; PHR;
PH2); Bronchosis (2; APA; MAD; PHR; PH2); Cancer (f; JLH); Cancer, liver (f;
JLH); Cancer, spleen (f; JLH); Candida (1; HH2); Catarrh (2; HH2; KOM; MAD;
PH2; PIP); Cold (1; APA); Congestion (1; APA); Conjunctivosis (f; MAD);
Constipation (1; APA; HH2); Cough (2; MAD; PHR; PH2); Cramp (1; APA; CAN; HH2;
PH2); Croup (f; MAD); Cystosis (f; HH2; MAD; PH2); Dermatosis (f; PH2);
Dizziness (f; PH2); Dropsy (f; HH2); Exanthema (f; HH2); Fungus (1; HH2); Gastrosis
(f; PH2); Gout (f; APA; MAD; PHR; PH2); Headache (f; HH2; PHR; PH2); Hepatosis (f;
JLH); High Blood Pressure (1; APA; CAN); Hysteria (f; CAN; HH2); Induration (f;
JLH); Infection (1; HH2); Inflammation (1; APA; CAN); Insomnia (f; APA; CAN;
HH2; PH2; PNC); Low Blood Pressure (1; APA; CAN); Migraine (f; HH2; PH2);
Mycosis (1; HH2); Myocardosis (f; HH2); Nephrosis (f; HH2; MAD; PH2); Neuralgia
(f; APA; HH2; PHR; PH2); Nervousness (f; APA; CAN; HH2; PNC); Ophthalmia (f;
JLH); Pain (1; APA; CAN); Palsy (f; PH2); Pertussis (f; APA; MAD; PHR; PH2);
Pyelosis (f; MAD); Respirosis (2; APA; KOM; PH2; PIP); Rheumatism (f; MAD;
PH2); Sore (f; MAD); Splenosis (f; JLH); Stomachache (f; HH2); Stomatosis (1;
HH2); Stress (1; APA); Trachoma (f; MAD); Tremor (f; PHR; PH2); Vertigo (f;
HH2; MAD; PHR; PH2); Water Retention (1; APA; HH2; PH2; PNC); Wound (f; MAD); Yeast
(1; HH2).
INDICATIONS AND USAGE
COWSLIP FLOWER
Approved by
Commission E:
•
Cough/Bronchitis
Unproven Uses: Cowslip flower
is used internally for catarrh of the respiratory tract. In folk medicine it is
used for insomnia, anxiety states, as a cardiac tonic for feelings of dizziness
and cardiac insufficiency. It is also used as a nerve tonic for shaking limbs,
headaches and neuralgia.
Homeopathic Uses: Primula veris is
used to treat headaches and skin rashes
COWSLIP ROOT
Approved by
Commission E:
•
Cough/Bronchitis
Unproven Uses: Cowslip root is
used internally for catarrh of the respiratory tract. In folk medicine it is
used internally for whooping cough, asthma, gout, rheumatic arthritis, bladder and
kidney disease, migraine, dizziness, stomach cramps, scurvy and neuralgia.
Externally it is used for headaches and skin impurities.
PRODUCT AVAILABILITY
Dried Herb, Fluid Extract
PLANT PART USED: Flowers
DOSAGES
DOSAGES
• Adult PO fluid extract: 1-2 ml tid (1:1 dilution in
alcohol 25%)
• Adult PO infusion: 1-2 g dried herb, tid
DOSAGES
Dosages
for oral administration (adults) for traditional uses recommended in standard
herbal reference texts are given below.
·
Dried
Flowers 1–2 g as an infusion
three times daily.(G7)
·
Liquid
Extract 1–2mL (1 : 1 in 25%
alcohol) three times daily.(G7)
DOSAGES
·
1 – 2 g flower as tea 3 ×/day (APA; CAN; HH2); 2 – 4 g flower (KOM; PH2; PIP);
·
1 – 2 ml liquid flower extract
(1:1 in 25% ethanol) 3 ×/day (APA; CAN); 2.5 – 7.5 g
flower tincture (KOM; PIP);
·
0.5 – 1.5 g root (KOM; PIP);
0.2 – 0.5 g finely cut root (PH2); 1.5 – 3 g root tincture (KOM; PIP).
DOSAGES
COWSLIP FLOWER
Mode of Administration: Cowslip
preparations are available as solid and liquid pharmaceutical forms for oral
intake and also available parenterally for homeopathic use.
Preparations: Tea: boiling
water is poured over 2 to 4 gm drug and strained after 10 minutes (1 teaspoon
corresponds to approximately 1.3 gm drug).
Liquid extract —
drug 1:1 with 25% ethanol (V/V) (BHP83)
Daily Dosage: The average daily
dose is 3 gm of drug. The single dose is 1 gm of drug.
Tea — 1 cup
several times a day. As a bronchial tea, several cups a day, possibly sweetened
with honey
Liquid extract —
1 to 2 ml 3 times a day
Homeopathic Dosage: 5 drops, 1
tablet or 10 globules every 30 to 60 minutes (acute) or 1 to 3 times daily
(chronic); parenterally: i to 2 ml sc acute: 3 times daily; chronic: once a day
(HAB34); different doses for children.
Storage: Should be
protected from light and moisture.
COWSLIP ROOT
Preparations: Tea: 0.2 to 0.5 gm
finely cut drug are added to cold water and brought to the boil, left to draw
for 5 minutes and strained (1 teaspoon corresponds to approximately 3.5 gm
drug).
Extract:
Percolation with 50 parts water and 50 parts ethanol, then filtration and
vacuum drying. The residue is dissolved in 60 parts ethanol and 40 parts water
and neutralized with ammonia. It is then cooled for 24 hours and filtered
again. It is finally dehydrated to produce a dry extract under low pressure.
(OAB90)
Liquid
extract: the Primula extract is dissolved in a mixture of ethanol (30 parts),
glycerol 85% (20 parts) and water (20 parts) and filtered when cool. (OAB90)
Tincture:
20 parts root and 100 parts diluted ethanol are processed to a tincture in
accordance with the OAB VII maceration procedure.
Syrup:
1.5 parts Cowslip are dissolved in 20 parts water while being heated. It is
then mixed with 10 parts 85% glycerol and 68.5 parts simple syrup. (OAB90)
Daily Dosage: The average daily
dose is 1 gm of drug. The single dose is 0.5 gm of drug.
Tincture:
The daily dose is 7.5 gm.
Extract:
The single dose is 0.1 to 0.2 gm.
Liquid
extract: The single dose is 0.5 gm.
Tea:
as an expectorant, 1 cup every 2 to 3 hours, sweetened with honey
Storage: Cowslip should
be protected from light.
OVERDOSAGE
COWSLIP FLOWER
Overdose could
lead to gastric complaints and nausea.
COWSLIP ROOT
Overdose could
lead to queasiness, nausea, gastric complaints and diarrhea.
PRECAUTIONS AND ADVERSE REACTIONS
COWSLIP FLOWER
No health
hazards or side effects are known in conjunction with the proper administration
of designated therapeutic dosages. The epigeal organs of the Primula species
possess a very high potential for sensitization due to the primine content. In
the cases of Primula veris and P. elatior, the primine content is quite low,
but sensitizations are nevertheless possible.
COWSLIP ROOT
No health
hazards or side effects are known in conjunction with the proper administration
of designated therapeutic dosages.
CONTRAINDICATIONS, INTERACTIONS, AND SIDE EFFECTS
CLASS 1 (AHP). Occasional GI distress and nausea recorded
(AHP). “Hazards and/or side effects not known for proper therapeutic dosages”
(PH2). Commission E reports for flower, contraindications: hypersensitivity; adverse
effects: GI disturbances (occasionally). For root, GI disturbances
(occasionally) (AEH; KOM). The Herbal PDR lists diarrhea, gastric discomfort,
nausea, and queasiness as side effects of the root (PH2). CAN cautions the
quinones are allergenic. May interfere with blood pressure therapy (CAN).
CONTRA-INDICATIONS, WARNINGS
Cowslip may cause an allergic reaction in sensitive individuals.
Drug Interactions None documented. However, the potential for preparations of
cowslip to interact with other medicines administered concurrently, particularly
those with similar or opposing effects, should be considered. There is limited
evidence from preclinical studies that cowslip has hypo- and hypertensive activity.
Pregnancy And
Lactation The safety of cowslip has
not been established. In view of the lack of toxicity data, use of cowslip during
pregnancy and lactation should be avoided.
CONTRAINDICATIONS
CLASS
1 HERB (FLOWER, ROOT).
Until more research is available, cowslip should not be
used during pregnancy and breastfeeding. It should not be given to children.
Cowslip should not be used by persons with hepatic disease, gastrointestinal
conditions, or hypersensitivity to this herb.
SIDE EFFECTS/ADVERSE REACTIONS
CV: Hyper/hypotension
GI: Nausea,
vomiting, anorexia, diarrhea, gastritis, hepatotoxicity
INTEG: Hypersensitivity
reactions, contact dermatitis
SYST: Hypersensitivity
INTERACTIONS
Drug
Antihypertensives,
diuretics: Cowslip may increase the effect
of antihypertensives, diuretics.
CNS depressants:
Cowslip may increase the effect
of antianxiety agents and sedatives/hypnotics; do not use concurrently.
Lab Test
AST, ALT,
alkaline phosphatase: Cowslip
may increase these levels.
EFFECTS
EFFECTS:
COWSLIP FLOWER
The drug has an expectorant
effect, which is due to the flavonoid and saponin content. An increase of the
volume of bronchial secretion has been demonstrated in animal experiments.
EFFECTS:
COWSLIP ROOT
The saponin content gives the
drug expectorant and diuretic effects. Recent studies on these effects are not
available. The mode of action is postulated to be due to vagal stimulation.
SIDE-EFFECTS, TOXICITY
There is a lack of clinical safety and toxicity data for cowslip
and further investigation of these aspects is required. Allergic contact
reactions to related Primula species have been documented; quinone compounds are
stated to be the allergenic principles with primin described as a strong
contact allergen.(7)
Two positive patch test reactions to cowslip have been recorded,
although allergenicity was not proven.(G51) An LD50 value (mice, intraperitoneal
injection) for the saponin fraction is documented as 24.5 mg/kg body weight
compared to a value of 9.5 mg/kg for reparil (aescin). Haemolytic activity has
been reported for the saponins, and an aqueous extract of cowslip is stated to
contain saponins that are toxic to fish. Saponins are stated to be irritant to the
gastrointestinal tract.
The toxicity of cowslip seems to be associated with the saponin constituents.
However, these compounds have only been documented for the underground plant
parts, and not for the flowers which are the main plant parts used in the UK.
CLIENT CONSIDERATIONS
ASSESS
·
Assess the reason the client is
using cowslip.
·
Assess for hypersensitivity
reactions, including contact dermatitis. If present, discontinue use of cowslip
and administer antihistamine or other appropriate therapy.
·
Assess for hepatotoxicity
(increased AST, ALT, bilirubin levels; jaundice; claycolored stools; right
upper-quadrant pain). If present, herb use should be discontinued and
appropriate action taken.
·
Assess for the use of
antihypertensives, antianxiety agents, diuretics, and sedative/ hypnotics (see
Interactions).
Administer
·
Instruct the client to store
cowslip products in a cool, dry place, away from heat and moisture.
Teach Client/Family
·
Caution the client not to use
cowslip in children or those who are pregnant or breastfeeding until more
research is available.
·
Inform the client that
scientifi c research is lacking to support any of the uses for or actions of
cowslip.
PREPARATIONS
PROPRIETARY
MULTI-INGREDIENT PREPARATIONS
Argentina: Expectosan Hierbas y Miel. Austria: Bronchithym; Cardiodoron;
Heumann's Bronchialtee; Krauter Hustensaft; Sinupret; Thymoval. Canada: Original
Herb Cough Drops. Czech Republic: Biotussil; Bronchialtee N; Bronchicum Elixir;
Bronchicum Hustensirup; Bronchicum Sekret-Loser; Sinupret. Germany: Bronchicum
Elixir S; Bronchicum; Bronchipret; Brust- und Hustentee; Cardiodoron;
Drosithym-N; Equisil N; Expectysat N; Harzer Hustenloser; Heumann Bronchialtee Solubifix
T; Kinder Em-eukal Hustensaft; Phytobronchin; Sinuforton; Sinuforton; Sinupret;
Solvopret; Tussiflorin Hustensaft; Tussiflorin Hustentropfen; TUSSinfant N. Hong
Kong: Sinupret. Hungary: Sinupret. Netherlands: Bronchicum. Russia: Bronchicum
(Бронхикум); Bronchicum Husten (Бронхикум Сироп от Кашля); Sinupret (Синупрет).
South Africa: Cardiodoron. Singapore: Sinupret. Switzerland: Demo- Pectol;
Kernosan Elixir; Pectoral N; Sinupret; Sirop pectoral contre la toux S; Sirop S
contre la toux et la bronchite; Strath Gouttes contre la toux; Strath Gouttes
pour les veines; Strath Gouttes Rhumatisme; Tisane pectorale pour les enfants. Thailand:
Sinupret; Solvopret TP. UK: Bio-Strath Willow Formula; Onopordon Comp B.
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
Figure
3. Primary Chemical Components and Possible Actions
(Linda, S-R. 2010)
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