MEADOWSWEET -- Filipendula ulmaria (L.) Maxim. (Rosaceae) ++

HERBAL

MEDICINAL

PLANT

 

 

 

 

 

 

 

 

 

 

 

                                                                          

    

  

 MEADOWSWEET  

Filipendula ulmaria (L.) Maxim. (Rosaceae) ++

 

BY

 

RETTODWIKART THENU

MEADOWSWEET

(meh’dow-sweet)

 

 

Filipendula ulmaria (L.) Maxim. (Rosaceae) ++

 

SUMMARY AND PHARMACEUTICAL COMMENT

The chemistry of meadowsweet is characterised by a number of phenolic constituents, including flavonoids, salicylates and tannins. Documented scientific evidence from preclinical studies supports some of the antiseptic, antirheumatic and astringent traditional uses. However, there is a lack of clinical research assessing the efficacy and safety of meadowsweet. No documented toxicity data were located for meadowsweet and, in view of this, excessive use of meadowsweet and use during pregnancy and lactation should be avoided.

Meadowsweet was one of the most sacred herbs used by ancient Celtic druid priests, hundreds of years ago (Blumenthal et al 2000). Modern-day aspirin owes its origins to the salicin content isolated from meadowsweet in the early 1800s. In fact, the name aspirin relates to this herb’s former genus name ‘Spiracea’.

 

TRADE NAMES

Meadowsweet

 

OTHER COMMON NAMES

Fleur D’ulmaire, Flores Ulmariae, Gravel Root, Meadow Queen, Meadwort, Mede-sweet, Spierstaude

Bridewort, Dolloff, Dropwort, Lady of the Meadow, Meadow-wort, Queen of the Meadow, Spireae Flos.

 

DESCRIPTION

MEDICINAL PARTS: The medicinal parts are the dried flowers, the dried aerial parts ~6f the flowering plant, and the fresh underground and aerial parts of the flowering plant.

FLOWER AND FRUIT: The radial flowers are in terminal compound, loose cymes arranged with erect, very irregular branches. The 5 to 6 free sepals are triangular, pointed, 1 mm long, downy on the outside and fused to the flat receptacle at the base. The 5 to 6 petals are obviate, narrowed to a short stem, yellowish white and 2 to 5 mm long. The ovaries are glabrous or downy and have a flattened-stigma-bearing style under 1 mm. The one-seeded indehiscent fruit twine in a spiral.

LEAVES, STEM AND ROOT: The plant is perennial and grows to about 50 to 200 cm high. The stem is erect, simple or branched above, woody below, angular, usually glabrous or occasionally tomentose. The leaves are alternate, longpetioled to almost sessile, irregularly odd-pinnate with paired opposite pinna. These are ovate, rounded at the base or shortwedge-shaped, double serrate to dentate. The pinna is dark green and usually glabrous above and gray to white tomentose beneath and only pubescent on the ribs.

CHARACTERISTICS: The leaves smell very different from the flowers, having a pleasant, almond-like fragrance.

HABITAT: The plant is found in northern and southern Europe, North America and northern Asia.

PRODUCTION: Meadowsweet flower consists of the dried flower of Filipendula ulmaria (syn. Spiraea ulmaria), as well as its preparations. Meadowsweet herb consists of the dried above-ground parts of Filipendula ulmaria, harvested during flowering season, as well as its preparations. The plant is combed off during the flowering season and air-dried in a dark place.

NOT TO BE CONFUSED WITH: May be confused with elder flowers and Filipendula hexapetala.

 

SPECIES (FAMILY)

Filipendula ulmaria, Spiraea ulmaria

 

SYNONYM(S)

Dropwort, Filipendula, Queen of the Meadow

 

ORIGIN

Meadowsweet is a perennial shrub found in Europe and North America.

 

PHARMACOPODIAL AND OTHER MONOGRAPHS

BHC 1992(G6)

BHP 1996(G9)

BP 2007(G84)

Complete German Commission E(G3)

Martindale 35th edition(G85)

Ph Eur 2007(G81)

 

LEGAL CATEGORY (LICENSED PRODUCTS)

GSL(G37)

 

CONSTITUENTS

The following is compiled from several sources, including General References G2 and G6.

Flavonoids Flavonols, flavones, flavanones and chalcone derivatives (e.g. hyperoside(1) and spireoside,(2) kaempferol glucoside(3) and avicularin.(4)

Salicylates Main components of the volatile oil including salicylaldehyde (major, up to 70%), gaultherin, isosalicin, methyl salicylate, monotropitin, salicin, salicylic acid and spirein.(5–8)

Tannins 1% (alcoholic extract), 12.5% (aqueous extract).(5)

Hydrolysable type;(9) leaf extracts have also yielded catechols,(1) compounds normally associated with condensed tannins.

Volatile Oils Many phenolic components including salicylates (see above), benzyl alcohol, benzaldehyde, ethyl benzoate, heliotropin, phenylacetate, vanillin.(4, 5)

Other Constituents Coumarin (trace),(1) mucilage, carbohydrates and ascorbic acid (vitamin C).

 

COMPOUNDS

COMPOUNDS: MEADOWSWEET FLOWER

Flavonoids: chief components - spiraeoside (quercetin-4'-0- glucosides, 3-4%), further including among others kaempferol-4'-0-glucosides, hyperoside, rutin

Volatile oil (0.2%): chief components salicylaldehyde andmethyl salicylate (yielded through dehydration from monotropitin- salicylaldehyde primveroside - and spiraeine - salicylic acid ester primveroside), further, a little vanillin and heliotropine

Tannins: ellagic tannins

 

COMPOUNDS: MEADOWSWEET HERB

Etheric oil (traces): including salicylic acid ester

Flavonoids: including rutin, hyperoside, quercetin-3-O-glucuronide, auercetin-3-O-arabinoside

Tannins: ellagic tafinins

 

CHEMICAL COMPONENTS

Phenolic glycosides, essential oil, tannins, mucilage, flavonoids (up to 6% in fresh flowers) and ascorbic acid. The herb also contains various salicylate constituents including methyl salicylate, salicin and salicylic acid.

 

USES

USES

Traditionally, meadowsweet has been used to treat gastrointestinal disorders such as gastritis, heartburn, indigestion, irritable bowel syndrome, and peptic ulcer disease. It has also been used to treat urinary tract infections, joint and rheumatic muscle pains, headache, fever, colds, and cancer.

 

FOOD USE

Meadowsweet is listed by the Council of Europe as a natural source of food flavouring (category N2). This category indicates that meadowsweet can be added to foodstuffs in small quantities, with a possible limitation of an active principle (as yet unspecified) in the final product.(G16) Previously, meadowsweethas been listed by the Food and Drugs Administration (FDA) as a Herb of Undefined Safety.(G22)

 

HERBAL USE

Meadowsweet is stated to possess stomachic, mild urinary antiseptic, antirheumatic, astringent and antacid properties. Traditionally, it has been used for atonic dyspepsia with heartburn and hyperacidity, acute catarrhal cystitis, rheumatic muscle and joint pains, diarrhoea in children, and specifically for the prophylaxis and treatment of peptic ulcer.(G2, G6, G7, G8,G64)

 

CLINICAL USE

Meadowsweet has not been significantly investigated under clinical trial conditions, so evidence is largely derived from traditional, in vitro and animal studies.

Supportive therapy for colds

Commission E approval for this condition is based on historical use in well-established systems of medicine, in vitro tests and animal studies (Blumenthal et al 2000).

Acne

Researchers believe that Filipendula may stimulate the skin’s natural immune mechanisms, reducing bacterial colonies and therefore limiting the complications of acne (Lenaers et al 2007). Volunteers used the Filipendula preparation twice a day for 28 days and found a reduction in acne spots by 10%, an improvement in the homogeneity of the skin grain by 21% and a reduction of inflammatory lesions by 20%. Bacterial infiltration of lesions was also reduced by 22%.

Gastrointestinal conditions

Meadowsweet is often used to treat gastrointestinal conditions associated with hyperacidity, such as gastritis, acidic dyspepsia and peptic ulceration. In vivo testing has found a decoction made from flowers of meadowsweet reduced experimentally induced ulcers caused by acetylsalicylic acid. Additionally, it promoted healing of chronic stomach ulcers induced by ethanol (Barnaulov & Denisenko 1980). Currently, there is no evidence available to confirm an antacid activity.

Conditions associated with mild-tomoderate pain

Based on its significant salicylate content, meadowsweet is also prescribed for conditions associated with mild-to-moderate pain. However, no clinical study is available to confirm efficacy.

 

OTHER USES

Meadowsweet has traditionally been used as a treatment for diarrhoea based on the herb’s appreciable tannin content. It has also been used for conditions associated with mild-to-moderate pain (most likely due to the herb’s significant salicylate content), fever and inflammation.

 

 

Figure 1. Meadowsweet (Filipendula ulmaria).

 

Figure 2. Meadowsweet – dried drug substance (herb).

 

ACTIONS

Anticoagulant Action

In one study focusing on the anticoagulant effects of meadowsweet, extracts were administrated orally and anticoagulant levels tested (Liapina et al, 1993). The flowers and seeds showed a high level of anticoagulant activity. Another study using various methods showed that all components of meadowsweet exhibit heparin-like action (Kudriashowv et al, 1991). A third study showed similar results (Kudriashowv et al, 1990).

Antiinfective Action

A study evaluating the antimicrobial effects of various herbs found that those with the greatest effect against bacteria were meadowsweet, willow herb, cloudberry, and raspberry (Rauha et al, 2000, Ryzhikov et al, 2006).

Antioxidant Action

When researchers used spectrometry to evaluate the antioxidative activity of 92 phenolic extracts from plants, meadowsweet showed a high level of antioxidative activity calculated as gallic acid equivalents (Kahkonen et al, 1999).

Anticancer Action

One study found that meadowsweet caused a signifi cant decrease in precancerous changes in mice. Mice with cervical dysplasia or carcinoma of the vagina were given meadowsweet prepared from fl owers. A 67% drop in dysplasia occurred, and no recurrence was observed in 10 subjects considered completely cured in 1 year (Peresun’ko et al, 1993). Spiridonov et al (2005) studied the cytotoxicity of Russian ethnomedicinal plants including meadowsweet. The crude ethanol extract tested on cell growth exceeded the cytotoxicity of cyclophosphamide and fluoracil.

Antiulcer Action

One foreign study has demonstrated the antiulcer action of meadowsweet. The herb was shown to decrease formation of stomach lesions when reserpine injections were given to rats or mice (Barnaulov et al, 1980).

 

PHARMACOLOGICAL ACTIONS

IN VITRO AND ANIMAL STUDIES

Lowering of motor activity and rectal temperature, myorelaxation and potentiation of narcotic action have been documented for meadowsweet.(5) In addition, flower extracts have been reported to prolong life expectancy of mice, lower vascular permeability and prevent the development of stomach ulcers in rats and mice.(5, 10, 11) However, meadowsweet has also been reported to potentiate the ulcerogenic properties of histamine in the guinea-pig.(10) The

anti-ulcer action documented for meadowsweet is associated with the aqueous extract and greatest activity has been observed with the flowers.(9, 11) Meadowsweet has been reported to increase bronchial tone in the cat(9) and to potentiate the bronchospastic properties of histamine in the guinea-pig.(9) In vitro, meadowsweet has been reported to increase intestinal tone in the guineapig and uterine tone in the rabbit.(9) Bacteriostatic activity against Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Proteus vulgaris and Pseudomonas aeruginosa has been documented for flower extracts.(12) Tannins are generally considered to possess astringent properties and have been reported as constituents of meadowsweet. Meadowsweet is stated to promote uric acid excretion.(G42)

 

CLINICAL STUDIES

There is a lack of clinical research assessing the effects of meadowsweet and rigorous randomised controlled clinical trials are required.

 

MAIN ACTIONS

Gastroprotective effects

In vivo tests have identified protective effects against stomach ulcers induced by acetylsalicylic acid, but no protection was seen against ulcers produced under high-acid environments or due to stimulation by histamine (Barnaulov & Denisenko 1980). Based on these observations, it appears that the effect may involve a prostaglandin (PG)-mediated mechanism.

Hepatoprotective

An in vivo trial has demonstrated the hepatoprotective and antioxidant effects of meadowsweet (Shilova et al 2006). Meadowsweet extract (70% ethanol, 100 mg/kg) was shown to improve liver function in carbon tetrachloride (CCL4)-induced hepatitis in rats. In many parameters, the extract was shown to be more effective than Carsil, a silymarin preparation well known for its hepatoprotective ability.

 

OTHER ACTIONS

In vitro tests have identified antioxidant and anticoagulant activities (Calliste et al 2001, Liapina & Koval’chuk 1993). Bacteriostatic activity has also been reported in vitro against Staphylococcus aureus, S. epidermidis, Escherichia coli, Proteus vulgaris and Pseudomonas aeruginosa (Rauha et al 2000). Whether meadowsweet exerts antiinflammatory and analgesic effects because of its high salicylate content is unknown and remains to be tested.

 

ACTIVITIES

Analgesic (1; APA; CRC; WAM); Antacid (1; MAB; PNC); Antiaggregant (1; APA; MAB); Antibacterial (1; APA; MAB; PNC); Anticapillary Fragility (1; CAN); Anticarcinogenic (1; MAB); Anticomplement (1; MAB); Antiinflammatory (1; APA; MAB; PHR; PH2); Antipyretic (1; BGB; CAN; CRC; PH2); Antirheumatic (1; CAN; CRC; PNC); Antiseptic (1; CAN; CRC; PH2); Antispasmodic (f; CRC); Antithrombic (1; MAB); Antitumor (1; APA); Antiulcer (1; MAB; PNC); Astringent (1; APA; MAB; PHR; PH2); Bronchospastic (1; CAN); CNS Depressant (1; MAB); Deodorant (1; APA); Depurative (f; CRC); Diaphoretic (1; APA; CRC; MAB); Diuretic (1; APA; MAB; PHR; PH2); Elastase Inhibitor (1; MAB; X2131766); Enterotonic (1; PNC); Fibrinolytic (1; APA); Hemostat (f; CRC); Immunomodulator (1; MAB); Mucoprotective (1; MAB); Myorelaxant (1; CAN; MAB); Sedative (f; CRC); Stomachic (f; BGB; CRC; PNC); Tonic (f; CRC); Urinary Antiseptic (1; CAN); Uricosuric (1; CAN); Uterotonic (1; PNC); Vulnerary (1; MAB).

 

INDICATIONS

Acne (1; CRC; MAB); Ague (f; CRC); Arthrosis (1; APA; CAN; MAB; PH2); Ascites (f; CRC; HHB); Bacteria (1; APA; MAB; PNC; X10857921); Bladder Stone (f; CRC); Bleeding (f; CRC); Blennorrhea (f; CRC); Bronchosis (2; KOM; PH2); Bruise (f; PIP); Cancer (1; APA; JLH); Capillary Fragility (1; CAN); Cardiopathy (1; MAB); Catarrh (f; CAN; MAB); Cellulitis (1; MAB); Cervical Dysplasia (1; MAB); Cholecystosis (1; BGB; CRC); Cold (2; APA; KOM; PH2); Congestion (f; CRC; MAB); Contusion (f; PIP); Cough (2; PHR; PH2); Cramp (f; APA; CRC); Cystosis (f; CAN; CRC; MAB; PH2); Debility (1; MAB); Dermatosis (f; CRC); Diarrhea (f; APA; CAN; MAB; PH2); Dropsy (f; CRC; HHB); Dysmenorrhea (1; APA); Dyspepsia (f; APA; BGB); Dyspnea (f; CRC); Eczema (f; CRC); Edema (1; CRC; MAB); Enterosis (1; MAB); Epilepsy (f; CRC); Fever (1; APA; BGB; CAN; CRC; MAB; PH2); Flu (1; BGB); Gastrosis (1; BGB; CRC; MAB; PH2); Gastroesophageal Reflux Disease (f; MAB); Gout (1; CAN; CRC; MAB; PHR; PH2); Gravel (f; MAB); Halitosis (f; MAB); Headache (1; CRC; MAB; PH2; WAM); Heart (f; CRC); Heartburn (f; CAN); Hematoma (f; PIP); Hepatosis (f; MAB); Hoarseness (f; CRC); Hyperacidity (f; CAN; MAB; PH2); Infection (1; WAF; X10857921); Inflammation (1; APA; MAB; PHR; PH2); Insomnia (f; CRC); Kidney Stone (f; CRC); Leukorrhea (1; MAB); Melancholy (f; CRC); Menorrhagia (f; MAB); Mucososis (f; PH2); Myalgia (1; BGB; CRC; PH2; PIP; WAM); Nephrosis (f; CRC; MAB; PH2); Nervousness (f; CRC); Neuralgia (1; CRC); Old Age (f; CAN); Pain (1; APA; BGB; CRC; WAM); Phlegm (f; CRC); Puerperium (f; MAB); Pulmonosis (f; CRC); Pyelosis (f; CRC; HHB); Respirosis (f; CRC); Rheumatism (1; CAN; CRC; MAB; PHR; PH2; PIP; PNC); Sinusosis (f; WAF); Sore Throat (f; CRC); Sprain (f; PIP); Stomachache (f; MAB); Stone (1; MAB); Strain (f; PIP); Strangury (f; CRC); Swelling (1; CRC; MAB); Tapeworm (f; CRC); Thrombosis (1; MAB); Toothache (1; APA); Tumor (1; APA); Ulcer, peptic (prevent and treat) (1; APA; MAB; PH2; PNC; WAF); UTI (1; APA); Vaginosis (1; MAB); Vertigo (f; CRC; MAB); Water Retention (1; APA; MAB; PHR; PH2); Worm (f; CRC).

 

INDICATIONS AND USAGE

Approved by Commission E:

• Cough

• Bronchitis

• Fever and cold

Meadowsweet is used as supportive therapy for colds, for febrile colds, and as a diuretic.

UNPROVEN USES: In folk medicine Meadowsweet is used as a diuretic, for rheumatism of the joints and muscles, for gout, for bladder and kidney disease and for headaches. Meadowsweet herb is used for stomach complaints with hyperacidity, prophylaxis and therapy of stomach ulcers and for diarrhea in children.

HOMEOPATHIC USES: Filipendula ulmaria is used for rheumatism and inflammation of mucous membrane.

 

PRODUCT AVAILABILITY

Dried Flowers, Dried Herb, Fluid Extract, Infusion, Powder, Tablets, Tincture

PLANT PARTS USED: Dried Flowers, Other above-ground parts

 

DOSAGES

 

DOSAGES

·        Adult PO dried flowers: 2.5-3.5 g daily (Blumenthal, 1998)

·        Adult PO dried herb: 1.5-5 g bid-tid

·        Adult PO fluid extract: 2-3 mL tid (1:1 dilution in 25% alcohol)

·        Adult PO infusion: 3-6 g prepared with 100 mL every 2 hr

·        Adult PO powder: 1⁄2 tsp dissolved in 1 oz water

·        Adult PO tincture: 2-4 mL bid-tid (1:5 dilution in 25% alcohol)

 

DOSAGES

Dosages for oral administration (adults) for traditional uses recommended in standard herbal reference texts are given below.

·        Dried Herb   4–6 g as an infusion three times daily.(G6, G7)

·        Liquid Extract   1.5–6.0 mL (1 : 1 in 25% alcohol) three times daily.(G6, G7)

·        Tincture   2–4mL (1 : 5 in 45% alcohol) three times daily.(G6, G7)

 

DOSAGES

·        1–2 tsp flowers in tea several ×/day (APA); 1 tbsp flowers/cup, 1–2 cups in morning (HHB);

·        2.5–3.5 g flowers (KOM; MAB; PH2; PIP); 2–4 mL liquid flower extract (APA);

·        4–5 g herb (KOM; MAB; PH2; PIP); 4–6 g herb, or in tea, 3 ×/day (CAN);

·        1.5–6 mL liquid herb extract (1:1 in 25% ethanol) 3 ×/day (CAN);

·        2–4 mL herb tincture (1:5 in 45% ethanol) 3×/day (CAN).

 

DOSAGES

As no clinical trials are available to determine effective doses, the following doses are a general guideline.

·        Fresh Flowers: 2.5–3.5 g/day.

·        Fresh Herb: 4–5 g/day.

·        Infusion: steep 2–3 g in 150 mL boiled water for 10 min and drink as hot as tolerable.

·        Fluid Extract (1:1) (g/mL): 2–3 mL/day.

 

DOSAGES

MODE OF ADMINISTRATION: Comminuted drug and other galenic preparations for infusions. Meadowsweet flower is contained in various tea mixtures which are used for the flu, rheumatism, kidney and bladder inflammations.

PREPARATION: To prepare an infusion, pour boiling water over 3 to 6 gm cut drug, steam for 10 minutes and then strain.

·        Fluid extract (herb): 1:1 in 25% ethanol (BHP83).

·        Tincture (herb): 1:5 in 45% ethanol (BHP83)

DAILY DOSAGE: 2.5 to 3.5 gm of Meadowsweet flower or 4 to 5 gm Meadowsweet herb. Infusion dosage is 1 cup several times a day (1 tsp. = 1.4 gm drug). Liquid extract (herb) daily dose: 1.5 to 6 mL; Tincture (herb) daily dose: 2 to 4 mL

HOMEOPATHIC DOSAGE: 5 drops, 1 tablet or 10 globules every 30 to 60 minutes (acute),or 1 to 3 times daily (chronic); from D6: parenterally: 1 to 2 mL sc acute: 3 times daily; chronic: once a day (HAB1)

STORAGE: Should be protected from light and moisture.

 

OVERDOSAGE

Overdosage can lead to queasiness and stomach complaints.

 

PRECAUTIONS AND ADVERSE REACTIONS

No health hazards or side effects are known in conjunction with die proper administration of designated therapeutic dosages.

 

ADVERSE REACTIONS

Although salicylates are present, they appear to cause less gastrointestinal irritation than acetylsalicylic acid. In fact, a meadowsweet preparation protected against acetylsalicylic acid-induced stomach ulcers in vivo (Barnaulov & Denisenko 1980).

 

CONTRAINDICATIONS, INTERACTIONS, AND SIDE EFFECTS

CLASS 1 (AHP). “Hazards and/or side effects not known for proper therapeutic dosages” (PH2). For the flower, Commission E reports hypersensitivity to salicylates (AEH). Overdosage might cause gastric distress and queasiness (PHR). In view of the lack of toxicological data, excessive use, especially during lactation and pregnancy, should be avoided. Contraindicated with aspirin or salicylate allergy due to potential for cross-reactivity (O’Brien, 1998). Individuals with aspirin hypersensitivity, asthma, diabetes, gout, hemophilia, hepatosis, hypothrombinemia, nephrosis, and peptic ulcers should be cautious with salicylates. Alcohol, barbiturates, and oral sedatives may potentiate salicylate toxicity. Beware of salicylate interaction with oral anticoagulants, methotrexate, metoclopramide, phenytoin, pronebecid, spironolactone, and valproate. Salicylates excreted in breast milk reportedly can cause macular rashes in breast-fed babies (CAN). Avoid use during viral infections (WAM). Flower extracts are bacteriostatic, prolong life expectancy of mice, lower vascular permeability, promote excretion of urine acid, and prevent gastric ulcers (but can potentiate ulcerogenic activity of histamine). Salicin does not irritate the stomach (CAN).

 

CONTRAINDICATIONS AND PRECAUTIONS

Meadowsweet should not be taken by people with salicylate sensitivity. Suspend use of concentrated extracts 1 week before major surgery.

 

PREGNANCY USE

Safety unknown.

 

CONTRA-INDICATIONS, WARNINGS

Salicylate constituents have been documented and therefore the usual precautions recommended for salicylates are relevant for meadowsweet (see Willow). Meadowsweet is stated to be used for the treatment of diarrhoea in children, but in view of the salicylate constituents, this is not advisable. Bronchospastic activity has been documented in preclinical studies and, therefore, it is prudent to advise that meadowsweet should be used with caution by asthmatics. Aqueous extracts have been reported to contain high tannin concentrations and excessive consumption should therefore be avoided.

Drug interactions None documented. However, the potential for preparations of meadowsweet to interact with other medicines administered concurrently, particularly those with similar or opposing effects, should be considered.

Pregnancy and lactation In vitro utero-activity has been documented for meadowsweet. In view of the salicylate constituents and the lack of toxicity data, the use of meadowsweet during pregnancy and lactation should be avoided.

 

CONTRAINDICATIONS

Preparations are contraindicated when sensitivity to salicylate exists.

 

CONTRAINDICATIONS

Pregnancy category is 4; Breastfeeding category is 3A. Meadowsweet should not be given to children. It should not be used by persons with asthma or hypersensitivity to salicylates.

 

SIDE EFFECTS/ADVERSE REACTIONS

GI: Nausea, vomiting, anorexia

INTEG: Hypersensitivity reactions

RESP: Bronchospasm

 

INTERACTIONS

Drug

Anticoagulants: Anticoagulants (heparin, warfarin), and salicylates may increase the risk of bleeding when used with meadowsweet; avoid concurrent use.

Iron salts: Meadowsweet may decrease the absorption of iron salts; separate by 2 hours.

Opioids: Meadowsweet may increase the action of opioids (Jellin et al, 2008).

Herb

Anticoagulant herbs: Meadowsweet given with anticoagulant herbs may increase risk of bleeding (theoretical).

 

SIGNIFICANT INTERACTIONS

Controlled studies are not available; therefore, interactions are based on evidence of activity and are largely theoretical and speculative.

Aspirin and simple analgesics

Theoretically, meadowsweet may enhance antiinflammatory and antiplatelet effects. Observe patients taking this combination — beneficial interaction possible.

Iron

Separate doses of iron and meadowsweet by 2 hours.

Warfarin

As increased bleeding may occur, observe patients taking warfarin concurrently. The herb has been shown to exert anticoagulant activity in vitro and in vivo, but the clinical significance of these results is unknown (Liapina & Koval’chuk 1993).

 

EFFECTS

EFFECTS: MEADOWSWEET FLOWER

Meadowsweet has antiphlogistic and astringent effects. The drug, which contains salicylate, has an antimicrobial, antipyretic and diuretic effect. In animal tests the flavonoid fraction had a positive effect on die healing of stomach ulcers and a tone-increasing effect on smootJi muscle was observed.

 

EFFECTS: MEADOWSWEET HERB

The drug, which contains salicylate, has an antimicrobial, antipyretic and diuretic effect. In animal tests the flavonoid fraction had a positive effect on the healing of stomach ulcers and a tone-increasing effect on smooth muscle was observed.

 

SIDE-EFFECTS, TOXICITY

None documented. However, there is a lack of clinical safety and toxicity data for meadowsweet and further investigation of these aspects is required.

 

CLIENT CONSIDERATIONS

ASSESS

·        Assess the reason the client is using meadowsweet.

·        Assess for hypersensitivity reactions. If present, discontinue the use of meadowsweet and administer an antihistamine or other appropriate therapy. Clients with salicylate sensitivity or asthma should not use this herb.

·        Assess for the use of anticoagulants (heparin, warfarin), salicylates; these drugs should be avoided when using this herb (see Interactions).

·        Monitor coagulation studies if the client is taking high doses of meadowsweet over a long period.

 

ADMINISTER

·        Instruct the client to store meadowsweet products in a cool, dry place, away from heat and moisture.

 

TEACH CLIENT/FAMILY

·        Inform the client that pregnancy category is 4 and breastfeeding category is 3A.

·        Caution the client not to give meadowsweet to children.

 

PATIENTS’ FAQs

What will this herb do for me?

Traditionally, the herb has been used to treat gastrointestinal

complaints such as dyspepsia and diarrhoea,

urinary tract infections and joint aches and pains. It is also used as supportive therapy for the

common cold.

When will it start to work?

Symptomatic relief should be experienced within

the first few doses.

Are there any safety issues?

People who are salicylate sensitive should not take meadowsweet.

 

PRACTICE POINTS/PATIENT COUNSELLING

·        Meadowsweet is traditionally used as a herbal antacid, analgesic and antipyretic, antidiarrhoeal and treatment for urinary tract infections.

·        Commission E approves its use as supportive therapy for the common cold.

·        It contains several different salicylates that are thought to be responsible for much of its clinical activity; however, this remains to be proven.

·        Although it contains salicylates, the herb does not appear to cause significant gastrointestinal irritation and may, in fact, have anti-ulcer activity.

·        People who are salicylate sensitive should not take this herbal medicine.

·        In practice, it is often combined with herbs such as chamomile and marshmallow in the treatment of gastrointestinal complaints.

 

PREPARATIONS

PROPRIETARY MULTI-INGREDIENT PREPARATIONS

Czech Republic: Antirevmaticky Caj. France: Mediflor Tisane Antirhumatismale No 2; Mediflor Tisane No 4 Diuretique; Polypirine. Italy: Pik Gel. Spain: Dolosul; Natusor Harpagosinol; Natusor Renal. Switzerland: Urinex. UK: Acidosis; Acidosis; Indigestion Mixture; Napiers Uva Ursi Tea; Roberts Acidosis Tablets. USA: Amerigel.

 

 

 

REFERENCE

 

 

Barnes, J., Anderson, L. A., and Phillipson, J. D. 2007. Herbal Medicines Third Edition. Pharmaceutical Press. Auckland and London.

 

Braun, L and Cohen, M. 2010. Herbs & Natural Supplements – An Evidence Based Guide 3rd Edition. Elsevier Australia. Australia

 

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.