HERBAL
MEDICINAL
PLANT
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.
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