Ruscus aculeatus, also known as Butcher’s Broom, is a prickly plant made up of a strong root system native to the Mediterranean region. The stem and root of this herb is responsible for the medicinal properties. There are many disease conditions patients may attempt to treat with this agent, but the only indication with strong evidence for efficacy is chronic venous insufficiency. Venous insufficiency may be related to degradation of veins in the legs by dysfunction of venous valves, varicose veins, and phlebitis. It may be induced by long term use of combination oral contraceptive pills. In addition to its diuretic effect, Butcher’s Broom is known for its vasoconstrictive and anti-inflammatory effects. Butcher’s Broom can support the circulation by stimulating smooth muscle of blood vessels to constrict. Butcher’s Broom has also been reported to help relieve pain and heaviness in the limbs, as well as cramping and swelling. Some of the brand names produced with Butcher’s Broom include Cyclo 3 Fort and Phlebodril. This agent is also under investigation for orthostatic hypotension.
Ruscus aculeatus and chronic venous insufficiency:
A meta-analysis on Ruscus aculeatus: In a meta-analysis of 25 studies (n=10,246) of patients with chronic venous insufficiency (CVI), a condition in which the veins do not return blood from the legs to the heart well and is associated with leg swelling, leg pain, and itching. Cyclo 3 Fort (each capsule containes 150 mg Ruscus aculeatus, 150 mg hesperidin methyl chalcone, and 100 mg ascorbic acid), taken twice per day was found to be superior to placebo. Compared to placebo, Cyclo 3 Fort significantly reduced severity of pain (0.44 points on 4 point scale), cramps (0.26 points), heaviness (0.53 points), paraesthesia or tingling/burning/numbness of a person’s skin (0.29 points), and venous capacity (0.70 ml/100 ml). Edema was also significantly better among patients receiving Cyclo 3 Fort versus placebo. (1)
Ruscus aculeatus vs. placebo was studied for its effect on leg circumference in venous insufficiency. Vanscheidt W et al performed a multi-center, double-blind, randomized, placebo-controlled trial on the extract of Ruscus aculeatus rhizomes. This study found that leg volume and circumference significantly improved over placebo at 8 and 12 weeks. Adverse events were similar to placebo. (5)
Ruscus aculeatus and chronic phlebitis:
A venotropic agent containing 16.5 mg per capsule of ruscus aculeatus, 75 mg hesperidin, and 50 mg ascorbic acid was found to be better than a placebo for treating chronic phlebopathy of the lower limbs in a double-blind trial with 40 subjects. The trial involved 2 periods of treatment lasting 2 months with participants receiving 2 capsules or placebo administered 3 times daily. Symptoms and measures of changes in volume in the body were significantly better in response to ruscus aculeatus treatment. Ruscus aculeatus was also well tolerated. (2)
Ruscus aculeatus adverse reactions and interactions:
Ruscus aculeatus tolerability: Ruscus aculeatus was well tolerated in multiple studies but not without adverse effects.
Ruscus aculeatus mechanism of action: The herb is known to alleviate edema and venous insufficiency by venous constriction and activation of alpha receptors, but it also acts upon other types of blood vessels (4). For this reason, it is also being studied for use in orthostatic hypotension because it does not cause supine hypertension seen with other agents used for this condition (4). Therefore, caution should be exercised in patients with cardiovascular disease, hypertension, and patients taking blood pressure medications.
Ruscus aculeatus and the Gastrointestinal tract: Gastrointestinal side effects have been reported (5).
Ruscus aculeatus and skin reactions: This herb caused contact dermatitis when applied topically in a cream (3).
Assessment and Plan: Butcher’s Broom, Ruscus aculeatus
- Boyle P et al authored a meta-analysis of 25 studies which showed that Cyclo 3 Fort (150 mg Ruscus aculeatus, 150 mg hesperidin methyl chalcone, and 100 mg ascorbic acid) taken twice per day significantly reduced severity of pain, cramps, heaviness, paraesthesias, and edema versus placebo in patients with chronic venous insufficiency (1).
- Cappelli R et al found that 2 capsules 3 times daily of 16.5 mg per capsule of ruscus aculeatus, 75 mg hesperidin, and 50 mg ascorbic acid was found to be better than a placebo for treating chronic phlebopathy (phlebitis) of the lower limbs in a double-blind trial with 40 subjects (2).
- Vanscheidt W et al found that leg volume and circumference significantly improved over placebo at 8 and 12 weeks. Adverse events were similar to placebo. (5)
- Ruscus aculeatus was well tolerated in multiple studies but not without adverse effects. The herb is known to alleviate edema and venous insufficiency by venous constriction and activation of alpha receptors, but it also acts upon other types of blood vessels (4). Caution should be exercised in patients with cardiovascular disease, hypertension, and patients taking blood pressure medications since it may make blood pressure increase. Gastrointestinal side effects have also been reported (5). This herb caused contact dermatitis when applied topically in a cream (3).
References:
1.Boyle P, Diehm C, Robertson C. Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency. Int Angiol . 2003;22:250-262. http://www.ncbi.nlm.nih.gov/pubmed/14612852
2.Cappelli R, Nicora M, Di Perri T. Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res 1988;14(4):277–83. http://www.ncbi.nlm.nih.gov/pubmed/3048951
3.Susana Córdoba, Cristina Martínez-Moràn, Almudena Hernàndez-Nuñez, Jesús Borbujo , Dept of Dermatology, Hospital Universitario de Fuenlabrada, Camino del Molino Contact dermatitis from an anti-haemorroidal cream containing ruscogenin. European Journal of Dermatology. Volume 19, Number 3, 276-7, May-June 2009. http://www.jle.com/e-docs/00/04/49/6F/article.phtml
4.Redman DA. Ruscus aculeatus (butcher’s broom) as a potential treatment for orthostatic hypotension, with a case report. J Altern Complement Med. 2000 Dec;6(6):539-49. http://www.ncbi.nlm.nih.gov/pubmed/11152059
5.Vanscheidt W, Jost V, Wolna P, Lücker PW, Müller A, Theurer C, Patz B, Grützner KI. Efficacy and safety of a Butcher’s broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency. Arzneimittelforschung. 2002;52(4):243-50. http://www.ncbi.nlm.nih.gov/pubmed/12040966