Butterbur

Assessment and Plan: Butterbur, Petasites hybridus

• The most common dose of Butterbur is 50-150mg three times daily. When Butterbur is purchased, make sure that pyrrolizidine alkaloids have been removed, which that are potentially hepatotoxic and carcinogenic, and are standardized to a guaranteed 15% petasins.

• Butterbur without pyrrolizidine alkaloids removed was reported to cause liver enzyme elevation in 1 out of 61 patients when used for 2 weeks in one study. This may have been due to pyrrolizidine alkaloids found naturally in the herb. Side effects were reported in 3.8% of patients with mostly gastrointestinal complaints. If a patient decides to take butterbur (Petasites hybridus) supplement, it is vitally important that the pyrrolizidine alkaloids have been removed, and the label states that the product is “standardized to a guaranteed 15% petasins and certified free of pyrrolizidine alkaloids.”

• Butterbur (Petasites hybridus) is established in research to be effective for migraine prevention. After treatment over 3-4 months, research indicates that patients taking doses of 100 mg to 150 mg of butterbur (Petasites hybridus) extract per day reported a fewer number of migraines and some reported a more than 50% improvement in migraines.

• Butterbur (Petasites hybridus) helps alleviate symptoms in allergic rhinitis patients without the fatigue and drowsiness seen with the antihistamine Zyrtec (cetirizine). The study included petasites carbon dioxide extract ZE 339, a butterbur (Petasites hybridus) extract standardized to 8.0 mg of total petasine per tablet, four times daily.

• In a German prospective, non-randomized, open trial, 80 asthma sufferers (64 adults and 16 children/adolescents) who took 50 mg butterbur extract (Petadolex®) 3 times a day (children: 50-150 mg daily, depending on age) saw the number, duration, and severity of their asthma attacks decrease during an eight-week study period. The dose for each age group was not described in the study. Petadolex®, softgel capsules (manufactured by Weber & Weber International GmbH & Co. KG, Germany) contains 50 mg of a standardized lipophilic extract of the rhizome of Petasites hybridus. Of the patients taking inhaled asthma medication in addition to butterbur extract, 43% reduced the amount of medication used while they were taking butterbur extract. The manufacturing process of Petadolex® removes pyrrolizidine alkaloids that are potentially hepatotoxic and carcinogenic.