About Herbs, Botanicals & Other Products

Scientific Name
Petasites hybridus
Top
Common Name

Butterbur, Butter dock, Bog rhubarb, Exwort

Top
Brand Name

ZE 339 (a standardized carbon dioxide extract of butterbur that contains 8mg petasine, Petadolex

Top
Clinical Summary

Butterbur is an herb native to Europe, south western Asia, and north Africa. The leaf and root extracts of Butterbur have been used to treat allergies, bronchial asthma, headache, pain, and muscle and urinary tract spasms. Petasins, the sesquiterpene compounds found in Butterbur, are thought to be the active constituents (1) (2) (3).

Leaf and root extracts of Butterbur are effective in controlling migraines in adults and in children (4) (5) (6) (17) (19) and asthma (7). Butterbur extract may also be effective against somatoform disorders (20).
But results from studies on allergic diseases are mixed. Some studies suggest the efficacy of Butterbur extract is comparable to standard antihistamine drugs (8) (9) (10) for allergic rhinitis but conflicting data indicate that it is no better than placebo for intermittent rhinitis (11) or for allergic skin disease (12). A systematic review of trials suggests the need for more rigorous studies before recommending use of Butterbur (13).
Raw butterbur extract may contain excessive toxic pyrrolizidine alkaloids that can cause liver damage (14).

Top
Purported Uses
  • Allergic rhinitis
  • Asthma
  • Migraine
Top
Constituents
  • Pyrrolizidine alkaloids
  • Sesquiterpene esters: petasin, furanopetasin
    (13)
Top
Mechanism of Action

The sesquiterpene petasin is thought to be responsible for butterbur's anti-inflammatory and antiallergic effects by blocking leukotriene and histamine activities (15). Petasins were also shown to have calcium channel blocking effects (18) making them effective for migraine prophylaxis (1). The vasorelaxation effects of petasin may be via direct Ca(2+) antagonism of L-type voltage-dependent Ca(2+) channel (VDCC) in vascular smooth muscle (21). Butterbur extract showed dose-dependent inhibition effect on cyclooxygenase (COX2) and prostaglandin E2 in vitro that is not correlated to the petasin content (16).

Top
Contraindications
  • Hypersensitivity to Butterbur
  • Patients with liver disease or dysfunction should avoid raw butterbur extract with pyrrolizidine alkaloids due to potential for hepatotoxicity.
Top
Literature Summary and Critique

Grossman W, Schmidramsl H. An extract of Petasites hybridus is effective in the prophylaxis of migraine. Altern Med Rev 2001;6(3):303-10.
Sixty patients with migraine received either butterbur extract or placebo 50 mg twice daily for 12 weeks. Compared to baseline, the frequency of attacks with butterbur decreased by a maximum of 60%. Results were also significant in favor of butterbur extract for the prevention of migraines compared to placebo (p<0.05). Butterbur was well tolerated with no adverse effects.


Danesch UC. Petasites hybridus (Butterbur root) extract in the treatment of asthma—an open trial. Altern Med Rev 2004;9(1):54-62.
In a prospective, non-randomized open trial, 80 patients were treated for two months with butterbur extract followed by two months of optimal intake of extract. Patients had either mild or moderate asthma and were allowed to continue to receive their asthma medication. The number, duration, and severity of asthma attacks decreased, while peak flow, forced ecpiratory volume (FEV1) and all measured symptoms improved during therapy. Forty percent of patients who were receiving asthma medications reduced their intake of the medications during the course of the study. Adverse events were considered not related to the use of butterbur and did not lead to withdrawal of any subjects in the study.

Lee DK, Gray RD, Robb FM, et al. A placebo-controlled evaluation of butterbur and fexofenadine on objective and subjective outcomes in perennial allergic rhinitis. Clin Exp Allergy 2004;34(4):646-9.
In a double-blind crossover placebo-controlled trial, 16 patients were randomized to receive butterbur 50 mg twice a day, fexofenadine 180 mg, or placebo. Peak nasal inspiratory flow (PNIF) was evaluated. There was a significant PNIF fall from baseline with butterbur compared to placebo. There was also a reduction in total nasal symptoms. Authors conclude that butterbur and fexofenadine may be equally effective in improving nasal symptoms in allergic rhinitis.

Top
References
  1. Thomet OA. Wiesmann UN, Schapowal A, et al. Role of petasin in the potential anti-inflammatory activity of a plant extract of petasites hybridus. Biochem Pharmacol 2001;61(8):1041-7.
  2. Thomet OA, Simon HU. Petasins in the treatment of allergic diseases: results of preclinical and clinical studies. Int Arch Allergy Immunol 2002;129(2):108-12.
  3. Saritas Y, von Reuss SH, Konig WA. Sesquiterpene constituents in Petasites hybridus. Phytochemistry 2002;59(8):795-803.
  4. Diener HC, Rahlfs VW, Danesch U, The first placebo-controlled trial of a special butterbur root extract for the prevention of migraine: reanalysis of efficacy criteria. Eur Neurol 2004;51(2):89-97.
  5. Grossman W, Schmidramsl H. An extract of Petasites hybridus is effective in the prophylaxis of migraine. Altern Med Rev 2001;6(3):303-10.
  6. Lipton RB, Gobel H, Einhaupl KM, et al. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology 2004;63(12):2240-4.
  7. Danesch UC. Petasites hybridus (Butterbur root) extract in the treatment of asthma—an open trial. Altern Med Rev 2004;9(1):54-62.
  8. Schapowal A: Petasites Study Group. Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ 2002;324(7330):144-6.
  9. Schapowal A. Butterbur Ze339 for the treatment of intermittent allergic rhinitis: dose-dependent efficacy in a prospective, randomized, double-blind, placebo-controlled study. Arch Otolaryngol Head Neck Surg. Dec 2004;130(12):1381-1386.
  10. Schapowal A: A Study Group. Treating intermittent allergic rhinitis: a prospective, randomized, placebo and antihistamine-controlled study of Butterbur extract Ze 339. Phytother Res 2005;19(6):530-7.
  11. Gray RD, Haggart K, Lee DK, Cull S, Lipworth BJ. Effects of butterbur treatment in intermittent allergic rhinitis: a placebo-controlled evaluation. Ann Allergy Asthma Immunol. Jul 2004;93(1):56-60.
  12. Jackson CM, Lee DK, Lipworth BJ. The effects of butterbur on the histamine and allergen cutaneous response. Ann Allergy Asthma Immunol. Feb 2004;92(2):250-254.
  13. Agosti R, Duke RK, Chrubasik JE, Chrubasik S. Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review. Phytomedicine. Nov 2006;13(9-10):743-746.
  14. Wildi E, Langer T, Schaffner W, Buter KB. Quantitative analysis of petasin and pyrrolizidine alkaloids in leaves and rhizomes of in situ grown Petasites hybridus plants. Planta Med. Apr 1998;64(3):264-267.
  15. Thomet OA, Schapowal A, Heinisch IV, Wiesmann UN, Simon HU. Anti-inflammatory activity of an extract of Petasites hybridus in allergic rhinitis. Int Immunopharmacol. Jun 2002;2(7):997-1006.
  16. Fiebich BL, Grozdeva M, Hess S, et al. Petasites hybridus extracts in vitro inhibit COX-2 and PGE2 release by direct interaction with the enzyme and by preventing p42/44 MAP kinase activation in rat primary microglial cells. Planta Med. Jan 2005;71(1):12-19.
  17. Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009 Jun;25(5):446-52. Review.
  18. Sheykhzade M, Smajilovic S, Issa A, et al. S-petasin and butterbur lactones dilate vessels through blockage of voltage gated calcium channels and block DNA synthesis. Eur J Pharmacol. 2008 Sep 28;593(1-3):79-86.
  19. Oelkers-Ax R, Leins A, Parzer P, et al. Butterbur root extract and music therapy in the prevention of childhood migraine: an explorative study. Eur J Pain. 2008 Apr;12(3):301-13.
  20. Melzer J, Schrader E, Brattström A, Schellenberg R, Saller R. Fixed herbal drug combination with and without butterbur (Ze 185) for the treatment of patients with somatoform disorders: randomized, placebo-controlled pharmaco-clinical trial. Phytother Res. 2009 Sep;23(9):1303-8.
  21. Wang GJ, Lin YL, Chen CH, et al. Cellular calcium regulatory machinery of vasorelaxation elicited by petasin. Clin Exp Pharmacol Physiol. 2010 Mar;37(3):309-15.
Top
How It Works

Bottom Line: Butterbur extracts have been shown effective in the treatment of migraines and allergies.

Butterbur is an herb native to Europe, southwestern Asia, and north Africa. It has been used to treat allergies, asthma, headache, and muscle spasms. Butterbur was shown in clinical studies to be effective for migraines, allergic rhinitis (runny nose), and asthma.

Top
Purported Uses
  • Allergic rhinitis
    Butterbur was shown to have benefits for allergic rhinitis in humans.
  • Migraine
    Several clinical trials have shown that Butterbur extract is effective but more well designed studies are needed.
  • Asthma
    Some studies have shown that Butterbur may be beneficial.
Top
Research Evidence

MigraineIn this study, 60 patients with migraine were randomized to receive 50 mg of butterbur extract or placebo twice daily for 12 weeks. Researchers observed that the frequency of migraine attacks decreased by 60% in the treatment group compared to those who took placebo.

Allergic rhinitis
In a double-blind, placebo-controlled, crossover study, 35 patients received butterbur 50 mg twice daily or placebo for two weeks for the treatment of intermittent allergic rhinitis. Peak nasal inspiratory flow was the primary outcome variable. Results showed that butterbur had no significant effect compared to placebo.

Top
Do Not Take If
  • You are hypersensitive to Butterbur.
  • You have liver disease or dysfunction as pyrrolizidine alkaloids present in Butterbur can be toxic to the liver.
Top
Dosage (Inside MSKCC Only)
This field is only visible to only Inside MSKCC users.
Top
Aliases
Petasites hybridus
Top
E-mail your questions and comments to aboutherbs@mskcc.org.
Last updated: February 24, 2011