Health Care Professional Information

Scientific Name
Harpagophytum procumbens
Common Name

Grapple plant, wood spider

Brand Name

Doloteffin ™

Clinical Summary

Derived from the root or tuber. Clinical studies reveal conflicting data about efficacy of devil's claw as an anti-inflammatory or analgesic. It has been thought that the iridoid glucosides may be responsible for activity, but they are not active when administered separately from whole root extract. The basis for chemical standardization is unknown. Analysis of commercial products reveals wide variance in chemical components. Limited side effects have been reported; diarrhea and bradycardia also occur (1). An open clinical study suggests that Devil's claw may benefit patients with osteoarthritis of the hip or knee (6). A systematic review of clinical trials suggests that it may also be effective in treating low back pain (7). Devil's claw increases gastric acid secretions and may interfere with the activity of antacids and histamine-2 blockers (e.g. ranitidine and famotidine) (3). Other possible drug interactions include increased activity of anticoagulants and cardiac and anti-arrhythmic drugs (1).

Purported Uses
  • Anorexia
  • GI disorders
  • Inflammation
  • Muscle pain
  • Osteoarthritis
  • Pain
Constituents
  • Iridoid glucosides: Harpagoside, harpagide and procumbide
  • Phytosterols: B-sitosterol, oleanolic acid
  • Flavonoids: Kaempferol and luteolin
  • Phenolic acids
  • Glycosidic phenylpropanoic esters: Verbascoside and isoacteoside
    (1)
Mechanism of Action

In animal studies, an aqueous extract containing chiefly harpagoside showed significant dose-dependent anti-inflammatory and analgesic effects. Harpagoside is not implicated in the anti-inflammatory action, but, along with other constituents, it does appear to be involved in the peripheral analgesic properties. Devils claw also has antioxidant effects by scavenging both superoxide and peroxyl in a dose dependent manner (5). The bitter iridoids are responsible for the use of the herb as a stomachic. In vitro and in vivo animal studies have shown some evidence that devil's claw might be cardioactive. Lower doses seem to cause bradycardia and increase the strength of contraction, and high doses seem to weaken heart contractions and coronary blood flow (2).

Contraindications

Pregnancy

Adverse Reactions

Reported: Diarrhea, possible bradycardia. Dyspepsia (6).

Herb-Drug Interactions

Antacids / H2 Antagonists: Devil's claw may reduce efficacy due to increased production of stomach acid.
Beta blockers / Digoxin: Devil's claw may cause bradycardia and weaken heart contractions and coronary blood flow.
Anticoagulants: Devil's claw may have additive anticoagulant activity.
Cytochrome P450 enzymes: Devil's claw root can inhibit CYP1A2/2C8/2C9/2C19/2D6 and 3A4, and may interact with substances metabolized by these enzymes (8).

Literature Summary and Critique

Conflicting reports have been documented in the scarce clinical studies on the anti-inflammatory activity of devil's claw. Due to the inconclusive data, it may have very little activity as a single agent. Further research is needed with standardized iridoid glycosides to test efficacy.

Wegener T, Lupke NP. Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil's claw (Harpagophytum procumbens DC.). Phytother Res. 2003 Dec;17(10):1165-72.
75 patients with osteoarthritis of the knee or hip took part in an uncontrolled, open label study of Devil's claw. Patients received 2400 mg per day of Doloteffin for 12 weeks. During the treatment period, patients' WOMAC scores and VAS pain scores were reduced by nearly 25%. Adverse events were minor. Further placebo-controlled studies are needed to verify the effects of this study.

Dosage (Inside MSKCC Only)
This field is only visible to only OneMSK users.
References
  1. Newall CA, et al.Herbal Medicine: A Guide for Healthcare Professionals. London: Pharmaceutical Press; 1996.
  2. Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Boca Raton: CRC Press; 1994.
  3. Schulz V, et al. Rational Phytotherapy: A Physicians Guide to the Use of Herbs and Related Remedies, 3rd ed. Berlin (Germany): Springer; 1998.
  4. Fiebich BL, et al. Inhibition of TNF-alpha synthesis in LPS-stimulated primary human monocytes by Harpagophytum extract SteiHap 69. Phytomedicine 2001;8:28-30.
  5. Langmead L, et al. Antioxidant effects of herbal therapies used by patients with inflammatory bowel disease: an in vitro study. Aliment Pharmacol Ther 2002;16:197-205.
  6. Wegener T, Lupke NP. Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil's claw (Harpagophytum procumbens DC.). Phytother Res. 2003 Dec;17(10):1165-72.
  7. Gagnier JJ, van Tulder MW, Berman B, et al. Herbal medicine for low back pain. Spine 2007;32(1):82-92.
  8. Unger M, Frank A. Simultaneous determination of the inhibitory potency of herbal extracts on the activity of six major cytochrome P450 enzymes using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun Mass Spectrom. 2004;18(19):2273-81.

Consumer Information

How It Works

Bottom Line: There is limited proof from clinical trials that devil's claw can reduce inflammation or relieve pain.

Devil's claw is a root extract. It has been studied to some extent in test tubes and in animals, but its biological effects in humans are still not sorted out. In laboratory animals, devil's claw extracts reduce inflammation and cause pain relief, and also acts as an antioxidant. One study showed possible benefits for relieving some forms of arthritis, however, another study showed that devil's claw is not as effective as drugs such as aspirin in reducing inflammation. In rats, different doses of devil's claw have different effects on the heart: low doses seem to cause reduced heart rate and increased strength of contraction, while high doses seem to weaken heart contractions and coronary blood flow. These effects have not been shown in humans.

Purported Uses
  • To increase appetite
    No scientific evidence supports this use.
  • To treat gastrointestinal disorders
    No scientific evidence supports this use. Devil's claw might increase acid production by the stomach.
  • To reduce inflammation
    Studies in animals show a weak anti-inflammatory activity, but studies in humans do not support this use.
  • To relieve pain
    Studies in animals suggest that devil's claw can relieve pain, but there is no proof from clinical trials that this effect occurs in humans.
  • To treat osteoarthritis
    Studies in animals suggest that devil's claw can reduce inflammation, but there is limited proof from clinical trials that this herb can treat osteoarthritis.
Research Evidence

Only a few clinical trials have tested the anti-inflammatory properties of devil's claw, with weak and conflicting results. More research is needed to test whether this herb is safe and effective.

Osteoarthritis:
75 patients with osteoarthritis of the hip or knee participated in a study of a supplement that includes Devil's Claw. Patients received the supplement for 12 weeks after which time measurements of their level of pain, stiffness and physical function were shown to decrease by about a quarter. Because the study was not randomized, it is unclear if these findings are significant or are rather the result of a placebo effect.

Patient Warnings
  • This product is regulated by the F.D.A. as a dietary supplement. Unlike approved drugs, supplements are not required to be manufactured under specific standardized conditions. This product may not contain the labeled amount or may be contaminated. In addition, it may not have been tested for safety or effectiveness.
Do Not Take If
  • You are pregnant.
  • You are taking antacids or H2 blockers (Devil's claw can increase the production of stomach acid and reduce the effectiveness of these medications).
  • You are taking beta blockers or digoxin (Devil's claw might interfere with these medications).
  • You are taking warfarin or other blood thinners (Devil's claw might increase the risk of bleeding).
Side Effects
  • Diarrhea
  • Slowed heart rate (bradycardia) is a potential side effect
  • Upset stomach
E-mail your questions and comments to aboutherbs@mskcc.org.