Horse Chestnut

Purported Benefits, Side Effects & More
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Horse Chestnut

Common Names

  • Chestnut
  • Marron europeen
  • Escine
  • Escin
  • Aescin

For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.


How It Works

Horse chestnut may help treat chronic venous insufficiency, but its long-term effects are not known.

Horse chestnut is a seed extract. One of its active components is aescin, which may reduce inflammation and increase vein tone. It also reduces the release of enzymes that typically increase with chronic vein diseases. Other compounds in horse chestnut generally improve blood vessel tone. In some studies, horse chestnut extract was effective against chronic venous insufficiency.

A compound called aesculetin may act as an anticoagulant and blood thinner, and is therefore often excluded from over-the-counter horse chestnut products.

Purported Uses and Benefits
  • To treat circulatory disorders
    Several clinical trials support the use of horse chestnut as short-term treatment for chronic venous insufficiency, but long-term effects are unknown.
  • To treat vein inflammation
    No scientific evidence supports this use.
  • To treat varicose veins
    This claim is not backed by any evidence.
  • To treat diarrhea
    There is no scientific evidence to back this claim.
  • To treat hemorrhoids
    There are no data to support this.
Patient Warnings
  • Horse chestnut seeds are toxic, and can cause major stomach irritation, vomiting, muscle twitching, incoordination, redness, facial swelling, and other serious conditions. They can also be easily mistaken for edible chestnuts.
Do Not Take If
  • You are taking warfarin, aspirin, or other blood thinners: Horse chestnut products that contain aesculin may increase bleeding risk. Check to make sure that your horse chestnut product is aesculin-free.
  • You are taking CYP450 substrate drugs: Horse chestnut may increase their side effects while reducing the effectiveness of such drugs.
Side Effects

Case reports

  • Chestnut seed poisoning: In a 46-year-old male who mistook horse chestnut seed for Korean chestnut. Symptoms included epigastric pain, nausea, sweating, and palpitations as well as slight increases in liver enzymes, serum amylase, and pancreatic amylase.
  • Intestinal obstructions: Several cases requiring surgery for removal have occurred with the excessive consumption of horse chestnuts.
  • Life-threatening kidney rupture: In a patient with a benign kidney tumor, after taking horse chestnut seed extract for venous insufficiency.
  • Heart inflammation and shortness of breath: In a 32-year-old man who consumed 3 boxes of horse chestnut paste over 6 weeks.
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For Healthcare Professionals

Brand Name
Venastat™
Scientific Name
Aesculus hippocastanum
Clinical Summary

Horse chestnut, a tree native to the Balkan Peninsula, has been used in traditional medicine for centuries. The seed extract is used as a dietary supplement to support vascular function. Horse chestnut should not be confused with sweet chestnut.

Lab studies suggest that aescin, or escin, in horse chestnut has anti-inflammatory (1), neuroprotective (1), and antitumor (2) (3) effects, and may enhance gemcitabine efficacy (18).

Data from earlier trials suggest horse chestnut seed extract has efficacy against chronic venous insufficiency (4) (5) and is safe and well tolerated (6) (7) (8), but a Cochrane review of rutosides did not find any clear evidence of benefit for post-thrombotic syndrome (10). Other studies suggest aescin may improve sperm quality in patients with varicocele-associated infertility (14).

Patients with compromised renal or hepatic function should not consume horse chestnut products.

Purported Uses and Benefits
  • Circulatory disorders
  • Phlebitis
  • Varicose veins
  • Diarrhea
  • Hemorrhoids
Mechanism of Action

Aescin, a natural mixture of triterpenoid saponins isolated from the seed of horse chestnut, has been identified as the active principle. Its anti-inflammatory effects involve downregulation of inflammatory gene expression and upregulation granulocyte-macrophage colony-stimulating factor production, which also confers neuroprotection (1).

Aescin may reduce chronic venous insufficiency via inhibition of elastase and hyaluronidase, both involved in enzymatic proteoglycan degradation, which constitutes part of the capillary endothelium and is the main component of the extravascular matrix (19). Contraction of veins and arteries with horse chestnut may be partially mediated through 5-HT(2A) receptors (20). It also reduced platelet aggregation in vitro (20).

Beta-aescin and 5-fluorouracil inhibited human hepatocellular carcinoma cells, perhaps via synergistic effects including cell-cycle arrest, induction of apoptosis, caspase-3, -8 and -9 activation, and Bcl-2 downregulation (17). Escin potentiated gemcitabine efficacy in part through NF-κB inhibition and consequent inhibition of c-Myc, COX-2, cyclin D1, survivin, Bcl-2, and Bcl-xL, and caspase-3 activation (18).

Warnings

Horse chestnut seeds are toxic, and can cause major stomach irritation, vomiting, muscle twitching, incoordination, redness, facial swelling, paralysis, low blood pressure, and collapse (21). They can also be easily mistaken for edible chestnuts.

Adverse Reactions

Case reports

Chestnut seed poisoning: In a 46-year-old male who mistook horse chestnut seed for Korean chestnut. Symptoms included epigastric pain, nausea, sweating, and palpitations as well as slight increases in liver enzymes, serum amylase, and pancreatic amylase (23).
Intestinal obstruction: Caused by excessive consumption of horse chestnuts. In cases with bezoars, surgical removal was required (12) (15).
Life-threatening kidney rupture: In a patient with a benign kidney tumor after taking horse chestnut seed extract for venous insufficiency. Symptoms improved after an emergency embolization (16).
Pericarditis and dyspnea: In a 32-year-old man who had consumed 3 boxes of horse chestnut paste over 6 weeks (13).

Herb-Drug Interactions
  • Anticoagulants / antiplatelets: Horse chestnut may have additive effects due to aesculin, a hydroxycoumarin (9).
  • CYP450 substrates: In animal studies, aescin both inhibited and induced 1A2, 2C9, and 3A4, and may affect the intracellular concentration of drugs metabolized by these enzymes (22). Clinical relevance has yet to be determined.
Dosage (OneMSK Only)
References
  1. Zhang L, Fu F, Zhang X et al. Escin attenuates cognitive deficits and hippocampal injury after transient global cerebral ischemia in mice via regulating certain inflammatory genes. Neurochem Int. 2010 Sep;57(2):119-27.
  2. Zhou XY, Fu FH, Li Z, et al. Escin, a natural mixture of triterpene saponins, exhibits antitumor activity against hepatocellular carcinoma. Planta Med. 2009 Dec;75(15):1580-5.
  3. Harikumar KB, Sung B, Pandey MK, et al. Escin, a pentacyclic triterpene, chemosensitizes human tumor cells through inhibition of nuclear factor-kappaB signaling pathway. Mol Pharmacol. 2010 May;77(5):818-27.
  4. Diehm C, Trampisch HJ, Lange S, Schmidt C. Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency. Lancet. 1996;347:292-4.
  5. Diehm C, Vollbrecht D, Amendt K, Comberg HU. Medical edema protection—clinical benefit in patients with chronic deep vein incompetence. A placebo controlled double blind study. Vasa. 1992;21:188-92.
  6. Siebert U, Brach M, Sroczynski G, Berla K. Efficacy, routine effectiveness, and safety of horsechestnut seed extract in the treatment of chronic venous insufficiency. A meta-analysis of randomized controlled trials and large observational studies. Int Angiol. 2002 Dec;21(4):305-15.
  7. Pittler MH, et al.Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review. Arch Dermatol. 1998;134:1356-60.
  8. Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD003230.
  9. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. Jul 1 2000;57(13):1221-1227; quiz 1228-1230.
  10. Morling JR, Broderick C, Yeoh SE, et al. Rutosides for treatment of post-thrombotic syndrome. Cochrane Database Syst Rev. Nov 8 2018;11:Cd005625.
  11. Satake R, Chinda D, Shimoyama T, et al. Repeated Small Bowel Obstruction Caused by Chestnut Ingestion without the Formation of Phytobezoars. Intern Med. 2016;55(12):1565-1568.
  12. Ravindra RK, Das A, Chew GL, et al. Small bowel obstruction with multiple perforations post chestnut ingestion. BMJ Case Rep. Feb 3 2019;12(2).
  13. Edem E, Kahyaoglu B, Cakar MA. Acute Effusive Pericarditis due to Horse Chestnut Consumption. Am J Case Rep. May 4 2016;17:305-308.
  14. Fang Y, Zhao L, Yan F, et al. Escin improves sperm quality in male patients with varicocele-associated infertility. Phytomedicine. 2010 Mar;17(3-4):192-6.
  15. Chen WT, Suk FM. Abdominal pain after consuming a chestnut. Diagnosis: Chestnut bezoar in the jejunum. Gastroenterology. 2011 Jun;140(7):e9-10.
  16. Snow A, Halpenny D, Mc Neill G, Torreggiani WC. Life-threatening rupture of a renal angiomyolipoma in a patient taking over-the-counter horse chestnut seed extract. J Emerg Med. 2012 Dec;43(6):e401-3.
  17. Ming ZJ, Hu Y, Qiu YH, Cao L, Zhang XG. Synergistic effects of beta-aescin and 5-fluorouracil in human hepatocellular carcinoma SMMC-7721 cells.Phytomedicine. 2010;17(8-9):575-80.
  18. Wang YW, Wang SJ, Zhou YN, Pan SH, Sun B. Escin augments the efficacy of gemcitabine through down-regulation of nuclear factor-κB and nuclear factor-κB-regulated gene products in pancreatic cancer both in vitro and in vivo. J Cancer Res Clin Oncol. 2012 May;138(5):785-97.
  19. Facino RM, Carini M, Stefani R, Aldini G, Saibene L. Anti-elastase and anti-hyaluronidase activities of saponins and sapogenins from Hedera helix, Aesculus hippocastanum, and Ruscus aculeatus: factors contributing to their efficacy in the treatment of venous insufficiency. Arch Pharm (Weinheim). 1995;328720-724.
  20. Felixsson E, Persson IA, Eriksson AC, Persson K. Horse chestnut extract contracts bovine vessels and affects human platelet aggregation through 5-HT(2A) receptors: an in vitro study. Phytother Res. 2010 Sep;24(9):1297-301.
  21. webPOISONCONTROL, National Capital Poison Center in Washington, DC. Horse Chestnuts are Toxic. Accessed March 29, 2022.
  22. Huang Y, Zheng SL, Zhu HY, Xu ZS, Xu RA. Effects of aescin on cytochrome P450 enzymes in rats. J Ethnopharmacol. 2014;151(1):583-90.
  23. Yi HY, Lee JY. Poisoning due to consumption of horse chestnut seed. Clin Exp Emerg Med. Dec 2021;8(4):333-335.
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