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For Patients & Caregivers
How It Works
Horse chestnut was shown to be effective for treating 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 the tone of veins. It also reduces the release of enzymes, which is typically increased in chronic diseases of the vein. Other compounds in horse chestnut generally increase the tone of blood vessels and decrease their permeability. Horse chestnut extract was shown in some studies to be 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.
To treat circulatory disorders
Several clinical trials support use of horse chestnut as a short-term treatment for CVI, but its long-term effects are unknown.
To treat phlebitis
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.
Do Not Take If
- You are taking warfarin, aspirin, or other blood thinners: Horse chestnut products that contain aesculin may increase the risk of bleeding. Check to make sure that your horse chestnut product is aesculin-free.
- You are taking drugs that are substrates of Cytochrome P450 enzymes: Horse chestnut may increase the side effects, and may also reduce the effectiveness of such drugs.
Chestnut poisoning: Diarrhea, muscle twitching, dilated pupils, depression, and paralysis can occur after high doses of horse chestnut.
- 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.
- Inflammation around the heart and shortness of breath: In a 32-year-old man who had consumed 3 boxes of horse chestnut paste over 6 weeks.
For Healthcare Professionals
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.
Laboratory studies suggest that the compound in horse chestnut known as aescin, or escin, has anti-inflammatory (1), neuroprotective (1), and antitumor (2) (3) effects, and enhances the efficacy of gemcitabine (18).
Data from earlier clinical trials suggest efficacy of horse chestnut seed extract against chronic venous insufficiency (CVI) (4) (5). Although systematic reviews and meta analysis state that horse chestnut extract is a safe and well tolerated treatment for CVI (6) (7) (8), a Cochrane review of rutosides did not find any clear evidence of benefit for post-thrombotic syndrome (11).
Other studies suggest escin may be effective in improving sperm quality in patients with varicocele-associated infertility (14).
Patients with compromised renal or hepatic function should not consume horse chestnut products.
Mechanism of Action
Escin, also known as Aescin, a natural mixture of triterpenoid saponins isolated from the seed of the horse chestnut has been identified as the active principle. The anti-inflammatory effects of escin involve significant downregulation of expression of certain inflammatory genes, and upregulation of expression of granulocyte-macrophage colony-stimulating factor (GM-CSF), which also confers neuroprotection (1).
One of the mechanisms by which escin reduces chronic venous insufficiency is thought to be via inhibition of elastase and hyaluronidase, both involved in enzymatic proteoglycan degradation, which constitutes part of the capillary endothelium and is also the main component of the extravascular matrix (19). The contraction of veins and arteries by horse chestnut is believed, to be partially mediated through 5-HT(2A) receptors; horse chestnut also reduced platelet aggregation in vitro (20).
Beta-aescin and 5-fluorouracil were reported to inhibit human hepatocellular carcinoma SMMC-7721 cells, which may be due to the synergistic effects including cell-cycle arrest, induction of apoptosis, activation of caspases-3, 8 and 9, and down-regulation of Bcl-2 expression (17). In another study, escin was shown to potentiate the efficacy of gemcitabine, partially due to the inhibition of the nuclear transcription factor (NF-κB) activity and consequent inhibition of c-Myc, COX-2, Cyclin D1, Survivin, Bcl-2 and Bcl-xL, and the activation of caspase-3 (18).
Chestnut poisoning: Diarrhea, muscle twitching, dilated pupils, depression, and paralysis (14).
Intestinal obstruction: Caused by excessive consumption of horse chestnuts. In cases with bezoars surgical removal was required (15) (12) (13).
Life-threatening kidney rupture: In a patient with angiomyolipoma, a benign fat-containing mesenchymal tumor of the kidney, 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 (14).
- Anticoagulants / Antiplatelet agents: Horse chestnut may have an additive anticoagulant effect due to aesculin, a hydroxycoumarin (9).
- Cytochrome P450 substrates: Aescin was shown to both inhibit and induce CYP1A2, CYP2C9 and CYP3A4 enzymes in a study of rats, and may affect the intracellular concentration of drugs metabolized by these enzymes (22). Clinical relevance has yet to be determined.