Boldo is an evergreen shrub found in the Andean regions of Chile and Peru, and also is native to parts of Morocco. Boldo was employed in Chilean and Peruvian folk medicine and recognized as an herbal remedy in a number of pharmacopoeias, mainly for the treatment of liver ailments.
Boldine, a major alkaloidal constituent found in the leaves and bark of the boldo tree, has been shown to possess antioxidant and anti-inflammatory activity. The German Commission E has approved boldo leaf as treatment for mild dyspepsia (upset stomach) and spastic gastrointestinal complaints. Well-designed human studies on the efficacy of boldo are lacking.
Evidence
DISCLAIMER:
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Tradition
WARNING:
DISCLAIMER:
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below. Anthelmintic (expels worms), anticoagulant (blood thinner), anti-inflammatory, antioxidant (free radical scavenging), antipyretic (fever reducer), antiseptic, appetite stimulant, chemoprotective, cholagogue (increase bile flow), choleretic (stimulates bile formation), congestion, cystitis (bladder infection), digestion, diuretic, dyspepsia (upset stomach), earache, food uses, gallstones, gastrointestinal disorders, gonorrhea (STD), headache, hepatic (liver) disorders, hepatoprotection (liver protection), hypertension (high blood pressure), hypnotic, laxative, menstrual pain, nausea, neuromuscular blockade, pain, radioprotection, rheumatism, sedative, sunscreen, syphilis, urinary tract inflammation (UTI).
Dosing
Adults (18 years and older):
There is no proven safe or effective dose for boldo in adults. A common dose of the liquid extract, 1:1 in 45% alcohol, is 0.1-0.3 milliliters three times daily. Traditionally, 60-200 milligrams of the dried leaf three times daily or as a tea three times a day has been used. The tea is prepared by steeping 1 gram of the dried leaf in 150 milliliters boiling water for five to 10 minutes and then straining. The average daily dose of the boldo leaf by infusion is 3 grams. A tincture, 1:10 in 60% alcohol, is usually given as 0.5-2 milliliters three times daily.
Children (younger than 18 years):
There is no proven safe or effective dose for boldo in children.
Safety
DISCLAIMER:
Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.
Allergies
Avoid in individuals with a known allergy or hypersensitivity to boldo (Peumus boldus) or its constituents. Boldo intake has also been linked to one case of IgE-mediated anaphylactic allergic reaction.
Side Effects and Warnings
Boldo has generally recognized as safe (GRAS) status for use in foods in the United States. However, there is limited information regarding the side effects of boldo.
Use cautiously in patients taking anticoagulant or antiplatelet (blood thinning) agents. Boldo may increase the risk of bleeding.
Use cautiously in patients taking hepatotoxic (liver damaging) agents. Boldo may cause hepatotoxicity and, theoretically, concurrent use of boldo with hepatotoxic drugs may increase the risk of liver damage.
Use cautiously in patients taking diuretic drugs. Historically, boldo has been used as a diuretic and therefore may cause an additive effect when used with diuretic agents.
Use cautiously in patients with bile duct obstruction. Boldo is thought to stimulate bile flow and, theoretically, it may exacerbate bile duct obstruction.
Use cautiously in patients who drink alcohol. Boldo may cause hepatotoxicity (liver damage) and, theoretically, concurrent use of boldo with alcohol may increase the risk of liver damage. Avoid in patients with liver disease.
Pregnancy and Breastfeeding
Boldo is not recommended in pregnant or breastfeeding women. Pregnant rats taking 800 milligrams/kilogram of crude extract of boldo and boldine by mouth demonstrated anatomical alterations in the fetus. However, the German Commission E notes no contraindications to the use of ascaridole-free boldo preparations in pregnancy and breastfeeding.
Interactions
Interactions with Drugs
Concomitant use of boldo and anticoagulant or anti-platelet (blood thinning) drugs may increase the risk of bleeding. Some examples of drugs that may increase the risk of bleeding include aspirin, anticoagulants such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
Boldo may have anti-inflammatory effects, although this has not been well studied in humans. Caution is advised when using boldo with other anti-inflammatory agents.
Historically, boldo has been used as a diuretic and therefore may cause an additive effect when used with diuretic drugs. Boldo oil may also act as an irritant.
Boldo may cause hepatotoxicity. Theoretically, concomitant use of boldo with hepatotoxic drugs (e.g. ketoconazole, ritonavir, valproic acid, etc.) may increase the risk of liver damage.
Interactions with Herbs and Dietary Supplements
Concomitant use of boldo and anticoagulant/anti-platelet (blood thinning) herbs and supplements may increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
Boldo may have anti-inflammatory effects, although this has not been well studied in humans. Use of other anti-inflammatory herbs or supplements may have additive effects.
Historically, boldo has been used as a diuretic and therefore may cause an additive effect when used with other diuretic herbs and supplements. Boldo oil may also act as an irritant.
Boldo may cause hepatotoxicity (liver damage). Theoretically, concomitant use of boldo with other hepatotoxic herbs and supplements (e.g. chaparral, comfrey, pennyroyal oil, etc.) may increase the risk of liver damage.
Attribution
This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Nicole Giese, MS (Natural Standard Research Collaboration); Julie Montalbano, PharmD (Massachusetts College of Pharmacy); Erica Rusie, PharmD (Nova Southeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Heeja Yoon, PharmD (Drake University).
Bibliography
DISCLAIMER:
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Almeida ER, Melo AM, Xavier H. Toxicological evaluation of the hydro-alcohol extract of the dry leaves of Peumus boldus and boldine in rats. Phytother Res 2000;14(2):99-102.
Jang YY, Song JH, Shin YK, et al. Protective effect of boldine on oxidative mitochondrial damage in streptozotocin-induced diabetic rats. Pharmacol Res 2000;42(4):361-371.
Jimenez I, Garrido A, Bannach R, et al. Protective effects of boldine against free radical-induced erythrocyte lysis. Phytother Res 2000;14(5):339-343.
Kang JJ, Cheng YW. Effects of boldine on mouse diaphragm and sarcoplasmic reticulum vesicles isolated from skeletal muscle. Planta Med 1998;64(1):18-21.
Kang JJ, Cheng YW, Fu WM. Studies on neuromuscular blockade by boldine in the mouse phrenic nerve-diaphragm. Jpn J Pharmacol 1998;76(2):207-212.
Kubinova R, Machala M, Minksova K, et al. Chemoprotective activity of boldine: modulation of drug-metabolizing enzymes. Pharmazie 2001;56(3):242-243.
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Monzon S, Lezaun A, Saenz D, et al. Anaphylaxis to boldo infusion, a herbal remedy. Allergy 2004;59(9):1019-1020.
Piscaglia F, Leoni S, Venturi A, et al. Caution in the use of boldo in herbal laxatives: a case of hepatotoxicity. Scand J Gastroenterol 2005;40(2):236-239.
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Reiniger IW, de Oliveira JF, Caldeira-de-Araujo A, et al. Effect of Peumus boldus on the labeling of red blood cells and plasma proteins with technetium-99m. Appl Radiat Isot 1999;51(2):145-149.
Schmeda-Hirschmann G, Rodriguez JA, Theoduloz C, et al. Free-radical scavengers and antioxidants from Peumus boldus Mol. ("Boldo"). Free Radic Res 2003;37(4):447-452.
Silva E, Jopia M, Edwards AM, et al. Protective effect of Boldo and tea infusions on the visible light-mediated pro-oxidant effects of vitamin B2, riboflavin. Photochem Photobiol 2002;75(6):585-590.
Speisky H, Rocco C, Carrasco C, et al. Antioxidant screening of medicinal herbal teas. Phytother Res 2006;20(6):462-467.
Teng CM, Hsueh CM, Chang YL, et al. Antiplatelet effects of some aporphine and phenanthrene alkaloids in rabbits and man. J Pharm Pharmacol 1997;49(7):706-711.
Remember, keep this and all other medicines out of the reach of children,
never share your medicines with others, and use this medication only for the indication prescribed.
