Feverfew (Tanacetum parthenium L. Schultz-Bip.)

Category

Herbs & Supplements

Synonyms

6-hydroxykaempferol, alpha-Pinene, altamisa, apigenin, bachelor's button, camomille grande, camphene, camphor, crysanthemum parthenium, (E)-beta-ocimene, (E)-chrysanthenol, (E)-chrysanthenyl acetate, featherfew, featherfoil, febrifuge plant, federfoy, flirtwort, gamma-terpinene, golden feverfew, Leucanthemum parthenium, limonene, linalool, lipophilic flavonoids, luteolin 7-glucuronides, Matricaria capensis, matricaria eximia hort, Matricaria parthenium L., melatonin, midsummer daisy, MIG-99, Mig-RL, monoterpenes, mother herb, mutterkraut, nosebleed, p-cymene, Parthenium hysterophorus, parthenolide, Pyrenthrum parthenium L., quercetagetin, santa maria, sesquiterpene lactones, sesquiterpenes, Tanacetum parthenium, Tanacetum parthenium (L.) Schultz-Bip., tanetin, tannins, wild chamomile, wild quinine.

Background

Feverfew is an herb that has been used traditionally for fevers, as its name denotes, although this effect has not been well studied.

Feverfew is most commonly taken by mouth for the prevention of migraine headache. Several human trials have been conducted with mixed results. Overall, these studies suggest that feverfew taken daily as dried leaf capsules may reduce the incidence of headache attacks in patients who experience chronic migraines. However, this research has been poorly designed and reported.

There is currently inconclusive evidence regarding the use of feverfew for symptoms associated with rheumatoid arthritis.

Feverfew appears to be well tolerated in clinical trials, with a mild and reversible side effects profile. The most common adverse effect appears to be mouth ulceration and inflammation with direct exposure to leaves. In theory, there may be an increased risk of bleeding.

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.

Migraine headache prevention: Feverfew is often taken by mouth for the prevention of migraine headaches. Laboratory studies show that feverfew can reduce inflammation and prevent blood vessel constriction (squeezing) that may lead to headaches. Most of the available human studies are not high quality and report mixed results. However, overall they do suggest that feverfew may reduce the number of headaches that occur in people with frequent migraines. A large, well-designed study comparing feverfew to other migraine treatments is needed before a strong recommendation can be made.
Grade: A

Rheumatoid arthritis: It is not clear if feverfew is helpful for treating rheumatoid arthritis symptoms such as joint stiffness or pain.
Grade: C

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.
Abdominal pain, anemia, anti-inflammatory, asthma, blood vessel dilation (relaxation), blood vessel disorders (antiangiogenic), breast cancer, cancer, central nervous system diseases, colds, colorectal cancer, constipation, cystic fibrosis, diarrhea, digestion, dizziness, fever, gastrointestinal distress, joint pain, induction of labor/abortion, heart muscle injury, insect bites, insect repellant, leukemia, menstrual cramps, neurological complications of malaria, pancreatic cancer, parasitic infections (leishmaniasis), promotion of menstruation, rash, ringing in the ears, skin cancer, toothache, tranquilizer, uterine disorders.

Dosing

Adults (18 years and older)

2 to 3 dried leaves (approximately 60 milligrams) have been taken daily, or 50 to 250 milligrams of a dried leaf preparation taken daily, standardized to 0.2% parthenolide (a common dose is 125 milligrams daily). Human studies have used 50 to 114 milligrams of feverfew powdered leaves daily, packed into capsules, standardized to 0.2% parthenolide, or 0.50 milligrams of parthenolide daily. Doses of 70 to 86 milligrams of dried chopped feverfew leaves in capsules, taken once daily, have also been used.

Children (younger than 18 years)

There is not enough scientific information to safely recommend feverfew for use 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

Feverfew may cause allergy in people allergic to chrysanthemums, daisies, marigolds, or other members of the Compositae family, including ragweed. There are multiple reports of allergic skin rashes after contact with feverfew.

Side Effects and Warnings

Few side effects are reported in human studies of feverfew. The side effects that do occur are usually mild and reversible. Mouth inflammation or ulcers, including swelling of the lips, tongue irritation, bleeding of the gums, and loss of taste, have been reported and usually occur after direct contact of the mouth with the leaves, although some people report burning after swallowing a capsule containing dried leaf. Photosensitivity (sensitivity to sunlight or sunlamps) has been reported with other herbs in the Compositae plant family and may be possible with feverfew as well. Indigestion, nausea, flatulence, constipation, diarrhea, abdominal bloating, and heartburn have been reported rarely in human studies. Gardeners may develop skin irritation at sites of contact with feverfew plants. Feverfew can also cause allergic rashes. One small study reported increased heart rate in some patients.

Long-term feverfew users who stop treatment suddenly may experience feverfew withdrawal symptoms, including rebound headaches, anxiety, difficulty sleeping, muscle stiffness, and joint pain.

Laboratory tests suggest that feverfew affects blood platelets and in theory may increase the risk of bleeding. However, this has not been clearly shown in humans. Nonetheless, caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. Use caution prior to some surgeries or dental procedures, due to a theoretical increase in bleeding risk.

Pregnancy and Breastfeeding

There is not enough information about safety to recommend feverfew during pregnancy or breastfeeding. Traditional experience suggests that feverfew may stimulate menstrual flow and induce abortion, and therefore should be avoided.

Interactions

Interactions with Drugs

Based on laboratory research, feverfew theoretically may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. However, this has not been clearly shown in humans. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Sun sensitivity caused by certain drugs like doxycycline or Retin A® may be increased by feverfew. Feverfew may also alter the way that certain drugs are broken down by the liver.

Feverfew may have an additive effect if taken along with drugs taken for cancer, histamine release, fungal or protozoal infections, and drugs that increase blood flow. Feverfew may also interact with anesthetics and antibiotics.

In theory, feverfew may interact with anti-depressants and should be used with caution in people with a history of depression and/or other mental illness.

Interactions with Herbs and Dietary Supplements

In theory, feverfew may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. This is based on laboratory research, and has not been reported clearly in humans. 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.

Sun sensitivity caused by certain herbs and supplements may be increased by feverfew. Feverfew may alter the way that certain herbs and supplements are broken down by the liver.

Feverfew may theoretically interact with herbs that act as antidepressants, such as St. John's wort.

Feverfew may also interact with herbs taken for cancer, parasitic infection, fungal infection, bacterial infection, protozoal infection, and drugs that increase blood flow.

Attribution

This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Ernie-Paul Barrette, MD (Case Western Reserve University School of Medicine); Ethan Basch, MD, MPhil (Memorial Sloan-Kettering Cancer Center); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Paul Hammerness, MD (Harvard Medical School); Jenna Hollenstein, MS, RD (Natural Standard Research Collaboration); Anh Le, PhD (Emory University); Michael Smith MRPharmS, ND (Canadian College of Naturopathic Medicine); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration).

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.

Curry EA III, Murry DJ, Yoder C, et al. Phase I dose escalation trial of feverfew with standardized doses of parthenolide in patients with cancer. Invest New Drugs 2004;22(3):299-305.

DeWeerdt CJ, Bootsman H, Hendricks H. Herbal medicines in migraine prevention. Randomized double-blind placebo-controlled crossover trial of a feverfew preparation. Phytomed 1996;3(3):225-230.

Diener HC, Pfaffenrath V, Schnitker J, et al. 2005 Nov;25(11):1031-41. Efficacy and safety of 6.25 mg t.i.d. feverfew CO2-extract (MIG-99) in migraine prevention--a randomized, double-blind, multicentre, placebo-controlled study.

Ernst E, Pittler MH. The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review. Public Health Nutr 2000;3(4A):509-514.

Kuritzky A, Elhacham Y, Yerushalmi Z, et al. Feverfew in the treatment of migraine: its effect on serotonin uptake and platelet activity. Neurology 1994;44(Suppl 2):A201.

Maizels M, Blumenfeld A, Burchette R. A combination of riboflavin, magnesium, and feverfew for migraine prophylaxis: a randomized trial. Headache 2004;44(9):885-890.

Murphy JJ, Heptinstall S, Mitchell JR. Randomised double-blind placebo-controlled trial of feverfew in migraine prevention. Lancet 7-23-1988;2(8604):189-192.

Palevitch D, Earon G, Carasso R. Feverfew (Tanacetum parthenium) as a prophylactic treatment for migraine: a double-blind placebo-controlled study. Phytother Res 1997;11(7):508-511.

Pattrick M, Heptinstall S, Doherty M. Feverfew in rheumatoid arthritis: a double blind, placebo controlled study. Ann Rheum Dis 1989;48(7):547-549.

Pittler MH, Vogler BK, Ernst E. Feverfew for preventing migraine (Cochrane Review). The Cochrane Library 2000;(4):CD002286.

Shrivastava R, Pechadre JC, John GW. Tanacetum parthenium and Salix alba (Mig-RL) combination in migraine prophylaxis: a prospective, open-label study. Clin Drug Investig 2006;26(5):287-96.

Sriramarao P, Rao PV. Allergenic cross-reactivity between Parthenium and ragweed pollen allergens. Int Arch Allergy Immunol 1993;100(1):79-85.

Vogler BK, Pittler MH, Ernst E. Feverfew as a preventive treatment for migraine: a systematic review. Cephalalgia 1998;18(10):704-708.

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.