Petasitidis rhizoma

Petasitidis rhizoma, also called butterbur rhizome, is a drug used in herbal medicines for the treatment of acute and spasmodic pain in the area of the urinary tract, especially in nephrolithiasis(Commission E); furthermore, the drug is used for migraine prophylaxis. In some countries (e.g. Switzerland) the drug is approved for the treatment of allergic rhinitis.

HMPC: - not edited

ESCOP: - not edited

Commission E-monograph: -root: positive evaluation: Adjuvant for acute spasmodic pain in the urinary tract, especially stones.

negative evaluation for the leaves!

Empirical medicine: migraine, therapy and prophylaxis, neck and back pain, cramps.

Butterbur contains sesquiterpenes such as petasin, neopetasin and isopetasin, mucilages and pyrrolizdine alkaloids of toxicological concern with 1,2 unsaturated necin skeleton and their N-oxides. However, these are present in finished medicinal products in such small amounts that they are below the detection limit of 0.1 ppm and are negligible.

Petasitidis rhizoma has anti-inflammatory, antispasmodic and analgesic effects. In addition, it inhibits the synthesis of leukotriene and the synthesis of the enzyme COX-2. reduction of the release of histamine and serotonin.

Petasitidis rhizoma is used for the prophylaxis of migraine and for the symptomatic treatment of acute allergic rhinitis (approval in Switzerland). Other indications are bronchial asthma and acute and spasmodic pain in the urinary tract (especially in nephrolithiasis).

A clinical, placebo-controlled study in 60 patients demonstrated the efficacy of the extract (50 mg rhizome extract/day) in migraine prophylaxis.

Petasines, bicyclic sesquiterpene alcohols, as well as the total extract from butterbur leaves have a blocking effect on the release of various drugs. Inflammation mediators such as histamine. This effect forms the pahtogent basis for the improvement of the symptoms of allergic rhinitis. A synthesis inhibition of leukotrienes has also been proven. In a randomized double-blind clinical trial on 125 hay fever patients, an extract of butterbur leaves proved to be equally effective as the antihistamines cetirizine. Due to a relatively short half-life of the drug, it must be taken 4 times/day (Tesalin® an extract of butterbur leaves is approved in Switzerland for the indication rhinitis allergica.

Topical formulations of the extract in a lipolotion are being tested for atopic eczema.

Cosmetics: Root extracts of the plant are used under the name Petasides hybridus extract for skin care.

The daily dose of the drug is between 4.5 and 7 g. It should not exceed the value of 1 ug of pyrrolizide alkaloids with 1,2 unsaturated necine skeleton including N-oxides.
The duration of use should not exceed 4 to 6 weeks per year.

In a few individual cases liver damage and liver toxic reactions have been reported. Since the findings are not confirmed and are therefore not considered an official side effect, it is nevertheless advisable to refrain from prophylactic use in the case of pre-existing liver damage.

If you are pregnant or breastfeeding, you should not take it. Children < 12 years of age (no experience is available for this age group).

There are no known interactions with other drugs.

Petadolex Kps (1-1-1/day p.o. or 2-0-2)

1. Chang LL et al (2002) Effects of S-petasin on corticosterone release in rats. Chin J Physiol 45:137-142.
2. Agosti R et al. (2006) Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review. Phytomedicine13(9-10):743-76.
3. Lee KP et al.(2015) Therapeutic effects of s-petasin on disease models of asthma and peritonitis.
4. Biomol Ther (Seoul) 23:45-52.
5. Shih CH et al. (2011) S-Petasin, the Main Sesquiterpene of Petasites formosanus, Inhibits Phosphodiesterase Activity and Suppresses Ovalbumin-Induced Airway Hyperresponsiveness. Evid Based Complement Alternat Med 2011:132374.
6. Thomet OA et al (2001) Differential inhibition ofinflammatory effector functions by petasin, isopetasin and neopetasin in human eosinophils. Clin Exp Allergy 31:1310-1320.
7. Wang ZH et al (2015) Cytotoxic effect of s-petasin and iso-s-petasin on the proliferation of human prostate cancer cells. Anticancer Res 35:191-199.
8. Schilcher H (2016) In: Leitfaden Phytotherapie, Urban & Fischer Verlag Munich, pp. 244 f.
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