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Horse chestnut (Aesculus hippocastanum)

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Also listed as: Aesculus hippocastanum
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Aescin, aescine, Aesculaforce®, aescule, aesculetin, Aesculushippocastanum L., buckeye, bongay, chestnut, conkers, Conquerors, coumarins, eschilo, escin, escina, escine, esculin, fatty acids, fish poison, flavonoids, graine de marronnier d'Inde (French), fraxetin glucoside, fraxin, H. vulgare Gaertn., hestekastanje (Danish, Norwegian), HCSE, Hippocastanaceae (family), Hippocastani folium, Hippocastani semen, horse chestnut seed extract, horsechestnut, lectin, linolenic acid, Marron Europeen, marronnier (French), NV-101, palmitic acid, quinines, Rokastaniensamen, Rosskastanie (German), scopoletin glucoside, scopolin, Spanish chestnut, steric acid, sterols, tannins, Venastat®, Venoplant®.
  • Combination product examples: Venostasin® (a German preparation containing 100 milligrams of escin).

Background
  • Horse chestnut seed extract (HCSE) comes from the buckeye tree. Its primary active ingredient is called escin. HCSE is widely used in Europe to treat pain, itching, skin disorders, and ulcers. Limited studies suggest that HCSE may be used for inflammation, infertility, and bowel blockage after surgery.
  • There is strong evidence supporting the use of HCSE for circulation problems in the legs. Studies suggest that HCSE may be cost-effective when combined with conventional therapy for this condition.
  • Horse chestnut flower, branch bark, or leaves that are not fully processed should be avoided, due to the risk of bleeding and poisoning. HCSE given through tube feeding should be avoided due to the risk of kidney problems, life-threatening allergic reactions, and infection.

Evidence Table

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. GRADE *


Horse chestnut has been used to treat chronic venous insufficiency (CVI), a circulation disorder in the legs. HCSE has been found to significantly decrease CVI symptoms such as leg pain, itching, and fatigue. Some studies suggest that HCSE may be as effective as compression stockings, which are often used for vein disorders.

A


A study reports that escin injected into the veins, followed by danshen injected into the veins, may improve swelling of a fracture. More research is needed to confirm these findings.

C


Early research suggests that supplementing with escin may improve sperm density in infertile men. Further research is needed before firm conclusions can be made.

C


Early study suggests that injecting escin in the vein daily may improve bowel symptoms in people with colorectal cancer, compared to placebo. More research is needed in this area.

C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

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.

  • Bladder disorders, blood vessel disorders, bruising, cough, diarrhea, dizziness, enlarged prostate, fever, fluid in the lungs, gall bladder disorders, kidney diseases, liver congestion, lung blood clots (pulmonary embolism), menstrual pain, nerve pain, nocturnal leg cramps, osteoarthritis, pancreatitis (pancreas inflammation), rectal complaints (hemorrhoids), rheumatism, rheumatoid arthritis, ringing in the ears, skin conditions, ulcers, whooping cough.

Dosing

Adults (18 years and older)

  • Studies suggest doses of 50-75 milligrams of escin taken by mouth every 12 hours, for a total dose of 300 milligrams twice daily.
  • To treat circulation problems, doses of 50-1,200 milligrams of horse chestnut have been taken by mouth twice daily for 2-16 weeks in the form of Venostasin®, ecsin, and HCSE or HCSE capsules.
  • To treat male infertility, 150 milligrams of Aescuven Forte® has been taken by mouth every 12 hours for two months (daily total of 300 milligrams daily, 60 milligrams of escin), along with 20 milligrams of vitamin E, 400 milligrams of pentoxifylline, and 50 milligrams of clomiphene daily for two months.
  • To treat bowel blockage after surgery, doses of 5-25 milligrams of escin diluted in 500 milliliters of five percent dextrose have been injected into the vein once daily for up to seven days or up to the first bowel movement. However, reliable evidence is lacking in support of injecting HCSE into the vein, and life-threatening allergic reactions have been reported.

Children (younger than 18 years)

  • There is no proven safe or effective dose for horse chestnut in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in people with known allergy or sensitivity to horse chestnuts, esculin, or any of its parts.
  • Allergic skin rashes, cross-sensitivity to pollen, and life-threatening allergic reactions have been reported.

Side Effects and Warnings

  • Horse chestnut seed extract (HCSE) products are likely safe in adults in recommended doses for up to 12 weeks under the supervision of a healthcare professional.
  • Horse chestnut may cause anorexia, constipation, diarrhea, dizziness, dry mouth, fatigue, fullness, headache, heartburn, indigestion, infections, itching, kidney damage, liver damage or inflammation, muscle spasms, nausea, pseudolupus erythematosus (a condition causing abnormal substances in the lungs, fever, inflammation of heart muscle or sac, inflammation of stomach and intestines, joint pain, lung inflammation, and muscle pain), and stomach problems (discomfort, irritation, or pain).
  • Horse chestnut may affect blood sugar levels. Caution is advised in people with diabetes, low blood sugar, or blood sugar intolerance, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood sugar levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.
  • Use cautiously in people with bleeding disorders, renal angiomyolipoma (benign kidney growth), or in those taking drugs that may increase the risk of bleeding. HCSE, horse chestnut seeds, leaves, bark, and flowers that are not processed or properly extracted may increase the risk of bleeding due to the presence of esculin. Properly extracted HCSE should not contain esculin and therefore, should not carry this risk. However, life-threatening, acute hemorrhage from renal angiomyolipoma after use of HCSE for venous insufficiency has been noted.
  • Use cautiously in children and pregnant or breastfeeding women.
  • Use cautiously in people who have musculoskeletal problems, nervous system disorders, skin conditions, and stomach problems.
  • Use cautiously in people taking highly protein-bound agents.
  • Avoid in people with known allergy or sensitivity to horse chestnuts, esculin, or any of its parts.
  • Avoid injecting contaminated products or using products in non-sterile conditions.
  • Avoid injecting HCSE.
  • Avoid in people with liver problems.
  • Avoid taking "Venocuran" or "Venopyronum."
  • Avoid HCSE, horse chestnut seeds, leaves, bark, and flowers that are not processed or properly extracted.
  • Avoid using commercial skin products with horse chestnut (not HCSE) that contains aflatoxins, which may cause cancer.

Pregnancy and Breastfeeding

  • There is a lack of scientific evidence on the use of horse chestnut during pregnancy or breastfeeding.

Interactions

Interactions with Drugs

  • Horse chestnut (in the form of HCSE that is not properly extracted or unprocessed horse chestnut seeds, leaves, bark, and flowers) may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
  • Horse chestnut may affect blood sugar levels. Caution is advised when using medications that may also affect blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Horse chestnut may also interact with agents that affect blood vessel width, agents that harm the liver, agents that prevent new blood vessel formation, anti-inflammatory agents, fertility agents, highly protein-bound agents, kidney agents, musculoskeletal agents, nervous system agents, skin agents, and stomach agents.

Interactions with Herbs and Dietary Supplements

  • Horse chestnut (in the form of HCSE that is not properly extracted or unprocessed horse chestnut seeds, leaves, bark, and flowers) may increase the risk of bleeding when taken with herbs and supplements that are believed to 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.
  • Horse chestnut may affect blood sugar levels. Caution is advised when using herbs or supplements that may also affect blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Horse chestnut may also interact with anti-inflammatory herbs and supplements, antioxidants, fertility herbs and supplements, herbs and supplements that affect blood vessel width, herbs and supplements that harm the liver, herbs and supplements that prevent new blood vessel formation, herbs and supplements that treat kidney disorders, herbs and supplements that treat musculoskeletal disorders, herbs and supplements that treat nervous system disorders, herbs and supplements that treat skin disorders, herbs and supplements that may treat stomach disorders, and highly protein-bound herbs and supplements.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Agus GB. [Medical treatment of chronic venous disease: evolution or involution?]. Minerva Cardioangiol. 2011;59(3):285-298.
  2. Baronikova S, Apers S, Vanden Berghe D, et al. An ex-vivo angiogenesis assay as a screening method for natural compounds and herbal drug preparations. Planta Med 2004;70(10):887-892.
  3. Bassler D, Okpanyi S, Schrodter A, et al. Bioavailability of beta-aescin from horse chestnut seed extract: comparative clinical studies of two Galenic formulations. Adv.Ther. 2003;20(5):295-304.
  4. Carrasco OF, Ranero A, Hong E, et al. Endothelial function impairment in chronic venous insufficiency: effect of some cardiovascular protectant agents. Angiology 12-20-2009;60(6):763-771.
  5. Chen WT and Suk FM. Abdominal pain after consuming a chestnut. Diagnosis: Chestnut bezoar in the jejunum. Gastroenterology 2011;140(7):e9-10.
  6. Dickson S, Gallagher J, McIntyre L, et al. An open study to assess the safety and efficacy of Aesculus hippocastanum tablets (Aesculaforce 50mg) in the treatment of chronic venous insufficiency. J.Herb.Pharmacother. 2004;4(2):19-32.
  7. Difonzo EM, Campanile GL, Vanzi L, et al. Mesotherapy and cutaneous Mycobacterium fortuitum infection. Int.J.Dermatol. 2009;48(6):645-647.
  8. Fang Y, Zhao L, Yan F, et al. Escin improves sperm quality in male patients with varicocele-associated infertility. Phytomedicine. 2010;17(3-4):192-196.
  9. Leach MJ, Pincombe J, and Foster G. Using horsechestnut seed extract in the treatment of venous leg ulcers: a cost-benefit analysis. Ostomy.Wound.Manage. 2006;52(4):68-4, 76.
  10. Pittler, M. H. and Ernst, E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane.Database.Syst.Rev. 2012;11:CD003230.
  11. Soukand R and Kalle R. Change in medical plant use in Estonian ethnomedicine: a historical comparison between 1888 and 1994. J.Ethnopharmacol. 5-17-2011;135(2):251-260.
  12. Suter A, Bommer S, and Rechner J. Treatment of patients with venous insufficiency with fresh plant horse chestnut seed extract: a review of 5 clinical studies. Adv Ther 2006;23(1):179-190.
  13. Wang GJ and Liu J. [Clinical randomized controlled trial on ultrashort wave and magnetic therapy for the treatment of early stage distal radius fractures]. Zhongguo Gu.Shang 2012;25(7):572-575.
  14. Wu X, Liu L, Zhang M, et al. Simultaneous analysis of isomers of escin saponins in human plasma by liquid chromatography-tandem mass spectrometry: application to a pharmacokinetic study after oral administration. J.Chromatogr.B Analyt.Technol.Biomed.Life Sci. 4-1-2010;878(11-12):861-867.
  15. Xie Q, Zong X, Ge B, et al. Pilot postoperative ileus study of escin in cancer patients after colorectal surgery. World J.Surg. 2009;33(2):348-354.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


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