| The horse chestnut has been used as a traditional | | | | The FDA considers whole horse chestnut unsafe. |
| remedy for arthritis, rheumatism and the management | | | | Those with infectious or inflammatory Gl conditions |
| of varicose and hemorrhoids. The seeds are toxic, and | | | | shouldn't use horse chestnut because of the potential |
| many methods have been used to rid them of toxicity. | | | | for GI tract irritation. Patients with severe renal or |
| The herb is more popularly used in Europe. | | | | hepatic impairment, diabetic patients, and patients taking |
| The useful constituents of horse chestnut are derived | | | | anticoagulants should also avoid the herb, as should |
| from the seeds and bark of the Aesculus tree. Aescin | | | | pregnant or breast-feeding women. |
| seems to provide some weak diuretic activity and | | | | Safety Risk Horse chestnut may cause hepatotoxicity |
| may decrease the permeability of venous capillaries. It | | | | and anaphylaxis. High doses and nonstandardized |
| also has a tonic effect on the veins and prevents | | | | forms can be lethal. |
| collagen breakdown by inhibiting glycosaminoglycan | | | | Clinical considerations |
| hydrolases. Sterol content may have some | | | | The nuts, seeds, twigs, sprouts, and leaves of horse |
| anti-inflammatory activity. The toxic glycoside, aesculin, | | | | chestnut are poisonous. Standardized formulations |
| is a hydroxycoumarin with potential antithrombotic | | | | remove most of the toxins and standardize the |
| activity; however, the toxin is removed during | | | | amount of aescin. |
| preparation. Horse chestnut is available as capsules | | | | Signs and symptoms of toxicity include loss of |
| and as creams made from an aescin/cholesterol | | | | coordination, salivation, hemolysis, headache, dilated |
| complex, in products such as Arthro-Therapy, | | | | pupils, muscle twitching, seizures, vomiting, diarrhea, |
| Cell-U-Var Cream, Varicare, Varicosin, Venocare | | | | depression, paralysis, respiratory and cardiac failure, |
| Ultrajoint Response, and Venastat. | | | | and death. |
| Reported uses | | | | Monitor patient for signs of toxicity and discontinue |
| Horse chestnut is used to treat chronic venous | | | | horse chestnut immediately if any occur. |
| insufficiency, varicose veins, tiredness, and tension, and | | | | Monitor blood glucose level in patients taking |
| leg pain, swelling, and edema. The extract is used as a | | | | antidiabetics for hypoglycemia. |
| conjunctive treatment for lymphedema, hemorrhoids, | | | | Advise patient to use only a standardized extract |
| and enlarged prostate. | | | | containing 16% to 21 % aescin, at recommended |
| Horse chestnut has been used as an analgesic, | | | | doses, and to discontinue use if signs of toxic reaction |
| anticoagulant, antipyretic, astringent, expectorant, and | | | | occur. |
| tonic. It has also been used to treat skin ulcers, phlebitis, | | | | Tell patient that this is only symptomatic treatment of |
| leg cramps, cough, and diarrhea. | | | | chronic venous insufficiency and not a cure. |
| Administration | | | | Advise patient not to confuse horse chestnut with |
| For symptomatic treatment of chronic venous | | | | sweet chestnut, which is used as a food. |
| insufficiency: Dosage is 250 mg by mouth every day, | | | | Advise patient to keep the herb away from children. |
| up to three times a day. Some sources recommend | | | | Consumption of amounts of leaves, twigs, and seeds |
| taking 450 to 750 mg every day to decrease | | | | equaling 1 % of a child's weight may be lethal. |
| symptoms, and then decreasing dose to 175 to 350 | | | | Tell patient to notify pharmacist of any herbal or |
| mg every day | | | | dietary supplement that he's taking when obtaining a |
| Tincture formulation: Dosage is 1 to 4 ml by mouth | | | | new prescription. |
| three times a day. | | | | Advise patient to consult his health care provider |
| Hazards | | | | before using an herbal preparation because a |
| Side effects of horse chestnut include GI irritation | | | | treatment with proven efficacy may be available. |
| (especially with immediate release products) toxic | | | | Research summary |
| nephropathy, calf cramps, itching, and skin cancer | | | | FDA considers whole horse chestnut to be an unsafe |
| (topical skin cleansers). Use with anticoagulants may | | | | herb and warns that all parts of the plants in this genus |
| increase anticoagulant effects with increased bleeding | | | | are potentially toxic. However, German Commission E |
| and bruising. Increased hypoglycemic effects may | | | | considers it safe. European researchers have |
| occur when horse chestnut is used with antidiabetics | | | | evaluated its effectiveness and safety. There are |
| and insulin. Aescin binds to plasma proteins and may | | | | some reports of plants poisonings in Switzerland from |
| displace drugs that are proteinbound. | | | | 1966 to 1994 in which horse chestnut was responsible |
| When used with other herbs with anticoagulant or | | | | for allergic and anaphylactic responses. |
| antiplatelet potential, such as feverfew, garlic, ginkgo, | | | | Chestnuts of the genus Aesculus should be |
| and ginseng, horse chestnut may increase | | | | considered toxic and cannot be recommended for |
| anticoagulant effects, bleeding, and bruising. Other | | | | internal use. However, recent research suggests that |
| herbs with hypoglycemic potential, such as aconite, | | | | certain components of the horse chestnut may |
| dong quai, gotu kola, gymnema, sylvestie, and | | | | improve venous compliance and reduce edema in |
| fenugreek, may cause increased hypoglycemic | | | | patients with chronic venous insufficiency. |
| effects when combined with horse chestnut. | | | | |