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