Evening Primrose

Evening primrose is a plant also known as Primrose Seed Oil, Aceite de Onagra, Acide Cis-linoléique, Cis-Linoleic Acid, EPO, Fever Plant, Herbe-aux-ânes, Huile de Graines d'Onagre, Huile D'Onagre, Huile de Primerose, Huile de Primevère Vespérale, Jambon de Jardinier, Jambon du Paysan, King's Cureall, Mâche Rouge, Night Willow-Herb, Oenothera biennis, Oenothera muricata, Oenothera purpurata, Oenothera rubricaulis, Oenothera suaveolens, Onagra biennis, Onagraire, Onagre Bisannuelle, Onagre Commune, Primevère du Soir, Scabish, Sun Drop, and other names.

Evening primrose has been used in alternative medicine as a possibly effective aid in treating nerve damage caused by diabetes, and osteoporosis.

Evening primrose has also been used to treat asthma, eczema, attention deficit- hyperactivity disorder (ADHD), hepatitis B, high cholesterol, liver cancer, breast pain, obesity, menopausal hot flashes and night sweats, premenstrual syndrome (PMS), and skin or joint symptoms of psoriasis. However, research has shown that evening primrose may not be effective in treating these conditions.

Evening primrose may have been combined with other plants or extracts in a specific preparation to treat these conditions .

Other uses not proven with research have included chronic fatigue syndrome, dyslexia, coordination and movement problems, diaper rash, dry eyes, rheumatoid arthritis, multiple sclerosis, ulcerative colitis, schizophrenia, Alzheimer's and other conditions.

It is not certain whether evening primrose is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Evening primrose should not be used in place of medication prescribed for you by your doctor.

Evening primrose is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Evening primrose may also be used for purposes not listed in this product guide.

Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra evening primrose to make up the missed dose.

Evening primrose oil has been administered orally in clinical trials at doses between 6 and 8 g/day in adults and 2 and 4 g/day in children. The typical content of gamma-linolenic acid (GLA) in the oil is 8% to 10%.

Information regarding safety and efficacy in pregnancy and lactation is lacking. A case report exists of transient petechiae in a newborn following oral and intravaginal use of evening primrose oil for cervical ripening for a week prior to the infant's birth. Both linoleic and GLA are normally present in breast milk, and it is reasonable to assume that evening primrose oil may be taken while breast-feeding.

Seeds from O. biennis contain 14% of a fixed oil known as evening primrose oil that can contain 50% to 70% cis -linoleic acid and 7% to 10% cis -GLA. Wild varieties of O. biennis contain highly variable amounts of linoleic acid and GLA; however, extensive crossbreeding has produced a commercial variety that consistently yields oil with 72% cis -linoleic acid and 9% GLA. 2 , 3 Also found are cis -6,9,12-octadecatrienoic acid; small amounts of oleic, palmitic, and stearic acids; steroids; campesterol; and beta-sitosterol. Mucilage and tannin in the plant parts have been analyzed. 2

Essential fatty acids are important as cellular structural elements and as precursors of prostaglandins. Essential fatty acids are the biologically active parts of polyunsaturated fats that cannot be manufactured by the body and must be provided by the diet in relatively large amounts. 2 Recommended intake of linoleic acid and alpha-linolenic acid are 12 g and 1.1 g, respectively, for women 19 to 30 years of age. 4

In theory, the GLA provided by evening primrose oil can be converted directly to the prostaglandin precursor di-homo-gamma-linolenic acid and might be beneficial to individuals unable to metabolize cis -linoleic acid to GLA or those with low dietary intake of cis -linoleic acid. However, this relationship was not proven in a pharmacokinetic study in healthy participants. 5

Atopic dermatitis/Dermatologic disorders
Animal data

The widespread consumption of evening primrose oil as a supplement and the availability of clinical data make data from animal studies largely irrelevant.

Clinical data

A number of reviews and randomized clinical trials show a lack of support for the use of evening primrose oil for atopic dermatitis. 6 , 7 , 8 , 9 Many of the trials are of poor quality and have apparent issues of bias. 9 , 10 , 11

While an older review suggested promising results, 12 the most comprehensive meta-analysis to date did not establish efficacy. 10 Clinical studies continue to be conducted, with a gradual time-dependent improvement suggested. 13

Mastalgia
Animal data

The widespread consumption of evening primrose oil as a supplement and the availability of clinical data make data from animal studies largely irrelevant.

Clinical data

There is little evidence to support the efficacy of evening primrose oil in treatment of mastalgia, with most trials finding no advantage over placebo. 14 , 15 , 16 , 17 A meta-analysis of clinical trials found no evidence of effect in pain relief, with a mean pain score difference of -2.78 (95% confidence interval, -7.97 to 2.4). 18

Menopause-associated vasomotor symptoms/premenstrual syndrome
Animal data

The widespread consumption of evening primrose oil as a supplement and the availability of clinical data make data from animal studies largely irrelevant.

Clinical data

A number of reviews and randomized clinical trials found no evidence of benefit with evening primrose oil use for menopausal vasomotor symptoms or premenstrual syndrome. 19 , 20 , 21 , 22 , 23 , 24 , 25 In 2004, the North American Menopause Society did not support the use of evening primrose oil for menopausal vasomotor symptoms given the lack of efficacy data, but this has not been recently reviewed. 26

Multiple sclerosis
Animal data

The widespread consumption of evening primrose oil as a supplement and the availability of clinical data make data from animal studies largely irrelevant.

Clinical data

Despite a seemingly valid theoretical basis for the use of evening primrose oil in multiple sclerosis, there is a lack of evidence to substantiate its use. 27 A review of 3 trials suggested an effect with a slower progression of disability and improved relapse (severity and duration) scores, but a randomized, controlled trial, not included in the review, showed no effect. 28 , 29 , 30 , 31 , 32 No new trials have been published since the 1980s.

Rheumatoid arthritis
Animal data

The widespread consumption of evening primrose oil as a supplement and the availability of clinical data make data from animal studies largely irrelevant. A theoretical basis exists for the effect of GLA in inflammatory disease. 33

Clinical data

A Cochrane review of randomized trials comparing evening primrose oil with placebo suggests some benefit in using evening primrose oil for rheumatoid arthritis, despite the relative poor quality of the individual studies. A trend toward reduction of morning stiffness and joint tenderness, as well as pain relief, has been shown. The authors found the evidence to be sufficient to warrant further larger trials to provide conclusive results and define optimal dosage and duration of therapy. 34 These findings are supported by other reviews, especially with regard to effective duration of therapy. 35 , 36 A more recent randomized, double-blind, placebo-controlled study enrolling 90 patients with primary Sjögren syndrome found no statistically significant in patient fatigue with a higher dosage after 6 months of therapy. 37

Other uses
Cardiovascular disease

There is no recent evidence to support older studies, 38 , 39 , 40 suggesting that evening primrose oil reduced platelet aggregation. An observational study suggests serum linoleic acid may protect against ischemic stroke. 41 Despite limited older trials in humans and numerous studies using rats and rabbits, there are no recent randomized, controlled trials demonstrating a beneficial effect of evening primrose oil on cholesterol levels or serum lipids. A more recent randomized, controlled trial found no effect on endothelial function or vascular tone with evening primrose oil supplementation. 42

Diabetic neuropathy

A review of 3 randomized, controlled trials suggested evening primrose oil might improve symptoms of diabetic neuropathy. Dosages in these trials ranged from 360 to 480 mg GLA daily. Few adverse effects were noted in these trials, and there was no increase in blood glucose levels. 43 , 44

Dyslexia/Brain development

Current interest in the use of evening primrose oil for enhancing intellectual performance in children is yet to be validated by rigorous research. Studies conducted in children with dyslexia suggest improved reading, spelling, and behavior, 45 , 46 while a Cochrane systematic review and a long-term study (39 months) showed no long-term benefit in infants fed formula supplemented with long-chain polyunsaturated fatty acids. 47 , 48 An open study found benefit with the use of a fish oil and evening primrose oil combination in children with dyslexia. 49

Eye conditions

Study results disagree as to the effect of evening primrose oil on dry eye syndrome, 37 , 50 , 51 and there is concern regarding high intake of linoleic and linolenic acid and the risk of cataract development. 52 , 53

Hyperpigmentation

Topical application of saponified evening primrose oil reduced ultraviolet B-induced hyperpigmentation, while a decrease in melanin production has been demonstrated in vivo with the saponified oil. 54

Inflammation

Local injection-site reactions after subcutaneous injections of 5-azacitidine have been reduced with topical application of evening primrose oil. 55

Myalgic encephalomyelitis (chronic fatigue syndrome)

A theoretical model has been proposed for a place in therapy for evening primrose oil in this condition. Clinical trials are lacking. 56

Urolithiasis

An exploratory study found an increase in urinary citrate excretion following 1,000 mg/day of evening primrose oil. 57

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25. Wong VC, Lim CE, Luo X, Wong WS. Current alternative and complementary therapies used in menopause. Gynecol Endocrinol . 2009;25(3):166-174.
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31. Horrobin DF. Multiple sclerosis: the rational basis for treatment with colchicine and evening primrose oil. Med Hypothesis . 1979;5(3):365-378.
32. Namazi MR. The beneficial and detrimental effects of linoleic acid on autoimmune disorders. Autoimmunity . 2004;37(1):73-75.
33. Calder PC, Yaqoob P, Thies F, Wallace FA, Miles EA. Fatty acids and lymphocyte function. Br J Nutr . 2002;87(suppl 1):S31-S48.
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35. Darlington LG, Stone TW. Antioxidants and fatty acids in the amelioration of rheumatoid arthritis and related disorders. Br J Nutr . 2001;85(3):251-269.
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37. Theander E, Horrobin DF, Jacobsson LT, Manthorpe R. Gammalinolenic acid treatment of fatigue associated with primary Sjögren's syndrome. Scand J Rheumatol . 2002;31(2):72-79.
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39. Pirich C, Gaszo A, Granegger S, Sinzinger H. Effects of fish oil supplementation on platelet survival and ex vivo platelet function in hypercholesterolemic patients. Thromb Res . 1999;96(3):219-227.
40. Fan YY, Ramos KS, Chapkin RS. Dietary gamma-linoleic acid modulates macrophage-vascular smooth muscle cell interactions. Evidence for a macrophage-derived soluble factor that downregulates DNA synthesis in smooth muscle cells. Arterioscler Thromb Vasc Biol . 1995;15(9):1397-1403.
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44. Ford I, Cotter MA, Cameron NE, Greaves M. The effects of treatment with alpha-lipoic acid or evening primrose oil on vascular hemostatic and lipid risk factors, blood flow, and peripheral nerve conduction in the streptozotocin-diabetic rat. Metabolism . 2001;50(8):868-875.
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Summary of Use during Lactation

Evening primrose (Oenothera biennis) seed oil contains gamma-linolenic acid (GLA). Evening primrose oil (EPO) has no specific lactation-related uses. It is most often used for premenstrual syndrome, cyclical mastalgia, and atopic dermatitis. Supplementation of nursing mothers with EPO for 8 months increased the breastmilk content of linoleic acid and total GLA plus its metabolite, dihomo-gamma-linolenic acid, and caused no adverse reactions in the breastfed infants.[1] Supplementation of mothers with GLA had no effect on the development of atopic dermatitis in their breastfed infants.[2] Evening primrose oil is "generally recognized as safe" (GRAS) as a food by the U.S. Food and Drug Administration.

Heating breastmilk to 63.5 degrees C reduces the concentration of linolenic acid by about 22%. Freezing milk at -20 degrees C and thawing more than once decreases linolenic acid concentration by an average of 63%.[3] Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

Drug Levels

Maternal Levels. Thirty-six nursing mothers who were 2 to 6 months postpartum took either 2 grams of evening primrose oil (Efamol; n = 18) or placebo (n = 18) twice daily. The total daily intake of the treated mothers was 2.8 grams of linoleic acid and 320 mg of GLA. Samples of milk were taken on entry to the study and after 8 months of supplementation. Breastmilk of supplemented mothers contained more linoleic acid and total GLA plus its metabolite, dihomo-gamma-linolenic acid, than at baseline. Mothers who received placebo had no changes from baseline.[1]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Eighteen nursing mothers took EPO 2 grams daily for 8 months starting at an average of 3.4 months postpartum. After 8 months of supplementation, no adverse reactions were reported in their breastfed infants.[1]

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1. Cant A, Shay J, Horrobin DF. The effect of maternal supplementation with linoleic and gamma-linolenic acids on the fat composition and content of human milk: a placebo-controlled trial. J Nutr Sci Vitaminol (Tokyo). 1991;37:573-9. PMID: 1668100

2. Kitz R, Rose MA, Schonborn H et al. Impact of early dietary gamma-linolenic acid supplementation on atopic eczema in infancy. Pediatr Allergy Immunol. 2006;17:112-7. PMID: 16618360

3. Wardell JM, Hill CM, D'Souza SW. Effect of pasteurization and of freezing and thawing human milk on its triglyceride content. Acta Paediatr Scand. 1981;70:467-71. PMID: 7315290