Horse Chestnut

Horse chestnut has been used for swelling and pain due to varicose veins and poor circulation in the legs.Some herbal/dietary supplement products have been found to contain possibly harmful impurities/additives. Check with your pharmacist for more details about the brand you use.The FDA has not reviewed this product for safety or effectiveness. Consult your doctor or pharmacist for more details.

Take this product by mouth as directed. Follow all directions on the product package. Check the label carefully to make sure you have the correct product. Horse chestnut seed extract is different than whole horse chestnut seeds. Do not take the raw seeds, bark, flowers, or leaves of horse chestnut by mouth because these products are poisonous. Use only standardized horse chestnut seed extract products that have had the toxin removed. If you are uncertain about any of the information, consult your doctor or pharmacist.This herbal product should only be used short-term. It should not be used for more than 3 months.If your condition persists or worsens, or if you think you may have a serious medical problem, seek immediate medical attention.

Before taking horse chestnut, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. People allergic to latex should not take horse chestnut because they may be at greater risk of having an allergic reaction to it. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.If you have any of the following health problems, consult your doctor or pharmacist before using this product: bleeding or clotting problems, kidney problems, liver problems, diabetes, stomach/intestinal problems (e.g., infection/inflammatory disease of the gut).This product may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages.Liquid products may contain sugar and/or alcohol. Caution is advised if you have diabetes, alcohol dependence, or liver disease. Ask your doctor or pharmacist about using this product safely.This product is not recommended for use during pregnancy. Consult your doctor before using this product.It is unknown if this product passes into breast milk. Consult your doctor before breast-feeding.

Keep all regular medical and laboratory appointments.

When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use horse chestnut, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.

The usual dose of horse chestnut in capsule form is 1 capsule every 12 hours before a meal.

Take the capsule with a full glass of water.

Do not crush, chew, break, or open a horse chestnut capsule. Swallow it whole.

It is best to use a horse chestnut product that contains an exact amount of the labeled chemical. Check the label to be sure your product does not contain a toxic substance called "esculin."

It may take up to 4 weeks before your symptoms improve. Call your doctor if your symptoms do not improve, or if they get worse while using horse chestnut.

Store at room temperature away from moisture, heat, and light.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. The use of raw horse chestnut (seeds, flowers, stems, leaves) can cause fatal poisoning.

Signs of horse chestnut poisoning may include weakness, depressed mood, loss of coordination, dilated pupils, vomiting, diarrhea, little or no urinating, muscle twitching, or loss of movement in any part of the body.

Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.

Because of their prevalence, chestnuts have been used in traditional medicine and in a variety of commercial applications for centuries. Extracts of the bark have been used as a yellow dye, and the wood has been used for furniture and packing cases. In the western United States, the crushed, unripe seeds of the California buckeye were scattered into streams to stupefy fish, and leaves were steeped as tea to remedy congestion. The horse chestnut has been used as a traditional remedy for arthritis and rheumatism, as well as for gynecological bleeding and as a tonic.

Even though the seeds are toxic, several traditional methods were employed to rid them of their toxicity. Seeds were buried in swampy, cold ground during the winter to free them of toxic, bitter components, and then eaten in the spring after boiling. American Indians roasted the poisonous nuts, peeled and mashed them, and then leached the meal in lime water for several days, creating a meal used to make bread. 3 , 4 , 5 , 6

1. Chevallier A. The Encyclopedia of Medicinal Plants . New York, NY: DK Publishing; 1996:159.
2. Aesculus hippocastanum L. USDA, NRCS. 2010. The PLANTS Database ( http://plants.usda.gov , January 2010). National Plant Data Center, Baton Rouge, LA 70874-4490 USA.
3. Semen hippocastani . In: WHO Monographs on Selected Medicinal Plants . Vol 2. Geneva, Switzerland: World Health Organization; 2004.
4. Tyler V. Pharmacognosy . 9th ed. Philadelphia, PA: Lea & Febiger; 1988.
5. Evans WC, Brady LR, Robbers JE. Trease and Evans' Pharmacognosy . 13th ed. London, England: Bailliere Tindall; 1989.
6. Duke J. Handbook of Medicinal Herbs . Boca Raton, FL: CRC Press; 1985.
7. Sirtori CR. Aescin: pharmacology, pharmacokinetics and therapeutic profile. Pharmacol Res . 2001;44(3):183-193.
8. Kapusta I, Janda B, Szajwaj B, et al. Flavonoids in horse chestnut ( Aesculus hippocastanum ) seeds and powdered waste water byproducts. J Agric Food Chem . 2007;55(21):8485-8490.
9. Ogawa S, Kimura H, Niimi A, Katsube T, Jisaka M, Yokota K. Fractionation and structural characterization of polyphenolic antioxidants from seed shells of Japanese horse chestnut ( Aesculus turbinata BLUME). J Agric Food Chem . 2008;56(24):12046-12051.
10. Curir P, Galeotti F, Dolci M, Barile E, Lazotti V. Pavietin, a coumarin from Aesculus pavia with antifungal activity. J Nat Prod . 2007;70(10):1668-1671.
11. Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev . 2006(1):CD003230.
12. Vogel JH, Bolling SF, Costello RB, et al. Integrating complementary medicine into cardiovascular medicine. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (Writing Committee to Develop an Expert Consensus Document on Complementary and Integrative Medicine). J Am Coll Cardiol . 2005;46(1):184-221.
13. Leach MJ, Pincombe J, Foster G. Using horsechestnut seed extract in the treatment of venous leg ulcers: a cost-benefit analysis. Ostomy Wound Manage . 2006;52(4):68-70, 72-74, 76-78.
14. Wollina U, Abdel-Naser MB, Mani R. A review of the microcirculation in skin in patients with chronic venous insufficiency: the problem and the evidence available for therapeutic options. Int J Low Extrem Wounds . 2006;5(3):169-180.
15. Guillaume M, Padioleau F. Veinotonic effect, vascular protection, antiinflammatory and free radical scavenging properties of horse chestnut extract. Arzneimittleforschung . 1994;44(1):25-35.
16. Reynolds JE, ed. Martindale: The Extra Pharmacopoeia . 31st ed. London, England: Royal Pharmaceutical Society; 1996:1670.
17. Liu J, Li Y, Yuan X, Yang Z, Lin Z. Sodium beta-aescin may be an effective therapeutic agent for Bell's palsy. Med Hypotheses . 2008;71(5):762-764.
18. Sato I, Kofujita H, Suzuki T, Kobayashi H, Tsuda S. Antiinflammatory effect of Japanese horse chestnut ( Aesculus turbinata ) seeds. J Vet Med Sci . 2006;68(5):487-489.
19. Sato I, Kofujita H, Tsuda S. Identification of COX inhibitors in the hexane extract of Japanese horse chestnut ( Aesculus turbinata ) seeds. J Vet Med Sci . 2007;69(7):709-712.
20. Tsutsumi S, Ishizuka S. Anti-inflammatory effects of the extract of Aesculus hippocastanum L. (horse chesnut) seed [in Japanese]. Shikwa Gakuho . 1967;67(11):1324-1328.
21. Senatore F, Mścisz A, Mrugasiewicz K, Gorecki P. Steroidal constituents and anti-inflammatory activity of the horse chestnut ( Aesculus hippocastanum L.) bark. Boll Soc Ital Biol Sper . 1989;65(2):137-141.
22. Wang XH, Xu B, Liu JT, Cui JR. Effect of beta-escin sodium on endothelial cells proliferation, migration and apoptosis. Vascul Pharmacol . 2008;49(4-6):158-165.
23. Niu YP, Li LD, Wu LM. Beta-aescin: a potent natural inhibitor of proliferation and inducer of apoptosis in human chronic myeloid leukemia K562 cells in vitro. Leuk Lymphoma . 2008;49(7):1384-1391.
24. Patlolla JM, Raju J, Swamy MV, Rao CV. Beta-escin inhibits colonic aberrant crypt foci formation in rats and regulates the cell cycle growth by inducing p21(waf1/cip1) in colon cancer cells. Mol Cancer Ther . 2006;5(6):1459-1466.
25. Zhang Z, Li S. Cytotoxic triterpenoid saponins from the fruits of Aesculus pavia L. Phytochemistry . 2007;68(15):2075-2086.
26. Sato I, Suzuki T, Kobayashi H, Tsuda S. Antioxidative and antigenotoxic effects of Japanese horse chestnut ( Aesculus turbinata ) seeds. J Vet Med Sci . 2005;67(7):731-734.
27. Niu YP, Wu LM, Jiang YL, Wang WX, Li LD. Beta-escin, a natural triterpenoid saponin from Chinese horse chestnut seeds, depresses HL-60 human leukaemia cell proliferation and induces apoptosis. J Pharm Pharmacol . 2008;60(9):1213-1220. Retraction in: Jones DS. J Pharm Pharmacol . 2009;61(5):685.
28. Kimura H, Ogawa S, Jisaka M, Kimura Y, Katsube T, Yokota K. Identification of novel saponins from edible seeds of Japanese horse chestnut ( Aesculus turbinata Blume) after treatment with wooden ashes and their nutraceutical activity. J Pharm Biomed Anal . 2006;41(5):1657-1665.
29. Hu JN, Zhu XM, Han LK, et al. Anti-obesity effects of escins extracted from the seeds of Aesculus turbinate BLUME (Hippocastanaceae). Chem Pharm Bull (Tokyo) . 2008;56(1):12-16.
30. Kimura H, Ogawa S, Katsube T, Jisaka M, Yokota K. Antiobese effects of novel saponins from edible seeds of Japanese horse chestnut ( Aesculus turbinata BLUME) after treatment with wood ashes. J Agric Food Chem . 2008;56(12):4783-4788.
31. Suter A, Bommer S, 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.
32. Bassler D, Okpanyi S, Schrodter A, Loew D, Schurer M, Schulz HU. Bioavailability of beta-aescin from horse chestnut seed extract: comparative clinical studies of two Galenic formulations. Adv Ther . 2003;20(5):295-304.
33. Dickson S, Gallagher J, McIntyre L, Suter A, Tan J. An open study to assess the safety and efficacy of Aesculus hippocastanum tablets ( Aesculaforce 50 mg) in the treatment of chronic venous insufficiency. J Herb Pharmacother . 2004;4(2):19-32.
34. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm . 2000;57(13):1221-1227;1228-1230.
35. Scott GN, Elmer GW. Update on natural productdrug interactions. Am J Health Syst Pharm . 2002;59(4):339-347.
36. Hellum BH, Nilsen OG. In vitro inhibition of CYP3A4 metabolism and P-glycoprotein-mediated transport by trade herbal products. Basic Clin Pharmacol Toxicol . 2008;102(5):466-475.
37. Yoshikawa M, Murakami T, Matsuda H, Yamahara J, Murakami N, Kitagawa I. Bioactive saponins and glycosides. III. Horse chestnut. (1): The structures, inhibitory effects on ethanol absorption, and hypoglycemic activity of escins Ia, Ib, IIa, IIb, and IIIa from the seeds of Aesculus hippocastanum L. Chem Pharm Bull (Tokyo) . 1996;44(8):1454-1464.
38. Hardin JW, Arena JM. Human Poisoning from Native and Cultivated Plants . 2nd ed. Durham, NC: Duke University Press; 1974.
39. Caldas ED, Machado LL. Cadmium, mercury and lead in medicinal herbs in Brazil. Food Chem Toxicol . 2004;42(4):599-603.

Copyright © 2009 Wolters Kluwer Health