Natural Products

Horse Chestnut

Aesculus hippocastanum

Efficacy

• Indications with proven efficacy:
  Chronic venous insufficiency
• Also used for these other indications, but with no proof of efficacy:
  Hemorrhoids

Safety

• Risk of Drug Interaction: Low
• Adverse effects: Not Frequent

Description

The common horse chestnut is a large tree that is native to Turkey and Western Asia. It produces a fruit called horse chestnut seeds which is covered with soft spikes and contains a large, poisonous seed.

It was not until the 1960s that standardized and non-toxic horse chestnut extracts were first produced. The concentration of aescin used in products varies between 16 and 20%, standardized extract.

Warning

In 2004, Canada adopted new regulations that control the manufacturing, packaging, labeling and importing of natural health products. The new regulations also include an adverse reaction reporting system. Products that conform to the regulation's criteria are identified with a natural product number (NPN) or homeopathic medicine number (DIN-HM) and can be legally sold in Canada. This number indicates that the product meets specific criteria for safety and purity, not that it is effective for any indication.

Medicinal plants content varies naturally from plant to plant – just as fruits from the same package may vary in taste and texture. There is no standard to measure the active content of each plant. Thus, efficacy of natural products should be expected to vary from brand to brand as well as from bottle to bottle of the same brand.

For more information about the Natural Health Products Regulations, or to check if a product has been assessed, visit the Health Canada website at http://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.

Does it work?

Horse Chestnut seeds appear to improve the symptoms of chronic venous insufficiency.

• Chronic venous insufficiency:
  To relieve symptoms associated with chronic venous insufficiency such as pain, itch, swelling, heavy legs and varicose veins, 250 to 375 mg of horse chestnut seed extract, twice daily, with meals, is recommended. This is equal to 100 to 150 mg of aescin per day.

There is insufficient reliable information to conclude that horse chestnut is effective in any other indication.

Is it safe?

• Horse chestnut seed extract (which does not contain esculin) causes few adverse events. Dizziness, nausea, headache and itchiness have, on occasion, been reported.
• Diabetics should be cautious since horse chestnut seeds may reduce blood sugar levels. Those with latex allergies should also avoid horse chestnut since there may be a crossallergy.
• Given the absence of available data, it is not recommended to use horse chestnut during pregnancy or if nursing.
• Horse chestnut seeds may increase the effect of drugs that reduce glycemia including insulin. Caution!

Clinical Notes

• The presence of esculin, which is an anticoagulant and potentially dangerous toxin found in the plant, limited the plant's applications for quite some time. Esculin is a toxin that is found in the flowers, leaves, bark and seeds of the horse chestnut tree. It can cause several problems such as vomiting, diarrhea, headache, confusion, weakness, muscle contractions, pupil dilation, lack of coordination, coma and paralysis. Since 1960, standardized extract of horse chestnut seed is non-toxic.

References

1. Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2007
2. Passeportsanté.net. Marronnier d'Inde. http://www.passeportsante.net
3. Medline Plus, Horse Chestnut, medlineplus.gov, January 2007
4. Rotblatt M. et Ziment I. Evidence-Based Herbal Medicine, Hanley & Belfus, 2002