Butterbur
Petasites hybridus
also known as petasites
Moderate (migraine and allergy) — but only PA-free preparations are safe
A large-leaved European wetland plant used since ancient Greek medicine. Butterbur has real evidence for two specific uses — migraine prevention and seasonal allergies — but the raw plant contains pyrrolizidine alkaloids that cause serious liver injury. Only PA-free standardized preparations are appropriate for use, and even those have come under scrutiny.
- Real evidence for reducing migraine frequency when taken consistently — comparable to some prescription preventives in studies
- Eases seasonal allergy symptoms (hay fever) — runny nose, itchy eyes, congestion
- Long traditional European use for cough, fever, and pain
- Petadolex, a standardized PA-free butterbur extract, has been the most-studied preparation
- Most modern butterbur research uses pharmaceutical-grade PA-free extracts
Only use PA-free standardized preparations — raw butterbur and unverified products contain pyrrolizidine alkaloids that cause irreversible liver damage and have caused liver failure
Even PA-free preparations have caused liver injury reports — in 2012, German and UK regulators withdrew several butterbur products over hepatotoxicity concerns
Skip with pre-existing liver conditions
Skip during pregnancy and nursing
Possible cross-reactivity with ragweed and daisy-family allergies
Use caution with medications metabolized by the liver
Stop and seek medical attention if jaundice, dark urine, or right-side abdominal pain develop
Periodic liver function testing is reasonable for anyone using butterbur consistently
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