Alder Buckthorn
- Scientific Name
- Frangula alnus (synonym: Rhamnus frangula)
- Family
- Rhamnaceae
- Other Common Names
-
Alder Dogwood, Arraclán, Arrow Wood, Aulne Noir, Black Dogwood, Bois à Poudre, Bois Noir, Bourdaine, Bourgène, Buckthorn, Coudrier Noir, Dog Wood, Frangula, Frángula, Frangulae Cortex, Frangule, Glossy Buckthorn, Nerprun Bourdaine, Nerprun Noir, Rhubarbe des Paysans
See separate listings for European Buckthorn, Sea Buckthorn, and Cascara.
Overview
Alder buckthorn is a type of invasive shrub. It is native to bright wetlands in Europe but also grows in North America (101069). The bark is traditionally used as medicine. However, chronic use is associated with damage to gastrointestinal epithelial cells, pigmentation of the colonic mucosa, known as pseudomelanosis coli, and possibly colorectal cancer (12, 6138, 30743, 37266, 37269).
History
Alder buckthorn was introduced to North America in the late 18th or early 19th centuries (101069).
People Use This For
Orally, alder buckthorn is used for constipation, as a tonic, and as a component in the Hoxsey cancer formula.
In manufacturing, alder buckthorn is primarily used as a dye.
Possibly Safe when used orally and appropriately, short-term. Tea prepared with alder buckthorn bark 2 grams has been used with apparent safety for up to 8 days (12). Only properly aged bark should be used, and the recommended dose should not be exceeded (12).
Possibly Unsafe when used orally for more than 8 to 10 days (12). In 1993 the FDA removed Generally Recognized As Safe (GRAS) status from alder buckthorn due to lack of safety data. Chronic use of anthraquinone laxatives, such as alder buckthorn, for 9 months or longer is associated with damage to gastrointestinal epithelial cells and pigmentation of the colonic mucosa, known as pseudomelanosis coli (30743, 37266). There is some data linking this condition to an increased risk of colorectal cancer (30743, 37266, 37269), although there is also contradictory evidence that does not show a link (6138).
CHILDREN: Likely Unsafe when used orally in children younger than 12 years of age (12); avoid using.
PREGNANCY AND LACTATION: Likely Unsafe when used orally (12); avoid using.
General
Orally, alder buckthorn seems to be well tolerated when properly aged bark is used appropriately for no more than 8 to 10 days (12). Adverse effects include cramp-like discomfort (2). Chronic use, especially for 9 months or longer, is associated with damage to gastrointestinal epithelial cells and pigmentation of the colonic mucosa, known as pseudomelanosis coli (30743, 37266). There is some data linking this condition to an increased risk of colorectal cancer (30743, 37266, 37269), although there is also contradictory evidence which does not show a link (6138). Alder buckthorn has also been associated with potassium depletion, albuminuria, and hematuria when used orally (2).
Gastrointestinal
Orally, adverse effects include cramp-like discomfort (2). Chronic use, especially for 9 months or longer, is associated with damage to gastrointestinal epithelial cells and pigmentation of the colonic mucosa, known as pseudomelanosis coli (30743, 37266). The fresh bark contains free anthrone, which can cause severe vomiting. This constituent is destroyed by aging the bark naturally for one year or artificially with heat and aeration (2).
Genitourinary
Orally, adverse effects to alder buckthorn include albuminuria and hematuria (2).
Adult
Oral:
Constipation: Alder buckthorn dried bark 0.5-2.5 grams infused as tea has been used. Alder buckthorn liquid extract (1:1 in 25% alcohol) 2-5 mL three times daily has also been used (3, 4, 7, 12).
Standardization & Formulation
There is insufficient reliable information available about the standardization of alder buckthorn.
CORTICOSTEROIDS
- Interaction Rating
- Moderate Be cautious with this combination.
- Severity
- HIGH
- Occurrence
- POSSIBLE
- Level of Evidence
- D (Theoretical based on pharmacology)
Alder buckthorn has stimulant laxative effects. Theoretically, concomitant use of corticosteroids with alder buckthorn can increase the risk of potassium depletion (2).
DIGOXIN (Lanoxin)
- Interaction Rating
- Moderate Be cautious with this combination.
- Severity
- HIGH
- Occurrence
- POSSIBLE
- Level of Evidence
- D (Theoretical based on pharmacology)
Alder buckthorn has stimulant laxative effects. Theoretically, potassium depletion associated with alder buckthorn might increase the risk of digoxin toxicity (19).
DIURETIC DRUGS
- Interaction Rating
- Moderate Be cautious with this combination.
- Severity
- HIGH
- Occurrence
- POSSIBLE
- Level of Evidence
- D (Theoretical based on pharmacology)
Alder buckthorn has stimulant laxative effects. Theoretically, overuse of alder buckthorn might compound diuretic-induced potassium loss (19). There is some concern that people taking alder buckthorn along with potassium depleting diuretics might have an increased risk for hypokalemia.
Some diuretics that can deplete potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), and hydrochlorothiazide (HCTZ, HydroDIURIL, Microzide), and others.
STIMULANT LAXATIVES
- Interaction Rating
- Moderate Be cautious with this combination.
- Severity
- HIGH
- Occurrence
- POSSIBLE
- Level of Evidence
- D (Theoretical based on pharmacology)
Alder buckthorn has stimulant laxative effects. Concomitant use with stimulant laxative medications might compound fluid and electrolyte loss (19).
WARFARIN (Coumadin)
- Interaction Rating
- Moderate Be cautious with this combination.
- Severity
- HIGH
- Occurrence
- POSSIBLE
- Level of Evidence
- D (Theoretical based on pharmacology)
Alder buckthorn has stimulant laxative effects. In some people alder buckthorn can cause diarrhea. Diarrhea can increase the effects of warfarin, increase international normalized ratio (INR), and increase the risk of bleeding. Advise patients who take warfarin not to take excessive amounts of alder buckthorn.
CARDIAC GLYCOSIDE-CONTAINING HERBS
Theoretically, potassium depletion associated with alder buckthorn might increase the risk of cardiac glycoside toxicity when used with other cardiac glycoside-containing herbs (19). Cardiac glycoside-containing herbs include black hellebore, Canadian hemp roots, digitalis leaf, hedge mustard, figwort, lily of the valley roots, motherwort, oleander leaf, pheasant's eye plant, pleurisy root, squill bulb leaf scales, and strophanthus seeds.
HORSETAIL
Theoretically, overuse or misuse of horsetail with alder buckthorn may increases the risk of toxicity due to potassium depletion (19).
LICORICE
Theoretically, anthraquinone-containing herbs such as alder buckthorn can increase the risk of potassium depletion associated with licorice (19).
STIMULANT LAXATIVE HERBS
Theoretically, concomitant use of alder buckthorn with other stimulant laxative herbs can increase the risk of potassium depletion (19). Stimulant laxative herbs include aloe, black root, blue flag, butternut bark, colocynth, European buckthorn, fo ti, gamboge, gossypol, greater bindweed, jalap, manna, Mexican scammony root, rhubarb, senna, and yellow dock
DIARRHEA
Alder buckthorn might compound fluid and electrolyte loss in patients with diarrhea (19); avoid using.
GASTROINTESTINAL (GI) CONDITIONS
Alder buckthorn is contraindicated in cases of intestinal obstruction; appendicitis; abdominal pain of unknown origin; and inflammatory conditions of the intestines including Crohn's disease, colitis, and irritable bowel syndrome (IBS) (12).
There is insufficient reliable information available about the toxicology of alder buckthorn.
There is insufficient reliable information available about the pharmacokinetics of alder buckthorn.
General
The applicable part of alder buckthorn is the bark. Constituents include anthraglycosides, including diglycosides (1, 8, 11). The fresh bark also contains free anthrone (2).
Gastrointestinal effect
The anthraglycosides and particularly the diglycosides of alder buckthorn are cathartic in the large intestine (1, 8, 11). They can increase intestinal motility by inhibiting stationary contractions, stimulating propulsive contractions, stimulating active chloride secretion, and increasing water and electrolytes in the intestinal contents (2).
Classes
Laxatives, VasodilatorsReferences
See Monograph ReferencesLiterature Review Current Through: 7/4/2024, Last Updated: 12/12/2025
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