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POSSIBLY EFFECTIVE

• Osteoarthritis. When used alone or in combination with other ingredients, oral rose hip seems to reduce pain and improve function in patients with osteoarthritis. Details: Orally, rose hip seems to have beneficial effects when used to treat osteoarthritis. Most clinical research shows that taking a specific Rosa canina rose hip powder product (LitoZin/i-flex, Hyben Vital), 2.5 grams orally twice daily for 3-4 months, reduces pain and stiffness, improves function and mobility, and decreases use of rescue medication when compared with placebo (71646,71658,71660,71661). Clinical research in adults with knee osteoarthritis shows that taking a specific combination product containing Rosa canina rose hip fruit puree 24 grams, stinging nettle leaf 160 mg, devil's claw 108 mg, and vitamin D 200 IU (Rosaxan, Medagil Gesundheitsgesellschaft) daily for 12 weeks reduces pain by 66% and improves quality of life, but does not reduce analgesic use, when compared with a control group (97937). However, one crossover study shows mixed results. Rose hip was shown to be effective for osteoarthritis only when administered after, but not before, placebo treatment (71641). This inconsistency might be due to a carryover effect of rose hip or delayed activity of the supplement.
• Postoperative pain. When taken immediately prior to surgery, oral rose hip seems to reduce pain following a Cesarean section. Details: Clinical research shows that taking a single dose of Rosa damascena rose hip extract 1600 mg, 15 minutes prior to anesthesia for a Cesarean section, delays the need for postoperative analgesics and reduces their use over the next 24 hours when compared with placebo. Almost all patients taking placebo requested analgesics within 2 hours of surgery, compared with only 11% of those taking rose hip extract. In addition, this rose hip extract moderately reduced the level of pain over the 24-hour period (104556).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. It is unclear if oral rose hip is beneficial for improving wrinkles. Details: Preliminary clinical research shows that taking Rosa canina rose hip powder (Hyben Vital) 1.5 grams twice daily for 8 weeks improves wrinkles, skin moisture, and elasticity when compared with baseline. However, it is unclear if these benefits are clinically significant (104557). Also, the validity of these findings is limited by the lack of a comparator group.
• Benign prostatic hyperplasia (BPH). Although there has been interest in using oral rose hip for BPH, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Cancer. Although there has been interest in using oral rose hip for cancer, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Common cold. Although there has been interest in using oral rose hip for the common cold, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Diabetes. Although there has been interest in using oral rose hip for diabetes, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Dysmenorrhea. It is unclear if oral rose hip is beneficial for reducing menstrual pain. Details: Preliminary clinical research shows that taking Rosa damascena rose hip extract 200 mg every 6 hours for 3 days is as effective as taking mefenamic acid 250 mg on the same dosing schedule for reducing pain associated with dysmenorrhea (104555).
• Gout. Although there has been interest in using oral rose hip for gout, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Hyperlipidemia. Although there has been interest in using oral rose hip for hyperlipidemia, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Hypertension. Although there has been interest in using oral rose hip for hypertension, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Influenza. Although there has been interest in using oral rose hip for influenza, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Obesity. It is unclear if oral rose hip is beneficial for obesity. Details: Preliminary clinical research shows that taking Rosa canina rose hip powder 40 grams daily mixed with apple juice for 6 weeks does not significantly affect weight or glucose tolerance when compared with placebo. However, it decreases total cholesterol by 5%, low-density lipoprotein (LDL) cholesterol by 6%, and systolic blood pressure by 4% when compared with placebo (18104).
• Rheumatoid arthritis (RA). It is unclear if oral rose hip is beneficial for RA. Details: Preliminary clinical research in adults with RA shows that taking a specific Rosa canina rose hip powder product (LitoZin/i-flex, Hyben Vital) 2.5 grams (5 capsules) twice daily over 6 months improves patient scores on a disability index, as well as other subjective physician- and patient-based assessments, when compared with placebo (17416).
• Sciatica. Although there has been interest in using oral rose hip for sciatica, there is insufficient reliable information about the clinical effects of rose hip for this condition.
• Sexual dysfunction. Oral rose hip has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in women with sexual dysfunction shows that taking a specific combination tablet (Lady Prelox, Horphag Research) containing a standardized extract of rose hip (Rosvita) 50 mg, maritime pine bark (Pycnogenol, Horphag Research) 20 mg, L-arginine 200 mg, and L-citrulline 200 mg orally daily for 8 weeks, in combination with a management program consisting of lifestyle, diet, exercise, and stress control changes, improves overall sexual function when compared with the management program alone (91963). Taking the same product in a dose of 2 tablets twice daily for 8 weeks, in addition to the lifestyle management program, improves vaginal dryness in pre- and post-menopausal women when compared with lifestyle management alone (103611). The effect of rose hip extract alone on sexual dysfunction is unclear.
• Stretch marks (striae gravidarum). Topical rose hip has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that applying a specific formulation containing hydroxyprolisilane C, rose hip oil, gotu kola triterpenes, and vitamin E (Velastisa Antiestrías, ISDIN) twice daily during pregnancy, beginning at week 10-14 and continuing throughout pregnancy, decreases the severity of both new and old stretch marks when compared with placebo. It also appears to decrease the incidence of stretch marks by about 84% in women without previous striae (92507).
• Urinary tract infections (UTIs). It is unclear if oral rose hip is beneficial for UTI prevention. Details: Preliminary clinical research in women who have undergone a Cesarean section shows that taking Rosa canina rose hip powder 500 mg twice daily, starting 2 days post-partum and continuing for 20 days, reduces the odds of asymptomatic, culture-positive UTIs by 68% when compared with placebo. However, rose hip does not appear to reduce the incidence of symptomatic UTIs in these patients (97938).
• Vitamin C deficiency. Although there has been interest in using oral rose hip for vitamin C deficiency, there is insufficient reliable information about the clinical effects of rose hip for this condition. More evidence is needed to rate rose hip for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. It is unclear if topical rutin is beneficial for aging skin. Details: Preliminary clinical research shows that topical application of a cream containing rutin 2% twice daily for 4 weeks reduces signs of skin aging around the eye in females aged 30-50 years. Skin dermal density is improved by 20%, area of crow's feet is reduced by 26%, and the number of wrinkles under the eye is reduced by 53% when compared with placebo (92236).
• Autism spectrum disorder. Oral rutin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in children 4-10 years-old with autism spectrum disorder shows that taking a product containing rutin 3 mg/kg, luteolin 10 mg/kg, and quercetin 7 mg/kg daily for 26 weeks improves aspects of behavior, such as hyperactivity, irritability, and lethargy, by a moderate to large amount when compared to baseline. It also seems to improve some indices of functioning, such as daily living and social behavior, by a small amount. These improvements were considered to be greater than expected when taking aging into consideration; however, no placebo was used in this study (96765).
• Diabetes. It is unclear if oral rutin is beneficial for diabetes. Details: A small clinical study in adults with type 2 diabetes conducted in Iran shows that taking rutin 500 mg twice daily for 3 months reduces fasting blood glucose and glycated hemoglobin by approximately 40 mg/dL and 1%, respectively, and modestly reduces triglycerides and total and low-density lipoprotein cholesterol when compared with placebo (112182). The interpretation of these findings is limited by the omission of data regarding concurrent diabetes medications. A small observational study in patients with a family history of type 1 diabetes shows that taking a specific product (Mucos Pharma) containing rutin 100 mg, trypsin 48 mg, and bromelain 90 mg daily for 24 months is not associated with reduced incidence of type 1 diabetes at 8 years (99472).
• Exercise-induced respiratory infections. Oral rutin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in non-elite male runners shows that taking a combination product (Wobenzym Plus, Mucos Pharma) providing rutin 600-1200 mg, trypsin 288-576 mg, and bromelain 540-1080 mg daily for 3 weeks, starting one week before a marathon, does not reduce the risk of a post-race respiratory tract infection when compared with placebo (96766).
• Hemorrhoids. Although there is interest in using oral rutin for hemorrhoids, there is insufficient reliable information about the clinical effects of rutin for this condition.
• Inflammatory bowel disease (IBD). Although there is interest in using oral rutin for IBD, there is insufficient reliable information about the clinical effects of rutin for these conditions.
• Lymphedema. Oral rutin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Some clinical research in patients who have undergone a mastectomy shows that taking a specific combination product containing rutin, pancreatin, papain, bromelain, trypsin, and chymotrypsin (Wobenzym N, Mucos Pharma) daily for 7 weeks reduces arm swelling associated with lymphedema when compared with diuretics (24560). Also, preliminary clinical research in patients with primary or secondary lymphedema of the upper or lower limbs shows that taking a combination product containing rutin 300 mg, bromelain 100 mg, and sweet clover 100 mg daily for 6 months decreases pitting, limb volume, pain, and quality of life when compared to baseline (103298). The validity of these findings is limited by the lack of a comparator group. Also, it is unclear if these effects are due to rutin, other ingredients, or the combination.
• Multiple sclerosis (MS). Oral rutin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A preliminary clinical study in patients with relapsing-remitting MS shows that taking an enzyme combination containing rutin 100 mg, trypsin 48 mg, and bromelain 90 mg per tablet for at least 3 months does not affect the progression of disability, relapse rate, or central nervous system lesions when compared with placebo (99468). The validity of these results are limited by the short duration of treatment.
• Obesity. It is unclear if oral rutin is beneficial for obesity. Details: In Japanese adults with a body mass index (BMI) of 23-30 kg/m2, a small clinical trial shows that taking a specific monoglucosyl rutin ( αG Rutin PS) 200 mg or 400 mg daily for 8 weeks reduces the area of visceral fat by 2.4 cm and 3.5 cm, respectively, compared with an increase of 5.2 cm in those taking placebo. However, there were no differences between groups in the actual value of visceral fat, changes in total fat or subcutaneous fat, BMI, body weight, abdominal circumference, or cholesterol or triglyceride levels (105298).
• Oral mucositis. Although there is interest in using oral rutin for oral mucositis, there is insufficient reliable information about the clinical effects of rutin for this condition.
• Osteoarthritis. Oral rutin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research shows that taking a specific combination product (Wobenzym PS, formerly Phlogenzym, Mucos Pharma) at a dose providing up to 600 mg rutin, 288 mg trypsin, and 540 mg bromelain daily for 3-12 weeks, is as effective as diclofenac for relieving pain and improving knee function in patients with painful osteoarthritis of the knee. This product also reduces the need for rescue medication by 95% when compared with placebo (6252,91104,99467,99477).
• Postoperative swelling. Oral rutin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small preliminary clinical study in patients undergoing surgery of the jaw shows that taking an enzyme combination of rutin 200 mg, trypsin 96 mg, and bromelain 180 mg twice daily for 5 days in addition to standard treatment reduces soft-tissue thickness (indicating the amount of swelling) at most of the nine assessed facial points when compared to control (99476).
• Sprains. Oral rutin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A clinical study in patients with a sprained ankle shows that taking a specific enzyme combination (Phlogenzym, Mucos Pharma) containing rutin 100 mg, trypsin 48 mg, and bromelain 90 mg, or taking different combinations of the individual enzymes three times daily for 10 days, is no more effective for relieving pain than placebo (99473).
• Stroke. Although there is interest in using oral rutin for stroke prevention, there is insufficient reliable information about the clinical effects of rutin for this purpose.
• Sunburn. Although there is interest in using topical rutin for sunburn prevention, there is insufficient reliable information about the clinical effects of rutin for this purpose.
• Varicose veins. Although there is interest in using oral rutin for varicose veins, there is insufficient reliable information about the clinical effects of rutin for this condition. More evidence is needed to rate rutin for these uses.

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LIKELY SAFE ...when rose hip extract is used orally in the amounts found in foods. Rose hip extract has Generally Recognized as Safe (GRAS) status in the US (4912). ...when rose hip from Rosa canina is used orally and appropriately in medicinal amounts. A specific formulation of rose hip powder from Rosa canina (LitoZin/i-flex, Hyben Vital), taken in doses of up to 2.5 grams (5 capsules) twice daily, has been safely used for up to 6 months (17416,71641,71646,71658,71660,71661,104557). Rose hip powder from Rosa canina, 40 grams daily mixed in apple juice, has been used safely for up to 6 weeks (18104). Rose hip powder from Rosa canina, 500 mg twice daily for 20 days, has also been safely used (97938).

POSSIBLY SAFE ...when rose hip from Rosa damascena is used orally and appropriately in medicinal amounts. Rose hip extract from Rosa damascena has been used safely in doses of 200 mg every 6 hours for 3 days (104555). There is insufficient reliable information available about the safety of medicinal amounts of rose hip from other Rosa species. There is also insufficient reliable information available about the safety of rose hip when used topically.

PREGNANCY AND LACTATION:
There is insufficient reliable information available about the safety of rose hip when used orally or topically in medicinal amounts; avoid using in amounts greater than those found in foods.

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LIKELY SAFE ...when used orally in amounts found in foods, such as fruits and vegetables.

POSSIBLY SAFE ...when used orally in medicinal amounts, short-term. Rutin has been used with apparent safety at doses of up to 600 mg daily for up to 12 weeks (6252,24560,91104,96766,105298). ...when applied topically as a cream (92236,99258,99260).

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts commonly found in foods. There is insufficient reliable information available about the use of supplemental rutin; avoid amounts greater than those found in foods.

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ALKYLATING AGENTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, the antioxidant effects of rose hip might reduce the effectiveness of alkylating agents but might also reduce the oxidative damage caused by certain alkylating agents.  Details Rose hip contains vitamin C. The use of antioxidants like vitamin C during chemotherapy is controversial. There is concern that antioxidants could reduce the activity of chemotherapy drugs that generate free radicals, such as cyclophosphamide, chlorambucil, carmustine, busulfan, and thiotepa (391). In contrast, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells (14012,14013). Further, some animal research suggests that the antioxidant effects of rose hip might attenuate cyclophosphamide-induced testicular toxicity (111413). More evidence is needed to determine what effect, if any, antioxidants found in rose hip, such as vitamin C, have on the effectiveness and adverse effects of chemotherapy.

ALUMINUM Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Probable •  Level of Evidence = D Theoretically, rose hip might increase the amount of aluminum absorbed from aluminum compounds.  Details Rose hip contains vitamin C. Theoretically, vitamin C increases the absorption of aluminum. Concomitant use might increase aluminum absorption, but the clinical significance of this is unknown (3046). Administer rose hip two hours before or four hours after antacids.

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, rose hip might reduce the effectiveness of anticoagulant or antiplatelet drugs.  Details In vitro and animal research suggests that a constituent of rose hip, rugosin E, can induce platelet aggregation (71653). This has not been shown in humans. Theoretically, concomitant use of rose hip might reduce the effectiveness of antiplatelet or anticoagulant drugs.

ANTITUMOR ANTIBIOTICS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, the antioxidant effects of rose hip might reduce the effectiveness of antitumor antibiotics.  Details Rose hip contains the antioxidant vitamin C. There is concern that antioxidants might reduce the activity of chemotherapy drugs that generate free radicals, such as antitumor antibiotics (391). In contrast, other researchers theorize that antioxidants might make antitumor antibiotic chemotherapy more effective by reducing oxidative stress that could interfere with apoptosis (cell death) of cancer cells (14012,14013). More evidence is needed to determine what effects, if any, antioxidants such as vitamin C have on antitumor antibiotic chemotherapy.

ASPIRIN Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Unlikely •  Level of Evidence = B Theoretically, rose hip might reduce the clearance of aspirin; however, its vitamin C content is likely too low to produce clinically significant effects.  Details Rose hip contains vitamin C. It has been suggested that acidification of the urine by vitamin C can decrease the urinary excretion of salicylates, increasing plasma salicylate levels (3046). However, short-term use of up to 6 grams daily of vitamin C does not seem to affect urinary pH or salicylate excretion (10588,10589). The vitamin C content of rose hip is typically about 500 mg per 100 grams. Thus, a clinically significant interaction between rose hip and aspirin is unlikely.

ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, rose hip might increase blood levels of estrogens.  Details Rose hip contains vitamin C. Increases in plasma estrogen levels of up to 55% have occured under some circumstances when vitamin C is taken concurrently with oral contraceptives or hormone replacement therapy, including topical products (129,130,11161). It is suggested that vitamin C prevents oxidation of estrogen in the tissues, regenerates oxidized estrogen, and reduces sulfate conjugation of estrogen in the gut wall (129,11161). When tissue levels of vitamin C are high, these processes are already maximized and supplemental vitamin C does not have any effect on estrogen levels. However, increases in plasma estrogen levels may occur when women who are deficient in vitamin C take supplements (11161).

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, rose hip might increase blood levels of lithium.  Details Rose hip is thought to have diuretic properties (5,18). Theoretically, due to these potential diuretic effects, rose hip might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.

WARFARIN (Coumadin) Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, rose hip might reduce the effectiveness of warfarin; however, its vitamin C content is likely too low to produce clinically significant effects.  Details Rose hip contains vitamin C. High doses of vitamin C may reduce the response to warfarin, possibly by causing diarrhea and reducing warfarin absorption (11566). This occurred in two people who took up to 16 grams daily of vitamin C, and resulted in decreased prothrombin time (9804,9806). Lower doses of 5-10 grams daily of vitamin C can also reduce warfarin absorption, but this does not seem to be clinically significant (9805,9806,11566,11567). The vitamin C content of rose hip is typically about 500 mg per 100 grams. Thus, a clinically significant interaction between rose hip and warfarin is unlikely.

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ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking rutin with antidiabetes drugs might increase the risk of hypoglycemia.  Details Animal research suggests that rutin has hypoglycemic effects (105299).

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General ...Orally, rose hip from Rosa canina is well tolerated. Rose hip from Rosa damascena also seems to be well tolerated. A thorough evaluation of safety outcomes has not been conducted for rose hip derived from other species.
Most Common Adverse Effects:
Orally: Flatulence, loose stools.

Dermatologic ...Orally, one case of mild urticaria has been reported in a clinical trial for a patient taking a specific rose hip powder product (LitoZin/i-flex, Hyben Vital) 2. 5 grams twice daily (71646).

Gastrointestinal ...Orally, gastrointestinal reactions have been reported. These include abdominal cramps, acid reflux, constipation, diarrhea, flatulence, nausea, vomiting, gastrointestinal obstruction, esophagitis, heartburn, acid reflux, and water brash. However, in most cases, these adverse effects occurred at the same frequency in patients taking placebo (15,18104,71641,71646,97938).
Rose hip powder is a source of vitamin C. Osmotic diarrhea and gastrointestinal upset have been reported with doses of vitamin C greater than the tolerable upper intake level (UL) of 2000 mg daily (4844). However, most rose hip products contain only 500 mg of vitamin C per 100 grams.

Genitourinary ...Orally, a few mild cases of frequent voiding have been reported in clinical trials. However, the frequency of occurrence does not seem to differ from those taking placebo (71641,71646).

Immunologic ...When inhaled in the workplace, rose hip dust has caused mild to moderate anaphylaxis (6).

Neurologic/CNS ...Orally, vertigo and headache have been reported rarely (97938).

Ocular/Otic ...A case of keratoconjunctivitis secondary to contact with rose hip has been reported. The adverse effect was attributed to irritant hairs found on the fruit of rose hip. Symptoms resolved after treatment with topical prednisolone 1% eye drops (71642).

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General ...Orally, rutin is generally well tolerated.

Dermatologic ...Orally, rutin may cause flushing and rashes in some people (313).

Gastrointestinal ...Orally, rutin may cause gastrointestinal disturbance in some people (313).

Neurologic/CNS ...Orally, rutin may cause headache in some people (313).

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