Bupleurum by Hawaii Pharm

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Asthma. Although there has been interest in using oral bupleurum for asthma, there is insufficient reliable information about the clinical effects of bupleurum for this purpose.
• Autoimmune thyroiditis. Oral bupleurum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with Hashimoto's thyroiditis receiving conventional levothyroxine supplementation shows that taking bupleurum 10 grams in combination with other traditional Chinese medicines for 8 weeks improves thyroid antibody levels, thyroid stimulating hormone levels, depression scores, and anxiety scores when compared with control at 24 weeks follow up. However, TSH levels were normalized by week 8 in both groups, and bupleurum does not improve free T3 or T4 levels (112353). It is unclear if these effects are due to bupleurum, other ingredients, or the combination.
• Cancer. Although there has been interest in using oral bupleurum for cancer, there is insufficient reliable information about the clinical effects of bupleurum for this purpose.
• Depression. Oral bupleurum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A meta-analysis of 55 Chinese studies shows that taking herbal combinations which include Bupleurum chinense root for 2-12 weeks slightly reduces depression severity on the Hamilton Rating Scale for Depression (HRSD) when compared with fixed standard doses of selective serotonin reuptake inhibitors (SSRIs). Using bupleurum mixtures in combination with SSRIs greatly reduces depression severity on the HRSD when compared with SSRIs alone (104103). However, the validity of this analysis is limited by considerable heterogeneity amongst the studies, which were generally of low quality and at a high risk of bias. There were 49 different bupleurum-containing formulas used in the included studies, and these contained 103 different herbs. It is unclear whether any effects were due to bupleurum, other herbs, or the combinations. It is also unclear what the depression severity was at baseline, whether SSRIs were given in sufficient doses and durations, and whether patients were treatment-naïve.
• Dysmenorrhea. Although there has been interest in using oral bupleurum for dysmenorrhea, there is insufficient reliable information about the clinical effects of bupleurum for this purpose.
• Epilepsy. Although there has been interest in using oral bupleurum for epilepsy, there is insufficient reliable information about the clinical effects of bupleurum for this purpose.
• Hepatitis B. Oral bupleurum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with chronic hepatitis B shows that taking a specific combination product (sho-saiko-to) 5.4 grams daily for 24 weeks decreases liver enzyme levels when compared with taking this same combination product at a dose of 0.5 grams daily (37391). Another small clinical study in children with chronic hepatitis B shows that taking this same combination product at an unknown dose increases the production of hepatitis B antibodies and increases the clearance of hepatitis B virus when compared with historical controls (37384). However, the clinical significance of these changes is unknown.
• Influenza. Oral bupleurum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with H1N1 influenza shows that taking a specific bupleurum-containing combination decoction (chima qingwen) twice daily for 5 days is as effective as taking oseltamivir 75 mg twice daily for 5 days for improving symptoms by at least 30% (100167).
• Liver cancer. Oral bupleurum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in adults with hepatitis B and liver cirrhosis shows that taking a specific bupleurum-containing combination product (sho-saiko-to, TJ-9, Tsumura and Co.) 7.5 grams daily for 60 months along with conventional medicine reduces the risk of developing liver cancer when compared with conventional treatment alone in patients without anti-hepatitis B antibodies. Taking this combination product did not reduce the risk of developing liver cancer in patients with anti-hepatitis B antibodies (37410).
• Pain. Although there has been interest in using oral bupleurum for pain, there is insufficient reliable information about the clinical effects of bupleurum for this purpose.
• Peptic ulcers. Although there has been interest in using oral bupleurum for peptic ulcers, there is insufficient reliable information about the clinical effects of bupleurum for this purpose.
• Respiratory tract infections. Although there has been interest in using oral bupleurum for various respiratory tract infections, including bronchitis and the common cold, there is insufficient reliable information about the clinical effects of bupleurum for these conditions. More evidence is needed to rate bupleurum for these uses.

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POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts. Bupleurum has been used with apparent safety as part of a multi-ingredient decoction (sho-saiko-to) for up to 5 years (37391,37410). It has also been used with apparent safety as part of another multi-ingredient decoction (chima qingwen) at doses of up to 40 grams bupleurum daily for up to 5 days (100167).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, bupleurum might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.  Details In vitro research suggests that saikosaponins, constituents of bupleurum, can inhibit platelet aggregation (3159,3156).

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, bupleurum might decrease the effects of antidiabetes drugs.  Details Animal research suggests that saikosaponins, constituents of bupleurum, can increase blood glucose (37402,37403).

IMMUNOSUPPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, bupleurum might decrease the effects of immunosuppressants.  Details In vitro and animal research suggests that bupleurum might stimulate immune function (2598,3160,3161).

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General ...Orally, bupleurum seems to be well tolerated. However, most research has evaluated bupleurum in combination with other ingredients; the adverse effects of bupleurum when used alone are unclear.

Gastrointestinal ...Orally, a specific bupleurum-containing combination product (sho-saiko-to) has been reported to cause nausea, anorexia, and abdominal fullness (37391). It is unclear if these adverse effects are due to bupleurum, other ingredients, or the combination.

Hepatic ...Orally, a specific bupleurum-containing combination product (sho-saiko-to) has been associated with at least 24 reported cases of hepatotoxicity (92575). It is unclear if these adverse effects are due to bupleurum, other ingredients, or the combination.

Neurologic/CNS ...Orally, a specific bupleurum-containing combination product (sho-saiko-to) has been reported to cause fatigue and paresthesia (37391). It is unclear if these adverse effects are due to bupleurum, other ingredients, or the combination.

Pulmonary/Respiratory ...Orally, combination products containing bupleurum have been reported to cause eosinophilic pneumonia (354), pulmonary edema (361), and multiple cases of pneumonitis (355,356,357,37404). A specific combination product (sho-saiko-to), used in combination with interferon-alpha in patients with chronic active hepatitis, has also been associated with multiple cases of pneumonitis (358,359,360). It is unclear if these adverse effects are due to bupleurum, other ingredients, or the combination.

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