Arnica Pain by Genexa

POSSIBLY EFFECTIVE

• Osteoarthritis. Topical arnica gel might reduce osteoarthritis pain. Details: One open-label clinical trial shows that applying arnica gel (A. Vogel Arnica Gel, Bioforce AG) twice daily for 3 weeks decreases total symptom scores, including pain, stiffness, and restriction-of-function, when compared to baseline (19112). A larger randomized clinical trial shows that applying the same gel is as effective as ibuprofen for reducing the intensity of pain and improving hand function (19108).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. Although there is interest in using topical arnica for acne, there is insufficient reliable information about the clinical effects of arnica for this purpose.
• Bleeding. It is unclear if oral arnica reduces bleeding after surgery. Details: A small clinical study in patients undergoing total mastectomy for breast cancer suggests that sublingual treatment with 5 drops of a homeopathic preparation of arnica extract (Arnica 1000 K) three times daily for 6 days might reduce the volume of blood and serum drainage by 95 mL over 5 days when compared with placebo (96769). However, because this product is a dilute homeopathic preparation, there is unlikely to be any arnica in the doses given. There is speculation that the slightly higher mean weight of the patients in the arnica group, rather than any effects of arnica itself, might have led to the statistically significant findings (96768).
• Breast cancer-related hot flashes. Oral homeopathic arnica has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A clinical study in females with non-metastatic breast cancer treated with tamoxifen or an aromatase inhibitor shows that taking a specific homeopathic medicine (Actheane, Laboratories Boiron) daily for 3 months does not reduce hot flashes when compared with placebo. This product contains 4CH each of arnica, black cohosh, bloodroot, and nitroglycerin and 5CH of snake Lachesis muta (103004).
• Bruises. Most small clinical trials show that neither topical nor oral arnica reduces postoperative bruising. Details: Most clinical research shows that topical products containing arnica 10%, as well as homeopathic oral products such as tablets, globules, and capsules, are not effective for reducing postoperative bruising (19107,19119,19120,19121,19122,19123,19124,90611,96769,96772). However, some conflicting research shows benefit. One clinical study shows that applying arnica 20% ointment 0.25 grams twice daily for 2 weeks reduces laser-induced bruising when compared to white petrolatum ointment (19125). Another clinical study shows that applying a specific arnica cream (Arnica Krem 75 g, MediTech) four times daily reduces periorbital bruising in the first week after rhinoplasty when compared with no local treatment (96773). One small study has also evaluated oral homeopathic arnica. In females undergoing a face-lift, taking a specific homeopathic oral arnica product (SinEcch, Alpine Pharmaceuticals) may reduce bruising on postoperative days 1 and 7 when compared with placebo (19124).
• Diabetic retinopathy. Small clinical studies suggest that oral homeopathic arnica may reduce symptoms of diabetic retinopathy. Details: Two preliminary clinical trials in patients with diabetic retinopathy associated with both type 1 and type 2 diabetes shows that taking three pearls of homeopathic arnica 5C orally for 6 months might modestly improve measures of vision when compared with placebo (19110,19111).
• Dry eye. It is unclear if eye drops containing arnica extract can improve dry eye in children. Details: A small observational study in children aged 9-14 years with dry eye disease and allergic conjunctivitis suggests that applying eye drops containing hyaluronic acid 0.2% and arnica extract 0.1% three times daily for four weeks is associated with improvements in subjective and objective measures of dry eye severity when compared to baseline. Improvements in these outcomes were smaller and mostly non-significant in patients using eye drops containing hyaluronic acid only (111421). The validity of these findings is limited by a lack of between-group analysis and randomization.
• Exercise-induced muscle soreness. Small studies suggest that oral homeopathic arnica does not reduce muscle soreness after exercise. It is unclear if topical arnica is beneficial. Details: Despite some conflicting evidence (19135), most clinical research shows that taking homeopathic arnica formulations orally does not prevent delayed-onset muscle soreness (19129,19130,19131,19132,19133). Research on the use of topical arnica formulations is conflicting. One small study in trained athletes shows that using a gel containing 25 mg of dry arnica herb on muscles immediately after a run and then every 4 hours while awake for 5 days improves muscle tenderness and pain by a small amount after 3 days, but not at other time points, when compared with placebo (90612). However, another small study suggests that applying arnica 7% cream (Boiron Group) increases muscle pain following calf raises when compared with placebo (17113).
• Postoperative swelling. It is unclear if topical arnica reduces swelling after surgery. Details: One clinical study shows that applying arnica 10% ointment following blepharoplasty does not reduce postoperative swelling when compared with using a placebo ointment (96772). However, lower quality studies have yielded more promising results. One small clinical study shows that applying a specific arnica cream (Arnica Krem 75 g, MediTech) four times daily reduces swelling by a small amount in the first week after rhinoplasty when compared with no local treatment (96773). The validity of this finding is limited by the lack of a placebo control. A small retrospective study suggests that using a topical homeopathic preparation containing arnica 50M and marsh tea 50M (OcuMend, Cearna Inc.) is associated with reduced postoperative swelling after oculofacial surgery (96770); however, this study is limited by poor design (96771).
• Postoperative pain. Findings related to the use of oral homeopathic arnica are mixed; most studies utilizing a placebo control have yielded negative results. Details: Many small clinical studies show that taking homeopathic arnica preparations orally modestly reduces postoperative pain following tonsillectomy, knee surgery, and carpal tunnel release when compared with baseline or control. Most studies have used homeopathic arnica in dilutions of 30C, 30X, D6, or D4, for up to two weeks postoperatively (19102,19114,19115,19116). In one study, oral homeopathic arnica has been used along with arnica 5% ointment from 72 hours after surgery for up to 2 weeks (19116). The validity of these findings is limited by the lack of a placebo comparator. Studies utilizing a placebo or active control have not yielded positive results. Clinical research in patients recovering from carpal tunnel surgery shows that taking a homeopathic Arnica montana solution by mouth is no more effective than taking placebo for reducing postoperative pain and bruising (19107). Other clinical research shows that taking homeopathic arnica 30C for 5 days after total abdominal hysterectomy does not reduce postoperative pain when compared with placebo and usual treatment (19117). Also, homeopathic arnica D4 is inferior to diclofenac following bunion surgery (109102). Some clinical research in patients recovering from a knee ligament reconstruction shows that a homeopathic solution containing Arnica montana 5 CH, Bryonia alba 5 CH, Hypericum perforatum 5 CH, and Ruta graveolens 3 DH is no more effective than placebo for reducing analgesic use (32413).
• Postoperative recovery. It is unclear if oral homeopathic arnica is beneficial for postoperative recovery. Details: One meta-analysis of small- to moderate-sized clinical trials shows that taking homeopathic arnica does not improve postoperative recovery when compared with controls. Recovery endpoints were combined and included pain, swelling, bruising, wound healing, and others (109061).
• Stroke. A small study suggests that oral homeopathic arnica does not improve outcomes after stroke. Details: Preliminary clinical research shows that taking one tablet of arnica 30C sublingually every 2 hours for six doses doesn't benefit stroke patients (19126). Endpoints included level of consciousness, mobility, incontinence, social performance, and mental state.
• Tooth extraction. It is unclear if oral homeopathic arnica improves symptoms after tooth extraction in adults or children. Details: A small clinical trial in children aged 8-12 years undergoing two sessions of tooth extraction in different parts of the mouth shows that taking homeopathic arnica 30 minutes prior to the procedure, and then 3 times daily for 72 hours, is as effective as taking ibuprofen for reducing patient-reported and operator-assessed pain levels 24 hours after extraction. However, 48 hours after extraction, ibuprofen was more effective. Each child was provided with both arnica and weight-based doses of ibuprofen in a crossover manner while undergoing two sessions of tooth extraction in different parts of the mouth ten days apart (109224). A small observational study in adults undergoing third molar extractions suggests that taking homeopathic arnica 30X (Hyland's Inc.) 4 tablets before the procedure and then 4 tablets four times daily for 4 days after the procedure is associated with less pain, bleeding, and swelling when compared with standard treatment alone (105062). However, the validity of this study is limited by the lack of a placebo control. More evidence is needed to rate arnica for these uses.

(Read more about ARNICA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. Topical calendula has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients with mild to moderate acne associated with mask wearing shows that topical application of a combination of calendula 4%, licorice root extract 0.3%, and snail secretion filtrate 40% (AI complex) to the face twice daily for 12 weeks modestly reduces inflammatory, but not non-inflammatory or total, acne lesions when compared with placebo. There was no difference in overall treatment success, defined as at least almost clear skin or a large improvement (110322). It is unclear if any benefits are due to calendula, other ingredients, or the combination.
• Bacterial vaginosis. It is unclear if topical calendula is beneficial for improving bacterial vaginosis. Details: A small clinical study in patients with bacterial vaginosis shows that applying 5 grams of vaginal cream containing calendula flower extract before bed for one week improves vaginal burning, odor, painful urination, and painful intercourse when compared to baseline (96649). The validity of these findings is limited by the lack of a comparator group.
• Burns. It is unclear if oral calendula is beneficial for burn healing. Details: A small clinical trial in patients hospitalized for second-degree burns shows that taking calendula 2 grams daily for 2 weeks has a large beneficial effect on wound healing when compared with placebo (110323).
• Chronic obstructive pulmonary disease (COPD). Oral calendula has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in males aged 40-70 years with a history of smoking and stage 2 COPD shows that taking a specific combination of calendula flowers 165 mg, elderberry 165 mg, and heart's ease herb 165 mg (Inflaminat, INAT-Farma), 3 capsules daily for 6 months, modestly improves symptoms, as measured on the breathlessness, cough, and sputum scale (BCSS), and mean forced expiratory volume in 1 second (FEV1) when compared to baseline. However, there was no improvement of COPD exacerbations or other pulmonary function tests (103629). The validity of this finding is limited by the lack of statistical comparison to the placebo group. Furthermore, it is unclear if these effects are due to calendula, the other ingredients, or the combination.
• Chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS). Calendula in rectal suppositories has only been evaluated in combination with turmeric extract; its effect when used alone is unclear. Details: A small clinical study in patients with CP/CPPS shows that using a rectal suppository containing turmeric extract 350 mg and calendula extract 80 mg daily for one month improves pain, peak urine flow rate, and erectile function when compared with placebo (96648). It is unclear if these effects are due to calendula, turmeric, or the combination.
• Conjunctivitis. Although there is interest in using topical calendula for conjunctivitis, there is insufficient reliable information about the clinical effects of calendula for this condition.
• Diabetic foot ulcers. It is unclear if topical calendula is beneficial for improving diabetic foot ulcers. Details: Observational research has found that applying a calendula hydroglycolic extract spray in addition to standard care and hygiene is associated with reduced bacterial colonization and improved odor in patients that have had a diabetic ulcer for over 3 months (93548).
• Diaper rash. It is unclear if topical calendula is beneficial for improving diaper rash. Details: One preliminary clinical study in children less than 3 years of age shows that topical application of calendula 1.5% ointment three times daily for 10 days improves diaper rash when compared with aloe gel (19779). However, other preliminary clinical research shows that applying calendula 1.5% cream every 4-6 hours for 3 days improves diaper rash in fewer infants when compared to treatment with bentonite 50% mineral solution (93545,93554).
• Dysmenorrhea. Although there is interest in using oral calendula for dysmenorrhea, there is insufficient reliable information about the clinical effects of calendula for this condition.
• Gingivitis. It is unclear if using a mouth rinse with calendula is beneficial for improving gingivitis. Details: Preliminary clinical research in patients with mild gingivitis and bleeding gums shows that rinsing the mouth with a tincture containing calendula 25% (Dr. Willmar Schwabe Germany Home Pharmacy Pvt. Ltd.) twice daily for 6 months decreases plaque, gingivitis, and bleeding by 10% to 18% when compared to rinsing with water (93551). Other preliminary clinical research in adults with mild to moderate gingivitis and mild plaque shows that rinsing the mouth with a combination mouthwash containing a 5% extract of calendula, rosemary, and ginger for 30 seconds twice daily after food for 2 weeks decreases plaque, gingivitis, and bleeding when compared with a placebo mouthwash. The effects of this combination mouthwash appear to be similar to chlorhexidine 0.2% mouthwash (93555). It is unclear if these effects are due to calendula, other ingredients, or the combination.
• Hemorrhoids. Although there is interest in using topical calendula for hemorrhoids, there is insufficient reliable information about the clinical effects of calendula for this purpose.
• Liver disease. Although there is interest in using oral calendula for liver disease, there is insufficient reliable information about the clinical effects of calendula for this condition.
• Mosquito repellent. It is unclear if topical calendula essential oil helps to repel mosquitos. Details: Preliminary clinical research shows that applying calendula 50% essential oil to the skin does not repel mosquitos as effectively as applying DEET. Mean repellency time was about 2 hours for patients applying calendula, which was shorter than the 6 hour repellency with DEET (93562).
• Oral leukoplakia. It is unclear if topical calendula is beneficial for improving oral leukoplakia. Details: Preliminary clinical research in patients with oral leukoplakia shows that applying a gel containing calendula flower extract 0.2% three times daily for one month reduces lesion size by about 2 cm when compared to baseline (96650). The validity of this finding is limited by the lack of a comparator group.
• Oral mucositis. Calendula as a mouth rinse has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients with head and neck cancer receiving chemotherapy and radiotherapy shows that rinsing with 7 mL of a specific product (Faringel, Cadigroup) containing calendula powder extract 2%, propolis, aloe vera, and chamomile three times daily for 6 weeks does not prevent oral mucositis when compared with placebo (95879).
• Otitis media. Topical calendula has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in children with otitis media shows that applying a specific combination product containing calendula, mullein, garlic, and St. John's wort in olive oil (Otikon Otic Solution, Healthy-On Ltd, Petach-Tikva, Israel), five drops into the affected ear three times daily for 3 days, may reduce ear pain when compared with baseline (39500,39552). It is unclear if this effect is due to calendula, other ingredients, or the combination. Furthermore, due to the lack of an adequate control group, it is unclear whether the pain reduction was due to the resolution of otitis media.
• Peptic ulcers. Although there is interest in using oral calendula for peptic ulcers, there is insufficient reliable information about the clinical effects of calendula for this condition.
• Pressure ulcers. It is unclear if topical calendula is beneficial for improving pressure ulcers. Details: Observational research has found that the application of a specific calendula product (Plenusdermax) twice daily is associated with improved healing in patients with pressure ulcers that have not changed in size for at least 3 months (93549). Preliminary clinical research in hospice patients with symptomatic pressure ulcers and other wounds shows that applying a homeopathic powder (RGN107) containing calendula 0.1% and arnica 0.01% to wounds for 4 weeks is rated by the patients and caregivers to be acceptable for controlling pain, odor, and exudate when compared with baseline (96647). The validity of this finding is limited by the lack of a control group.
• Radiation dermatitis. It is unclear if topical calendula reduces radiation dermatitis symptoms. Details: Meta-analyses of three preliminary clinical trials in patients with breast cancer show that topical calendula does not affect the development of radiation dermatitis or the incidence of moderate to severe symptoms when compared to control (110325,113674). In addition, a meta-analysis of two studies (39503,93560) shows that topical calendula does not reduce the incidence of treatment interruptions due to severe symptoms of radiation dermatitis (110325). In one of the included studies, a specific calendula petroleum jelly ointment (Pommade au Calendula par Digestion, Boiron Ltd.) used twice daily during radiation therapy was found to reduce acute radiation dermatitis occurrence when compared with topical trolamine (Biafine) (39503). However, it is unclear if the benefit was due to calendula or petroleum jelly. Another clinical study used a specific calendula 10% cream in wool fat and sesame oil (Calendula Weleda, Weleda AG) twice daily during radiation therapy. This product was found to be no better than aqueous petroleum jelly cream (Essex, Schering-Plough) for reducing acute skin reactions and dermatitis symptoms of pain, burning, itching, pulling, and tenderness (93560).
• Vaginal atrophy. Topical calendula has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in menopausal patients with vaginal atrophy shows that use of a specific vaginal gel containing calendula, Lactobacillus sporogenes, isoflavones, and lactic acid (Estromineral Gel, Rottapharm-Madaus) daily for 4 weeks reduces vaginal itching, burning, dryness, and painful intercourse when compared with no topical treatment. Both groups also received oral isoflavones (39534). It is unclear if these effects are due to calendula, other ingredients, or the combination.
• Vaginal candidiasis. One small clinical study suggest that topical calendula is not beneficial for the treatment of vaginal candidiasis. Details: Preliminary clinical research shows that applying 5 grams of calendula 1% cream intravaginally once daily for 7 days effectively treats vaginal candidiasis in 34% fewer patients when compared with using clotrimazole 1% cream (93559).
• Venous leg ulcers. It is unclear if topical calendula is beneficial for improving venous leg ulcers. Details: Preliminary clinical research shows that applying a calendula 7.5% ointment twice daily for 3 weeks to venous leg ulcers accelerates healing when compared with applying saline solution dressing (39509).
• Wound healing. It is unclear if topical calendula is beneficial for improving the healing of small wounds. Details: Two small clinical trials in postpartum patients show that applying calendula ointment (formulation unspecified) to the episiotomy wound every 8 hours for 5-10 days modestly reduces pain, and seems to speed up the resolution of redness, edema, and ecchymosis, when compared with standard care, such as application of betadine solution (93550,105087). Another small clinical study in adults with wounds smaller than 10 cm² on the hands and fingers shows that applying calendula flower extract 2% to the wound twice daily may modestly improve healing and epithelialization time when compared with mineral oil (107806). More evidence is needed to rate calendula for these uses.

(Read more about CALENDULA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Back pain. Topical marsh Labrador tea has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with acute low back pain shows that using a topical homeopathic gel (Spiroflor SRL) containing marsh Labrador tea, comfrey, and poison ivy, for one week, might have similar efficacy to capsaicin cream for reducing pain scores on a visual analog scale (40358).
• Insect bite. Topical marsh Labrador tea has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that using a homeopathic after-bite gel, containing marsh Labrador tea, echinacea, and stinging nettle, topically on mosquito bites does not reduce erythema or itching when compared with placebo (89235).
• Osteoarthritis. Topical marsh Labrador tea has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with knee osteoarthritis shows that topical use of a homeopathic gel containing marsh Labrador tea, comfrey, and poison ivy, 1 gram three times daily for 4 weeks, is as effective as topical piroxicam gel 5% for reducing pain scores on a visual analog scale (89245).
• Postoperative swelling. Topical marsh Labrador tea has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small observational study in adults undergoing oculofacial surgery shows that applying hydrogel pads (OcuMend, Cearna Inc) containing homeopathic doses of marsh Labrador tea and arnica for 6 days postoperatively might improve swelling and healing when compared to historical data (96770). The validity of these results is reduced by the absence of a control group, and the lack of information on how efficacy was measured. More evidence is needed to rate marsh Labrador tea for these uses.

(Read more about MARSH LABRADOR TEA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Back pain. Topical poison ivy has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with acute low back pain shows that a specific homeopathic gel (Spiroflor SRL) containing poison ivy, comfrey, and marsh Labrador tea in a 1:2:1 ratio might work as well as capsaicin cream for reducing pain (40358).
• Osteoarthritis. Topical poison ivy has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with osteoarthritis shows that use of a homeopathic gel containing poison ivy, marsh Labrador tea, and comfrey, 1 gram three times daily for 4 weeks, is as effective as a 5% piroxicam gel for reducing pain (89245).
• Pain (acute). Although there has been interest in using oral homeopathic preparations of poison ivy for acute pain, there is insufficient reliable evidence about the clinical effects of poison ivy for this purpose.
• Pruritus. Although there has been interest in using oral homeopathic preparations of poison ivy for pruritic skin conditions, there is insufficient reliable evidence about the clinical effects of poison ivy for this purpose.
• Rheumatoid arthritis (RA). Although there has been interest in using oral homeopathic preparations of poison ivy for RA, there is insufficient reliable evidence about the clinical effects of poison ivy for this purpose.
• Sprains. Although there has been interest in using oral homeopathic preparations of poison ivy for sprains, there is insufficient reliable evidence about the clinical effects of poison ivy for this purpose. More evidence is needed to rate poison ivy for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Abortion. Although there has been interest in using oral rue to induce an abortion, there is insufficient reliable information about the clinical effects of rue for this purpose.
• Cancer. Although there has been interest in using oral rue for cancer, there is insufficient reliable information about the clinical effects of rue for this purpose.
• Contraception. Although there has been interest in using oral rue as a contraceptive, there is insufficient reliable information about the clinical effects of rue for this purpose.
• Dyspepsia. Although there has been interest in using oral rue for dyspepsia, there is insufficient reliable information about the clinical effects of rue for this purpose.
• Insect repellent. Although there has been interest in using topical rue as an insect repellent, there is insufficient reliable information about the clinical effects of rue for this purpose. More evidence is needed to rate rue for these uses.

(Read more about RUE)

POSSIBLY SAFE ...when used orally in amounts commonly found in foods. Arnica has Generally Recognized As Safe (GRAS) status for use as a food flavoring in the US (4912). However, Canadian regulations do not allow its use as a food ingredient (12). ...when used orally in homeopathic dilutions of 30C and up to 5C (19110,19111,19117,19124,19126,96769). ...when used topically on unbroken skin, short-term (12).

LIKELY UNSAFE ...when used orally or when applied topically to broken skin. Arnica is considered poisonous and has caused severe or fatal poisonings (5). Arnica can cause gastroenteritis, muscle paralysis, bleeding, arrhythmia, hypertension, shortness of breath, nausea and vomiting, multi-organ failure, and death (4,5,17,104,19101,19102,19103,19104,19105,19106,19107,19108).

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally or topically; avoid using (12).

(Read more about ARNICA)

LIKELY SAFE ...when the flower preparations are used orally or topically and appropriately (4,19779,36931,39503,93552,93557,96647,105088).

PREGNANCY: LIKELY UNSAFE
when used orally; contraindicated due to spermatocide, antiblastocyst, and abortifacient effects. There is insufficient reliable information available about the safety of calendula when used topically during pregnancy (4).

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about CALENDULA)

LIKELY UNSAFE ...when large amounts are used orally to induce abortion (2). The essential oil of marsh Labrador tea can cause severe gastrointestinal tract irritation, kidney and urinary tract damage, and paralysis (2). There is insufficient reliable information available about the safety of marsh Labrador tea for its other uses.

PREGNANCY: LIKELY UNSAFE
when used orally; avoid using (2,19). Marsh Labrador tea is considered to be a potential uterine stimulant and abortifacient (19,97164).

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about MARSH LABRADOR TEA)

LIKELY UNSAFE ...when used orally or topically (6). Poison ivy is highly irritant and allergenic (68970).

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally or topically (6); avoid using.

(Read more about POISON IVY)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Rue and rue oil have Generally Recognized as Safe (GRAS) status for use in foods at concentrations that do not exceed 2 parts per million (ppm) (12,4912).

POSSIBLY SAFE ...when products containing dried rue leaves are used medicinally in appropriate doses (6,12,18,515). However, therapeutic doses can cause drowsiness, dizziness, and gastrointestinal irritation and cramps (12).

LIKELY UNSAFE ...when fresh rue and rue oil are used orally, or when large doses of the dried herb are used orally (2,12,18). Overdose is associated with severe abdominal pain, vomiting, liver damage, kidney damage, vertigo, respiratory distress, and delirium, and can be fatal (12,18). ...when fresh rue is applied topically. Rue can cause contact dermatitis and severe photodermatitis (2,6,11,19,104119,107948).

PREGNANCY: LIKELY UNSAFE
when used orally. Rue has uterine stimulant and abortifacient effects (12,19); avoid using. Deaths have been reported in women who used rue as an abortifacient (2).

LACTATION:
There is insufficient reliable information available about the use of rue when breast-feeding; avoid use.

(Read more about RUE)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, arnica might have additive effects with anticoagulant and antiplatelet drugs. Homeopathic arnica preparations are unlikely to have this interaction.  Details In vitro evidence shows that sesquiterpene lactones in arnica flowers can decrease platelet aggregation (104). However, this effect has not been reported in humans.

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CNS DEPRESSANTS Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, calendula might have additive effects when used with CNS depressants, although this appears to be unlikely.  Details Although some animal research has suggested that a saponoside constituent in calendula may have sedative effects (39545,39547), calendula has been used for over 30 years without reports of sedation in humans (105088).

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PHOTOSENSITIZING DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, rue might increase the risk for phototoxicity when used with photosensitizing drugs.  Details Rue contains photosensitizing furanocoumarins and psoralens and has been associated with multiple reports of phototoxic reactions (104119,107948). There is also one case report of an increased phototoxic response to psoralen and ultraviolet A (PUVA) therapy associated with ingestion of rue (6177).

(Read more about RUE)

General ...Orally, arnica is unsafe and can cause toxicity. When used in homeopathic amounts, arnica seem to be generally well tolerated. Topically, arnica also seems to be generally well tolerated.
Most Common Adverse Effects:
Orally: Bleeding, gastroenteritis, hypertension, muscle paralysis, nausea and vomiting, shortness of breath.
Topically: Contact dermatitis and irritation.
Serious Adverse Effects (Rare):
Orally: Arrhythmia, coma, multi-organ failure, and death.

Cardiovascular ...Orally, arnica can cause tachycardia or a faster heart rate (11,17113,19101,19102). A 24-year-old female presented to the emergency department with palpitations and vomiting 24 hours after ingesting a cup of tea that reportedly contained arnica flowers picked from her local area of mountainous Southern California. The species was not specified in the article and there was no indication by the authors that any testing had been done to confirm the identity of the plant (90610).

Dermatologic ...Orally, arnica can cause irritation of mucous membranes (11,17113). Topically, arnica can cause contact itchiness, dry skin, and rash (17113). Oral lesions resulted in a woman who used a mouthwash incorrectly by not following dilution instructions. The mouthwash was 70% alcohol and contained arnica and oil of peppermint (19106).

Gastrointestinal ...Orally, arnica can cause stomach pain, nausea, vomiting, and diarrhea (11,17113,19101,19102). Homeopathic arnica has been reported to cause dry mouth (30C) and sore tongue (6C) (19107). A 24-year-old female presented to the emergency department with palpitations and vomiting 24 hours after ingesting a cup of tea that reportedly contained arnica flowers picked from her local area of mountainous Southern California. The species was not specified in the article and there was no indication by the authors that any testing had been done to confirm the identity of the plant (90610).

Musculoskeletal ...Adverse effects after ingesting arnica include muscle weakness (19101). Homeopathic arnica has been reported to result in the feeling of a "throbby" head or neck (19107).

Neurologic/CNS ...Orally, arnica may cause drowsiness, nervousness, and headache (11,17113,19101,19107).

Ocular/Otic ...In a case report, accidental intake of a large amount of a homeopathic Arnica-30 resulted in acute vision loss due to bilateral toxic optic neuropathy (19105).

Psychiatric ...Oral homeopathic arnica (6C) may cause depressed feelings, specifically a feeling of unhappiness (19107).

Pulmonary/Respiratory ...Orally, arnica can cause shortness of breath (11,17113).

(Read more about ARNICA)

General ...Orally and topically, calendula is generally well tolerated.
Serious Adverse Effects (Rare):
All ROAs: Allergic reactions.

Dermatologic ...Topically, a preparation containing calendula powder 0. 1% resulted in inflammation around the wound to which it was applied (96647). Burning sensation, itching, redness, and scaling were reported rarely in patients applying a combination of calendula, licorice, and snail secretion filtrate to the face. The specific role of calendula is unclear (110322).

Immunologic ...Orally, calendula can cause allergic reactions. Topically, calendula can cause eczematous allergic reactions. Calendula-specific patch testing is recommended prior to usage to determine allergenic potential. Testing is particularly necessary in individuals sensitive to the Asteraceae/Compositae family (10691,11458,96647). Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs. A preparation containing calendula powder 0.1% resulted in hives in a patient with a ragweed allergy (96647). Despite the widespread use of calendula and the occurrence of allergies to other family members, there has been only one report of anaphylaxis (11152).

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General ...Orally, large amounts of marsh Labrador tea can cause poisoning due to its ledol constituent (2). The essential oil of marsh Labrador tea can cause severe irritation of the gastrointestinal tract, vomiting, diarrhea, irritation and damage to the kidneys and urinary tract, heavy perspiration, myalgias, and arthralgias. It can also cause central nervous system excitation with narcotic intoxication, seizures, paralysis, and even death (2,97164). The content of ledol in marsh Labrador tea is unpredictable, and seems to range from 3.9% to 30.5% depending on the geographical source (97164).

Gastrointestinal ...Orally, ledol, a constituent of the essential oil of marsh Labrador tea, can cause gastrointestinal irritation resulting in vomiting, gastroenteritis, and diarrhea (97164).

Genitourinary ...Orally, the essential oil of marsh Labrador tea can cause irritation and damage to the kidneys and urinary tract (2).

Musculoskeletal ...Orally, the essential oil of marsh Labrador tea can cause myalgias and arthralgias (2).

Neurologic/CNS ...Orally, ledol, a constituent of marsh Labrador tea essential oil, can cause central nervous system excitation in a dose-dependent manner. Small amounts of ledol can lead to mild stimulating effects similar to caffeine, while larger doses can lead to spasms, seizures, paralysis, and even death (97164).

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General ...When used orally or topically, poison ivy may be unsafe.
Most Common Adverse Effects:
Orally: Diarrhea, dizziness, fever, intestinal colic, nausea, vomiting, severe mucous membrane irritation.
Topically: Contact dermatitis, herpes-like blisters, reddening, swelling.
Inhaled: Fever.
Serious Adverse Effects (Rare):
Orally: Fever, hematuria, nephritis, stupor, unconsciousness.
Topically: Erythema multiforme, black spot poison ivy dermatitis. Eye contact can cause severe conjunctivitis, corneal inflammations, or loss of sight.
Inhaled: Lung infection, respiratory distress syndrome, throat swelling.

Dermatologic ...Topically, poison ivy can cause contact dermatitis, reddening, swelling, and herpes-like blisters (18). These reactions occur at the area of contact, usually within a few hours, but are sometimes delayed for several days (68970). Sometimes papules and vesicles develop and can spread beyond the area of initial contact, but are generally self-limiting and eventually form crusts. (3839,68955,68960,68977,69007,69008,69038,69042). In a few cases, small white papules known as milia have developed on an area of poison ivy exposure after the typical skin reaction has subsided (94222). Occasionally, poison ivy causes more severe dermatologic reactions such as erythema multiforme (3839,68983,69032,112851). Black spot poison ivy dermatitis also occurs in rare cases, with black lacquer-like lesions on the skin that cannot be washed off, followed by the typical pruritic papules (112850). The black lesions are concentrated urushiol oleoresin that has darkened with exposure to oxygen and moisture (68960,68997,69027,69034). They eventually peel off and the skin heals normally (68960,112850).

Gastrointestinal ...Orally, poison ivy can cause severe mucous membrane irritation, nausea, vomiting, and diarrhea (18).

Genitourinary ...Orally, poison ivy can cause hematuria (18).

Immunologic ...Cross-allergenicity with poison ivy exists with cashew, mango, and ginkgo biloba (106574).

Neurologic/CNS ...Orally, poison ivy can cause dizziness, fever, stupor, and unconsciousness (18).

Ocular/Otic ...Topically, eye contact with urushiol from poison ivy can cause severe conjunctivitis, corneal inflammation, and potentially loss of sight (18).

Pulmonary/Respiratory ...Inhaled, urushiol in the smoke from burning of poison ivy can result in life-threatening throat swelling, fever, and secondary lung infections (6). Respiratory distress syndrome after smoke inhalation from burning poison ivy has also been reported (69036). Two fatal cases of acute respiratory distress and anaphylaxis after inhaling burned poison ivy are reported in patients with known allergies to poison ivy (112420).

Renal ...Orally, poison ivy can cause nephritis (18).

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General ...Orally, rue is well tolerated when taken in the amounts found in foods. The dried herb seems to be generally well tolerated when taken in medicinal doses; however, a thorough evaluation of safety outcomes has not been conducted. Fresh rue is generally considered unsafe.
Most Common Adverse Effects:
Orally: Cramps, drowsiness, depression, dizziness, gastrointestinal irritation, and sleep disturbances with medicinal use of the dried herb.
Topically: Contact dermatitis and phototoxic skin reactions with the fresh plant.

Cardiovascular ...Orally, large doses of rue have been associated with bradycardia (2).

Dermatologic ...Topically, rue can cause contact dermatitis (2). Exposure to the fresh rue plant followed by sun exposure within 48 hours can lead to severe phototoxic reactions (2,6). Multiple case reports describe patients who developed pruritus, erythema, and severe blistering on the back of the hands and wrists, equivalent to a partial thickness burn, after contact with the fresh plant leaves and exposure to sunlight (104119,107948). One patient was successfully treated with cetirizine and oral and topical corticosteroids (107948).

Gastrointestinal ...Orally, rue can cause gastrointestinal irritation and cramps at therapeutic doses (2,12). When taken in large doses, it causes severe abdominal pain and vomiting (2,12,18).

Genitourinary ...Orally, rue can cause uterine stimulation and abortion (2).

Hepatic ...Orally, high doses of rue can cause liver damage (2,12,18).

Neurologic/CNS ...Orally, therapeutic doses of rue can cause tremor, dizziness, drowsiness, sleep disorders, and depression. High doses can cause vertigo, seizures, and delirium (2,12,18).

Pulmonary/Respiratory ...Orally, high doses of rue can cause respiratory distress (2,12,18).

Renal ...Orally, high doses of rue can cause kidney damage (2,12,18).

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