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There is insufficient reliable information available about the effectiveness of Clematis recta.

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POSSIBLY EFFECTIVE

• Chronic venous insufficiency (CVI). Most clinical research suggests that oral horse chestnut extract reduces symptoms of CVI. Details: Clinical research shows that taking horse chestnut seed extract 300 mg twice daily or providing aescin, a constituent of horse chestnut, 50-75 mg twice daily for up to 12 weeks can reduce some symptoms of CVI, such as varicose veins, pain, tiredness, tension, itching, edema, and swelling in the legs (281,282,283,284,285,12113,55477,55481,55501,55502)(55520,55526,55537). However, some preliminary clinical research suggests that horse chestnut seed extract (Venostasin, Klinge Pharma GmbH) may be less effective than maritime pine bark (Pygnoforton, Plantorgan) for reducing leg swelling, cramps, and a feeling of heaviness in patients with CVI (7693).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Irritable bowel syndrome (IBS). It is unclear if oral horse chestnut is beneficial for IBS. Details: A small, preliminary clinical trial and retrospective case series show that taking a combination product containing horse chestnut extract 470 mg, quebracho colorado 150 mg, and peppermint oil 0.2 mL (Atrantil, KBS Research, LLC) daily for 2 weeks reduces abdominal pain, constipation, and bloating when compared with baseline in patients with constipation-predominant IBS (95429,95430). The effects of horse chestnut alone are unclear.
• Kidney stones (nephrolithiasis). It is unclear if oral aescin, a constituent of horse chestnut, is beneficial for kidney stones. Details: A large clinical study in outpatient adults in Iraq with a single kidney stone shows that taking aescin, a constituent of horse chestnut, 120 mg daily for 10 days increases the rate of stone expulsion when compared with placebo, but not when compared with prednisolone 25 mg daily. Aescin also decreases the time to stone expulsion and increases the percent of patients experiencing complete pain relief when compared with prednisolone or placebo (110440). The validity of these findings is limited by the lack of blinding.
• Male infertility. It is unclear if oral horse chestnut is beneficial for male infertility. Details: Preliminary clinical research shows that taking horse chestnut seed extract 150 mg (Aescuven Forte), containing aescin 30 mg, twice daily for 2 months increases sperm density, but does not improve sperm motility, in men with varicocele-associated infertility (55493). More evidence is needed to rate horse chestnut for these uses.

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There is insufficient reliable information available about the effectiveness of rock rose.

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There is insufficient reliable information available about the effectiveness of star of Bethlehem.

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POSSIBLY UNSAFE ...when the fresh plant is used topically (18).

LIKELY UNSAFE ...when the fresh plant is used orally because it is severely irritating to mucous membranes and the gastrointestinal tract (18). There is insufficient reliable information available about the safety of the oral or topical use of dried Clematis recta.

PREGNANCY AND LACTATION: LIKELY UNSAFE
when the fresh plant is used orally. There is insufficient reliable information available for the safety of the dried plant; avoid using.

(Read more about CLEMATIS RECTA)

LIKELY SAFE ...when standardized horse chestnut seed extracts are used orally and appropriately, short-term. These extracts, from which esculin, a toxic constituent, has been removed (9420), have been used with apparent safety for 2-12 weeks (281,282,283,284,285,12113,95429,95430).

UNSAFE ...when the raw seed, bark, flower, or leaf is used orally. Horse chestnut contains significant amounts of the toxin esculin, and can be lethal (17). There is insufficient reliable information available about the safety of horse chestnut when used topically, intravenously, or intramuscularly.

CHILDREN: UNSAFE
when the raw seeds, bark, flower, or leaves are used orally. Poisoning has been reported from children drinking tea made with twigs and leaves (9,55528).

PREGNANCY AND LACTATION: UNSAFE
when the raw seed, bark, flower, or leaf are used orally. Horse chestnut preparations can be lethal (17); avoid using. There is insufficient reliable information available about the safety of horse chestnut seed extract when used during pregnancy and lactation; avoid using.

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There is insufficient reliable information available about the safety of rock rose.

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

(Read more about ROCK ROSE)

LIKELY UNSAFE ...when used orally. Star of Bethlehem contains toxic cardiac glycosides (15330,15331,15332,15333). Ingestion of star of Bethlehem could result in serious adverse effects including cardiac arrhythmia and death.

PREGNANCY AND LACTATION: LIKELY UNSAFE
when used orally. Star of Bethlehem contains toxic cardiac glycosides (15330,15331,15332,15333). Ingestion of star of Bethlehem could result in serious adverse effects.

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Horse chestnut may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.  Details Horse chestnut contains the constituent esculin which has been shown to have antithrombotic effects. Therefore, horse chestnut might have antiplatelet effects (19). This has not been shown in humans.

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CORTICOSTEROIDS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking star of Bethlehem with prolonged corticosteroid therapy might increase the risk of toxicity.  Details Star of Bethlehem contains cardiac glycosides (15330,15331). Concomitant use of corticosteroids with star of Bethlehem can increase the therapeutic and adverse effects of long-term corticosteroid use due to potassium depletion and electrolyte imbalance.

DIGOXIN (Lanoxin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking star of Bethlehem in combination with digoxin might have additive effects and increase the risk of toxicity.  Details Star of Bethlehem contains cardiac glycosides with effects similar to digoxin (15330,15331).

DIURETIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking diuretics with star of Bethlehem might increase the risk of toxicity.  Details Star of Bethlehem contains cardiac glycosides (15330,15331). Theoretically, concomitant use of potassium-depleting diuretics and star of Bethlehem can increase the risk of cardiac glycoside toxicity due to potassium depletion (506).

MACROLIDE ANTIBIOTICS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking macrolide antibiotics with star of Bethlehem might increase the risk of cardiac glycoside toxicity.  Details Star of Bethlehem contains cardiac glycosides (15330,15331). Macrolide antibiotics appear to increase the gastrointestinal absorption of oral digoxin. Theoretically, concomitant use of macrolide antibiotics might increase the absorption of the cardiac glycosides found in star of Bethlehem and increase the risk of adverse effects (17).

QUININE Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking quinine with star of Bethlehem might increase the risk of cardiac glycoside toxicity.  Details Star of Bethlehem contains cardiac glycosides (15330,15331). Quinine may reduce the clearance of oral digoxin. Theoretically, concomitant use of quinine might reduce the clearance of cardiac glycosides found in star of Bethlehem and increase the risk of adverse effects (2).

STIMULANT LAXATIVES Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, excessive use of stimulant laxatives with star of Bethlehem might increase the risk of toxicity.  Details Star of Bethlehem contains cardiac glycosides (15330,15331). Excessive use of stimulant laxatives can cause diarrhea, resulting in potassium depletion. This might increase the risk of cardiac glycoside toxicity.

TETRACYCLINE ANTIBIOTICS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking tetracycline antibiotics with star of Bethlehem might increase the risk of cardiac glycoside toxicity.  Details Star of Bethlehem contains cardiac glycosides similar to digitalis (15330,15331). Tetracycline antibiotics appear to increase the gastrointestinal absorption of oral digoxin. Theoretically, concomitant use of tetracycline antibiotics might increase the absorption of the cardiac glycosides found in star of Bethlehem and increase the risk of adverse effects (17).

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General ...Orally and topically, freshly harvested Clematis recta is unsafe. Any benefits of therapy may not outweigh the risk of toxicity.
Most Common Adverse Effects:
Orally: Colic, diarrhea, gastrointestinal irritation, urinary tract irritation.
Topically: Blisters, burns.

Dermatologic ...Topically, prolonged skin contact with fresh Clematis recta can cause slow-healing blisters and burns (18).

Gastrointestinal ...Orally, fresh Clematis recta can cause colic, diarrhea, and severe irritation to the gastrointestinal tract (18).

Genitourinary ...Orally, fresh Clematis recta can cause severe irritation to the urinary tract (18).

(Read more about CLEMATIS RECTA)

General ...Orally, horse chestnut seed extract, from which the toxic constituent esculin has been removed, seems to be well-tolerated. Topically, no adverse effects have been reported. However, a thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Orally (extract): Dizziness, gastrointestinal upset, headache, and pruritus.
Orally (seed or bark): Gastrointestinal irritation and toxic nephropathy.

Cardiovascular ...Orally, there is one case report of pericardial tamponade following exudative pericardial effusion in a previously healthy 32-year-old male who consumed three boxes of horse chestnut paste over 6 weeks. The patient was treated with steroid therapy for 2 months, as well as colchicine 0.5 mg twice daily and ibuprofen 600 mg twice daily for 3 months. These cardiovascular events were considered to be possibly related to the antiplatelet activity of horse chestnut or to an immunologic response to antigens present in horse chestnut paste (91972). A case of atrial fibrillation is also reported in a previously healthy 46-year-old male after accidental ingestion of a horse chestnut seed. The patient also presented with abdominal pain, nausea, sweating, and palpitations. The arrhythmia resolved within a few hours without medical intervention (110439).

Dermatologic ...Orally, horse chestnut seed extract has been reported to cause pruritus (282,12113,55486).

Gastrointestinal ...Orally, horse chestnut seed extract has been reported to cause nausea, vomiting, diarrhea, abdominal pain, constipation, dry mouth, gastrointestinal upset, and dyspepsia (282,12113,55477,55486,55493,55520,110439).

Hepatic ...Orally, there is one case report of hepatotoxicity in a 69-year-old female who took 6-15 tablets of a specific product (Venencapsan) containing horse chestnut leaf, milfoil, celandine, sweet clover, milk thistle, and dandelion root daily for 6 weeks. The patient's symptoms disappeared 6 weeks after discontinuing the product and reappeared following re-initiation (55518). Another case report describes a 70-year-old male presenting with acholia, choluria, and jaundice after 3 weeks of self-treatment with an unspecified dose of a specific combination product (Venenkraft) containing horse chestnut. The patient presented with elevated liver transaminase and bilirubin levels, and was diagnosed with drug-induced liver injury. Following discontinuation, laboratory values and symptoms progressively resolved (107702). In both of these case reports, it is unclear if hepatotoxicity was due to horse chestnut, another ingredient, or the combination.
Intravenously and intramuscularly, isolated cases of liver toxicity have occurred after administration of horse chestnut extract containing aescin (2,512,552).

Immunologic ...Pollen from the horse chestnut flower can cause allergic reactions in children (7775). Horse chestnut can also cause hypersensitivity reactions, which occur more commonly in people who are allergic to latex (7853,8418).
Rectally, the horse chestnut constituent esculin has caused severe allergic contact dermatitis and proctitis in a 38-year old man (10383).
Intravenously, administration of aescin can cause anaphylaxis (18,553).

Musculoskeletal ...Orally, calf spasms have been reported in patients with CVI who took horse chestnut seed extract (282).

Neurologic/CNS ...Orally, horse chestnut seed extract has been reported to cause headache or dizziness (55486,55520).

Renal ...Orally, high doses of aescin have been reported to cause kidney toxicity (55525). Horse chestnut seed and bark can cause toxic nephropathy (4). A case of life-threatening kidney rupture occurred in a patient who was taking horse chestnut seed extract and had been diagnosed with angiomyolipoma, a condition characterized by increased risk of kidney rupture with hemorrhage. The rupture was attributed to the anticoagulant effects of horse chestnut seed extract, which may have increased the risk of hemorrhage (55496).
Intravenously, isolated cases of kidney toxicity have occurred after administration of horse chestnut containing aescin (512).

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General ...No adverse effects have been reported. However, a thorough evaluation of safety outcomes has not been conducted.

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General ...Star of Bethlehem contains cardiac glycosides, which can cause serious adverse effects.
Serious Adverse Effects (Rare):
Orally: Star of Bethlehem contains toxic cardiac glycosides that can cause cardiac arrhythmia and death.

Cardiovascular ...Orally, the cardiac glycosides in star of Bethlehem can cause cardiac arrhythmias (2).

Gastrointestinal ...Orally, the cardiac glycosides in star of Bethlehem can cause nausea and vomiting (2).

Neurologic/CNS ...Orally, the cardiac glycosides in star of Bethlehem can cause headache and stupor (18). Visual color disturbances can also occur (18).

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