HERBAL MONOGRAPHSand in some products, partholide was not detected (Heptin-
stall, 1992).
Crude chloroform extracts of fresh Feverfew leaves (rich in
sesquiterpene lactones) and of commercially available pow-
ag dered leaves (lactone-free) produce a dose-dependent inhibi-
tion of thromboxane B2 and leukotriene B4 (eicosanoids) for
an anti-inflammatory effect (Sumner, 1992). Anti-inflamma-
tory properties of Feverfew also consist of inhibition of
cellular phospholipases. which prevents release of arachidon-
ic acid (Makheja, 1982). Parthenolide and chrysanthenyl
acetate have also been shown to inhibit prostaglandin
synthetase (Pugh, 1988). Extracts of Feverfew also inhibit
granule secretion in blood platelets and polymorphonuclear
leukocytes (Heptinstall. 1985).Major flavonol and flavone methyl ethers (tanetin) of the
herb inhibit the major pathways of arachidonate metabolism
in leukocytes (Williams, 1999).
Feverfew extract and parthenolide inhibit human blood
aggregation and serotonin (5-HT) secretion by platelets
(Groenewegen, 1990). The extract does this through neutral-
izing cellular sulfhydryl-affecting substances, which are
fm properties of monocyte adherence (Krause, 1990). The
chloroform extract of the Feverfew leaf contains an unidenti-
fied substance capable of producing a selective, open-
channel block of voltage-dependent potassium channels,
which results in an anti-spasmodic effect (Barsby, 1993).
Feverfew extract inhibited anti-IgE-induced histamine re-
lease in a unique way, which concludes that Feverfew extract
contains a novel type of mast cell inhibitor (Hayes, 1987).CLINICAL TRIALS
The efficacy of dried Feverfew leaves for migraine prophy-
laxis was assessed in a randomized, placebo-controlled,
double-blind, cross-over study. The study consisted of 72
patients with classic or common migraine headaches for over
2 years. The effect of 1 capsule daily of Feverfew was
determined by the use of diary cards and visual analogue
scores. Duration of treatment was 4 months. After this time,
Feverfew was associated with a reduction in number and
severity of attacks in each 2-month period. The degree of
vomiting was also reduced in the Feverfew treatment group.
A significant improvement in the visual analogue scale was
ffr also observed in the Feverfew treatment group (Murphy,
1988).
Patients already taking Feverfew for migraine prophylaxis
were randomized in a double-blind, placebo-controlled trial.
The placebo groups had a significant increase in the
frequency and severity of headache, nausea and vomiting
with the emergence of untoward effects during the early
months of treatment. There was no change in the frequency
or severity of symptoms of migraine in the Feverfew |FEVERFEW/307treatment group, thus suggesting that Feverfew may be taken
prophylactically to prevent attacks of migraines (Johnson,
1985).
A double-blind, placebo-controlled study evaluated the use
of dried chopped Feverfew (70-86 mg) in patients with
symptomatic rheumatoid arthritis. There were 41 patients
involved in the study, and they were observed during a 6-
week period. Variables assessed in the study included
stiffness, pain (visual analogue scale), grip strength, articular
index, full blood count, erythrocyte sedimentation rate, urea,
creatinine, C reactive protein, complement breakdown prod-
ucts, rheumatoid factor titre, immunoglobulins (IgG, IgA,
IgM), functional capacity, and patient and observer global
opinions. There were no important differences in clinical or
laboratory variables between the groups during the study
period (Pattrick, 1989).
INDICATIONS AND USAGE
Feverfew is used mainly for migraine, arthritis, rheumatic
diseases and allergies.
Unproven Uses: In folk medicine, Feverfew is used for
cramps, as a tonic, a stimulant, a digestive agent and a blood
purifier. Other uses in folk medicine include migraine
prophylaxis, digestion problems, intestinal parasites and
gynecological disorders. The herb is also used as a wash for
inflammation and wounds, as a tranquilizer, an antiseptic,
and following tooth extraction as a mouthwash. The infusion
is used for dysmenorrhea. In post-natal care, Feverfew is
used to reduce lochia. The drug is used externally as an
antiseptic and insecticide.
CONTRAINDICATIONS
The herb is not to be used during pregnancy or during breast-
feeding.
PRECAUTIONS AND ADVERSE REACTIONS
General: No health hazards or side effects are known in
conjunction with the proper administration of designated
therapeutic dosages. The drug has a high potential for
sensitization via skin contact. Feverfew has been known to
cross-react with Tansy, Yarrow, Marguerite, Aster, Sunflow-
er, Laurel and Liverwort (Schmidt, 1986). A post-Feverfew
syndrome has been reported in about 10% of migraine
patients who abruptly stopped taking Feverfew. Rebound
headaches, insomnia, muscle stiffness, joint pain, fatigue,
nervousness and tension have occurred (Miller, 1998).
Gastrointestinal: Gastrointestinal irritation and abdominal
pain or heartburn have been reported (Johnson, 1985;
Murphy, 1988; O'Hara, 1998). Glossitis and stomatitis are
significant problems if they do occur (Brown, 1996). The
occurrence of glossitis and stomatitis with encapsulated
products has not been shown to be more common than
placebo (Johnson, 1985; Murphy, 1988).