feverfew

Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

REMS

PO: Migraine headache prophylaxis
Topical Toothaches and as an antiseptic

Action ⬆ ⬇

The sesquiterpene lactone, parthenolide, may provide feverfew's migraine prophylaxis effects.
Feverfew may also have antiplatelet and vasodilatory effects and block prostaglandin synthesis.

Therapeutic effects:

May reduce the symptoms and frequency of migraine headaches.

Pharmacokinetics ⬆ ⬇

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	2–4 mo	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

OB: Pregnancy and lactation;
Feverfew hypersensitivity or allergy to Asteraceae/Compositae family plants, including ragweed, chrysanthemums, daisies, and marigolds.

Use Cautiously in:

Use >4 mo (safety and efficacy not established).

Adv. Reactions/Side Effects ⬆ ⬇

CNS: "Post-Feverfew Syndrome" (anxiety, headache, insomnia, muscle and joint aches)

CV: with long-term usetachycardia

GI: diarrhea, heartburn, mouth ulceration and soreness (from chewing fresh leaves), nausea, vomiting

Derm: contact dermatitis (when used topically)

Interactions ⬆ ⬇

Natural-Drug Products:

Use of feverfew with anticoagulant and antiplatelet drugs, thrombolytics, NSAIDs, some cephalosporins, and valproates may increase risk of bleeding.
Concomitant use with NSAIDs may also reduce feverfew effectiveness.

Natural-Natural Products:

Use with anise, arnica, chamomile, clove, dong quai, fenugreek, garlic, ginger, gingko, licorice, and Panax ginseng may increase anticoagulant potential of feverfew.

Route/Dosage ⬆ ⬇

PO (Adults ): 50–100 mg feverfew extract daily (standardized to 0.2–0.35% parthenolide) or 50–125 mg freeze-dried leaf daily with or after food.

Availability ⬆ ⬇

Feverfew extract: standardized to 0.2-0.35% parthenolide^OTC
Fresh leaf: ^OTC
Freeze-dried leaf: ^OTC

Assessment ⬆ ⬇

Monitor frequency, intensity, and duration of migraine headaches prior to and during ongoing therapy.
Assess for mouth ulcers or skin ulcerations during therapy.

Implementation ⬆ ⬇

Take with food or on a full stomach.

Patient/Family Teaching ⬆ ⬇

Instruct patients to take this medication on a consistent basis to prevent migraine headaches. This herbal supplement is not for treatment of migraines.
Warn patients about mouth ulcers and sores and that if this occurs to seek the advice of a health care professional. Encourage proper oral hygiene.
Advise patients not to abruptly stop this product because of the possibility of post-feverfew syndrome. Inform patients that anxiety, headache, insomnia, and muscle aches may indicate withdrawal. Feverfew should be gradually tapered.
Review dietary and medication profile of patient to identify potential interactions. Instruct patient about other herbs that may interact with feverfew.
Counsel patients on anticoagulants not to take feverfew except as directed by their health care provider.
Advise patients to avoid using NSAIDs as this may reduce the effectiveness of feverfew.
Instruct patients to look for signs of bleeding such as unusual bruising or inability to clot after a cut and to seek the advice of a health care professional if this occurs.
Inform patients that feverfew should reduce the number of migraines and severity of symptoms but that duration of the migraine may not be affected.

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Pronunciation ⬇

Classifications ⬆ ⬇

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