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.

• PO: Migraine headache prophylaxis
• Topical: Toothaches and as an antiseptic

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).

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

CV: with long-term use: tachycardia.

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

Derm: contact dermatitis (when used topically).

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.

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

• 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.

Altamisa, Bachelor's Buttons, Chrysanthemum parethenium, Featerfoiul, Featherfew, Featherfoil, Flirtwort Midsummer Daisy, Pyrethrum parthenium, Santa Maria, Tanaceti parthenii, Wild chamomile, Wild quinine

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

• May reduce the symptoms and frequency of migraine headaches.

Therapeutic Classification: vascular headache suppressants

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-life: Unknown.

• 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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