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.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity/allergy to Asteraceae/Compositae family plants, including ragweed, chrysanthemums, daisies, and marigolds;
Surgery (discontinue ≥2 wk before procedure);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding.

Use Cautiously in:

Bleeding disorder;
Liver disease;
Use >4 mo (safety and efficacy not established);
Pedi: Children <2 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: with long-term usetachycardia

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

Derm: contact dermatitis(when used topically)

MS: arthralgia, myalgia

Neuro: anxiety, headache, insomnia

Interactions ⬆ ⬇

Natural-Drug Products:

Anticoagulants, antiplatelets, thrombolytics, NSAIDs, some cephalosporins, and valproates may ↑ risk of bleeding.
NSAIDs may ↓ effectiveness.

Natural-Natural Products:

Anise, arnica, chamomile, clove, dong quai, fenugreek, garlic, ginger, gingko, licorice, and Panax ginseng may ↑ risk of bleeding.

Availability ⬆ ⬇

Feverfew extract: ^OTC
Fresh leaf: ^OTC
Capsules/tablets: ^OTC

Route/Dosage ⬆ ⬇

PO (Adults ): Capsules/Tablets: 50–150 mg once daily.Fresh leaf: 1–3 fresh leaves once daily. Fluid extract (1:1 in 25% ethanol): 0.5–1 mL up to 3 times daily. Tincture (1:5 in 45% ethanol): 1–2 mL 1–3 times daily.

US Brand Names ⬆ ⬇

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

Action ⬆ ⬇

The sesquiterpene lactone, parthenolide, may provide migraine prophylaxis effects.
May have antiplatelet and vasodilatory effects and block prostaglandin synthesis.

Therapeutic effects:

Reduced symptoms and frequency of migraine headaches.

Classifications ⬆ ⬇

Therapeutic Classification: vascular headache suppressants

Pharmacokinetics ⬆ ⬇

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	2–4 mo	unknown	unknown

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of herb to patient.
Advise patient to consult with health care provider before using any herbal supplement, especially when taken concurrently with Rx or OTC medications or vitamins.
Advise patient to take this medication on a consistent basis to prevent migraine headaches. This herb is not for treatment of migraines.
Advise patient to notify health care provider if mouth ulcers and sores occur. Encourage proper oral hygiene.
Advise patient not to stop this product abruptly because of the possibility of post-feverfew syndrome. Inform patient 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. Advise patient about other herbs that may interact with feverfew.
Advise patient on anticoagulants not to take feverfew except as directed by health care provider.
Advise patient to avoid using NSAIDs, as these medications may ↓ effectiveness of feverfew.
Advise patient to monitor for signs of bleeding (unusual bruising, inability to clot after a cut) and to notify health care provider if this occurs.
Inform patient that feverfew should ↓ the number of migraines and severity of symptoms but that duration of the migraine may not be affected.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or breastfeeding before using this herb.

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Indications ⬇