Arnica
Scientific Name(s): Arnica montana L. In addition, other related species have been used medicinally including A. sororia Greene, A. fulgens Pursh., A. cordifolia Hook., A. chamissonis subsp. foliosa (Nutt.) Maguire. Family: Asteraceae (daisies)
Common Name(s): Leopard's bane , mountain tobacco , mountain snuff , wolf's bane
Clinical Overview
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Uses of Arnica
Arnica and its extracts have been widely used in folk medicine. It is used externally as a treatment for acne, boils, bruises, rashes, sprains, pains, and other wounds. It also has been used for heart and circulation problems, to reduce cholesterol, and to stimulate the central nervous system. However, research reveals very limited clinical data regarding the use of arnica for any of these conditions.
Arnica Dosing
Arnica is most commonly used in homeopathic preparations, administered topically for bruising and muscle soreness. Classical use of arnica in nonhomeopathic herbal medicine considered a dose of 100 mg to be typical; however, because of toxicity, arnica should not be used internally.
Contraindications
Contraindications have not yet been identified.
Pregnancy/Lactation
Uterine stimulant action. Avoid use.
Arnica Interactions
None well documented.
Arnica Adverse Reactions
Arnica irritates mucous membranes and causes stomach pain, diarrhea, and vomiting. Contact dermatitis also has occurred.
Toxicology
The plant is poisonous and ingestion can cause gastroenteritis, dyspnea, cardiac arrest, and death.
Botany
Arnica is a perennial that grows from 0.3 to 0.6 m. 1 , 2 Its oval, opposite leaves form a basal rosette close to the soil surface. It has bright yellow, daisy-like flowers. 1 , 2 , 3 The dried flower heads are the primary parts used from the plant, but the rhizome also is used. 2 , 4 Arnica is native from the mountainous regions of Europe to southern Russia. 3 , 4 The unrelated plant, monkshood ( Aconitum spp.) is also referred to as wolf's bane.
History
Internal and external preparations made from the flowering heads of arnica have been used medicinally for hundreds of years. Alcoholic tinctures were used by early American settlers to treat sore throats, as a febrifuge, and to improve circulation. Homeopathic uses included the treatment of surgical or accidental trauma, as an analgesic, and in the treatment of postoperative thrombophlebitis and pulmonary emboli. 5 Arnica has been used externally for acne, bruises, sprains, and muscle aches, and as a general topical counterirritant. 6 It was used extensively in European folk medicine. German philosopher Johann Wolfgang von Goethe was said to have drunk arnica tea to ease his angina. 2 Arnica's bactericidal properties were employed for abrasions and gunshot wounds. 7
Chemistry
A number of flavonoid glycosides have been identified in arnica. 8 Flavonoids (0.4% to 0.6%) 3 include the following: betuletol, eupafolin, flavonol glucuronides, hispidulin, isorhamnetin, luteolin, patuletin, spinacetin, tricin, 3,5,7,-trihydroxy-6,3',4'-trimethoxyflavone, kaempferol, quercetin, 9 kaempferol and quercetin derivative, 10 jaceosidin, and pectolin-arigenin. 4 Isomeric alcohols include arnidiol and foradiol. 7 , 8
Terpenoids in arnica include arnifolin, arnicolide, 2 and sesquiterpenes (eg, helenalin 9 and helenalin derivatives, 11 dihydrohelenalin). The pseudoguaianolide ester helenalin methacrylate has been isolated from the flowers. 12
Amines present in the plant are betaine, choline, and trimethylamine. Coumarins include scopoletin and umbelliferone. 9
Carbohydrates such as mucilage and polysaccharides (eg, inulin) are found in arnica. 2 Two homogeneous polysaccharides include an acidic arabino-3,6-galactan-protein and a neutral fucogalactoxyloglucan. 13 Further polysaccharide isolation has been performed on a group of water-soluble acidic heteroglycans. 14
Volatile oils (0.3% to 1%) may be obtained from rhizomes and roots or from flower parts and are used in perfumery. 7 Constituents in the oil include thymol, its derivatives, 2 and fatty acids (eg, palmitic, linoleic, myristic, linolenic). 4 The fatty acid content in arnica leaf essential oil has been evaluated as well. 15
Other components found in arnica include bitter compound arnicin, caffeic acid, 7 , 9 carotenoids (alpha- and beta-carotene, cryptoxanthin, lutein), 4 , 9 , 16 phytosterols, resin, tannins, 2 , 4 and anthoxanthine. 7
Arnica Uses and Pharmacology
Arnica is employed in hair tonics, dandruff treatments, perfumery, and cosmetics, as well as in herbal and homeopathic medicines. 4 , 7
Anti-inflammatoryThe plant possesses a slight anti-inflammatory and mild analgesic effect, most likely because of the sesquiterpene lactones.
Animal dataHelenalin and dihydrohelenalin exert mild anti-inflammatory and antibacterial activity. 6 , 9 They demonstrated anti-inflammatory activity in mice and rats. 4
Clinical dataTopical arnica improved feelings of stiffness associated with hard physical exertion when tested in 36 marathon participants in a double-blind, randomized trial. 17 Helenalin and dihydrohelenalin demonstrated anti-inflammatory activity in humans. 4
PainAnimal data
Research reveals no animal data regarding the use of arnica for pain.
Clinical dataPatients who had impacted wisdom teeth removed received either metronidazole, arnica, or placebo. Metronidazole was more effective than arnica in controlling postoperative pain, inflammation, and healing. Patients receiving arnica had greater pain and inflammation than those receiving placebo. 18
Immunostimulatory activityArnica contains a group of polysaccharides with 65% to 100% galacturonic acid that can inhibit the complement system, thereby modifying the immune system reponse. 19 This polysaccharide displays marked phagocytosis enhancement in vivo. 13 Yet another compound stimulates macrophages to excrete tumor necrosis factor. 20 Arnica polysaccharides possess significant immunostimulatory activity. 14 , 21
Animal dataPhenolic compounds of arnica reduced toxic liver injury in rats. 22
Clinical dataResearch reveals no clinical data regarding the use of arnica to modify immune system response.
Blood coagulationExtracts of arnica blossoms have been used in traditional medicine to improve blood flow. The sesquiterpene lactones helenalin and 11-alpha, 13-dihydrohelenalin have been shown to inhibit platelet aggregation by interacting with platelet sulfhydryl groups. 23 Arnica increases the rate of reabsorption of internal bleeding. 2
Animal dataResearch reveals no animal data regarding the use of arnica to improve blood flow.
Clinical dataArnica did not affect blood coagulation parameters in a randomized, controlled trial. 24
Wound healingArnica has been used traditionally as a topical agent to improve wound healing. It has been used externally (eg, ointment, compress) for acne, boils, bruises, rashes, sprains, pains, and other wounds. 3 , 7 Constituent helenalin and related esters have strong antimicrobial activity. 3 It has bactericidal (eg, against Salmonella ) 9 and fungicidal activity as well. 4 , 7 The plant also possesses counterirritant properties 9 due to constituents arnidiol and foradiol. 25
Animal dataResearch reveals no animal data regarding the use of arnica for wound healing.
Clinical dataResearch reveals no clinical data regarding the use of arnica for wound healing.
Other usesTraditional uses have been for cardiac disease 2 , 3 , 7 (as arnica contains a cardiotonic substance 9 ), to improve circulation, 3 to reduce cholesterol, 3 , 7 and to stimulate the central nervous system. 7 A report on arnica's use in facial injury is available. 26
Dosage
Arnica is most commonly used in homeopathic preparations, administered topically for bruising and muscle soreness. No useful information on dosage has been generated by the several clinical trials reported in the literature. Classical use of arnica in nonhomeopathic herbal medicine considered a dose of 100 mg to be typical; however, because of toxicity, arnica should not be used internally.
Pregnancy/Lactation
Uterine stimulant action has been documented. Avoid use. 27
Interactions
None well documented.
Adverse Reactions
Arnica irritates mucous membranes, causes stomach pain, diarrhea, and vomiting. 4 , 9 Numerous cases of contact dermatitis related to arnica have been reported. Chemical and animal experimentation have proven the high sensitizing capacity of the plant. Sesquiterpene lactones helenalin, helenalin acetate, and helenalin methacrylate are the primary sources of this type of allergy. 28 Another report identifies the allergens in arnica. 29 Three cases of patients with occupational contact dermatitis to arnica have been reported. 30 A case report of a 65-year-old male garden hobbyist reported chronic eczema on the face and hands; this was shown to be caused by arnica's sesquiterpene lactones. 31
Toxicology
The internal use of arnica and its extracts cannot be recommended. The plant is considered poisonous, and oral use should be avoided. 2 , 3 , 9 Gastroenteritis has occurred with high oral dosages; dyspnea and cardiac arrest may occur and result in death. 3 The flowers and roots of the plant have caused vomiting, drowsiness, and coma when eaten by children. Gastric lavage or emesis followed by supportive treatment is recommended. 32 A tincture of 30 mL reportedly produced serious, but not fatal, effects. 4
The helenolide constituents of arnica are cardiotoxic, as determined in animal studies. 3 , 9
The plant's sesquiterpene lactones are responsible for its oxytocic activity. In folk medicine, arnica was used as an abortifacient because of these actions. 3
Bibliography
1. Schauenberg P, Paris F. Guide to Medicinal Plants . New Canaan, CT: Keats Publications; 1977.2. Chevallier A. Encyclopedia of Medicinal Plants . New York, NY: DK Publishing; 1996:170.
3. Bisset N. Herbal Drugs and Phytopharmaceuticals . Stuttgart, Germany: CRC Press; 1994:83-87.
4. Leung A. Encyclopedia of Common Natural Ingredients . 2nd ed. New York, NY: John Wiley & Sons; 1996:40-41.
5. Ghosh A. Lancet . 1983;8319:304.
6. DerMarderosian A. Natural Product Medicine . Philadelphia, PA: George F. Stickley Co; 1988:253-254.
7. Duke J. Handbook of Medicinal Herbs . Boca Raton, FL: CRC Press; 1989:64.
8. Merfort I. 1,4,5-Tricaffeoylquinic acid and new flavonoid glycosides from Arnicae flos DAB 9. Planta Med . 1989;55:608.
9. Newall C, et al. Herbal Medicines . London, England: Pharmaceutical Press; 1996:34-35.
10. Saner V, Leupin K. Contribution to the knowledge of the substances contained in Arnica montana L. [in German]. Pharm Acta Helv . 1966;41:431-445.
11. List PH, Friebel B. New components of blossoms from Arnica montana L [in German]. Arzneimittelforschung . 1974;24:148-151.
12. Herrmann HD, Willuhn G, Hausen BM. Helenalinmethacrylate, a new pseudoguaianolide from the flowers of Arnica montana L. and the sensitizing capacity of their sesquiterpene lactones. Planta Med . 1978;34:299-304.
13. Puhlmann J, Zenk MH, Wagner H. Immunologically active polysaccharides of Arnica montana cell cultures. Phytochemistry . 1991;30:1141-1145.
14. Wagner H, Proksch A, Riess-Maurer I, et al. Immunostimulant action of polysaccharides (heteroglycans) from higher plants. Preliminary communication [in German]. Arzneimittelforschung . 1984;34:659-661.
15. Willuhn G. Fatty acids of the essential oil from leaves of Arnica montana and Arnica longifolia [in German]. Z Naturforsch B . 1972;27:728.
16. Vanhaelen M. Identification of carotenoids in Arnica montana [in German]. Planta Med . 1973;23:308-311.
17. Tveiten D, Bruseth S, Borchgrevink CF, Lohne K. Effect of Arnica D 30 during hard physical exertion. A double-blind randomized trial during the Oslo Marathon 1990 [in Norwegian]. Tidsskr Nor Laegeforen . 1991;111:3630-3631.
18. Kaziro G. Metronidazole (Flagyl) and Arnica Montana in the prevention of post-surgical complications, a comparative placebo controlled clinical trial. Br J Oral Maxillofac Surg . 1984;22:42-49.
19. Knaus U, Wagner H. Planta Med . 1988;54:565.
20. Puhlmann J, Wagner H. Planta Med . 1989;55:99.
21. Wagner H, Proksch A, Riess-Maurer I, et al. Immunostimulating action of polysaccharides (heteroglycans) from higher plants [in German]. Arzneimittelforschung . 1985;35:1069-1075.
22. Marchishin S. Efficacy of the phenol compounds of Arnica in toxic lesion of the liver [in Russian]. Farmakol Toksikol . 1983;46:102-106.
23. Schroder H, Losche W, Strobach H, et al. Helenalin and 11 alpha,13-dihydrohelenalin, two constituents from Arnica montana L., inhibit human platelet function via thiol-dependent pathways. Thromb Res . 1990;57:839-845.
24. Baillargeon L, Drouin J, Desjardins L, Leroux D, Audet D. The effects of Arnica Montana on blood coagulation. Randomized controlled trial [in French]. Can Fam Physician . 1993;39:2362-2367.
25. Tyler V. Herbs of Choice . New York, NY: Pharmaceutical Products Press/Haworth Press, Inc.; 1994:157.
26. Arnica montana in facial injuries (proceedings) [in French]. Ann Otolaryngol Chir Cervicofac . 1977;94:65.
27. Brinker FJ. Herb Contraindications and Drug Interactions . 2nd ed. Sandy, OR: Eclectic Medical Publications; 1998.
28. Hausen BM. Arnica allergy [in German]. Hautarzt . 1980;31:10-17.
29. Hausen BM. Identification of the allergens of Arnica montana L. Contact Dermatitis . 1978;4:308.
30. Hausen BM, Herrmann HD, Willuhn G. The sensitizing capacity of Compositae plants. I. Occupational contact dermatitis from Arnica longifolia Eaton. Contact Dermatitis . 1978;4:3-10.
31. Spettoli E, Silvani S, Lucente P, Guerra L, Vincenzi C. Contact dermatitis caused by sesquiterpene lactones. Am J Contact Dermat . 1998;9:49-50.
32. Hardin JW, Arena JM. Human Poisoning from Native and Cultivated Plants . Durham, NC: Duke University Press; 1974.
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