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Devil's Claw

Scientific Name(s): Harpagophytum procumbens, subsp. procumbens DC. ex Meisn.
Common Name(s): Devil's claw, Grapple plant, Grapple vine, Radix Harpagophyti, Wood spider, Xwate

Medically reviewed by Drugs.com. Last updated on Jul 4, 2023.

Clinical Overview

Use

Devil's claw is a folk remedy used for an extensive range of diseases, including arthritis and rheumatism. Clinical trials are generally supportive of its use as an anti-inflammatory and analgesic in low back pain and osteoarthritis.

Dosing

Devil's claw has been studied for low back pain, muscle pain, and osteoarthritis using daily doses of crude tuber up to 9 g, 1 to 3 g of extract, or harpagoside 50 to 100 mg.

Contraindications

Do not use with antiarrhythmic, chronotropic, or inotropic medicines. Because of the bitterness of the preparation and consequent increase in gastric secretion, devil's claw is contraindicated in patients with gastric or duodenal ulcers.

Pregnancy/Lactation

Documented oxytocic adverse effects. Avoid use.

Interactions

Devil’s Claw should not be used with antiarrhythmic, chronotropic, or inotropic medicines. See Interaction section for more detail and for other possible drug interactions.

Adverse Reactions

Rare, generally consisting of headache, tinnitus, or anorexia. A case of devil’s claw-induced hypertension has been documented.

Toxicology

Clinically important toxicity has not been observed in limited, short-term use.

Scientific Family

Botany

Devil's claw grows naturally in the Kalahari Desert and Namibian steppes of southwest Africa. The plant is a weedy perennial bearing small, claw-like protrusions on the fruit and a strong central taproot growing up to 2 m deep. The secondary roots are used in decoctions and teas. The plant's leaves are large and grey-green in color, and it produces pink, red, or purple, trumpet-shaped flowers.USDA 2017, WHO 2007 Devil's claw is also known as Uncaria procumbens and Harpagophytum burchellii Decne.

History

Devil's claw has been widely used among indigenous people of South Africa as a folk remedy for diseases ranging from liver and kidney disorders to allergies, headaches, and most commonly, rheumatism. Devil's claw was reportedly introduced to Europe by a German soldier in the mid-1900s, and thereafter its popularity increased among British, Canadian, and European herbalists. Devil's claw is marketed in Canada and Europe as a home remedy for the relief of arthritic diseases.Brendler 2006, USDA 2017, WHO 2007

Chemistry

The major chemical component thought to be responsible for the anti-inflammatory activity of devil's claw is harpagoside, a monoterpene glucoside. Other iridoid glycosides include procumbide, harpagide, 8-para-coumaroyl-harpagide, and verbascoside. Harpagoside is found primarily in the roots; secondary tubers contain twice as much glucoside as the primary roots. Flowers, stems, and ripe fruits are essentially devoid of the compound, while traces have been isolated from the leaves. Harpagoside can be progressively hydrolyzed to harpagid and harpagogenin. Commercial sources of devil's claw extract contain 1.4% to 2% of harpagoside.

Other constituents include carbohydrates, flavonoids (kaempferol, luteolin), aromatic acids, phytosterols, and triterpenes. High-performance liquid chromatography methods for identification have been reported.Clarkson 2006, Grant 2007, WHO 2007

Uses and Pharmacology

Anti-inflammatory/Analgesic effects

In vitro studies are largely supportive of anti-inflammatory action. Mechanisms elucidated include inhibition of COX-2 enzymes and other proinflammatory enzymes, antioxidant activity, reductions in expression of prostaglandin PGE2, and inhibition of cysteinyl-leukotrienes.Abdelouahab 2008, Anauate 2010, Brendler 2006, Fiebich 2011, Grant 2007, Ouitas 2009

Animal data

Most animal studies support the anti-inflammatory and analgesic effects of devil's claw extracts. Studies have included oral, intraperitoneal, and intraduodenal routes of administration, with oral use having the most negative findings. Inhibition of carrageenin-induced paw edema by devil's claw was comparable with that of phenylbutazone, indomethacin, and acetyl salicylic acid. A dose-dependent effect has also been described.Brendler 2006, Catelan 2006, Grant 2007, Inaba 2010, Mahomed 2004, Uchida 2008, Wachsmuth 2011

Clinical data

Reviews of clinical trials have focused primarily on arthritic conditions (hip and knee) and low back pain. A meta-analysis of available data has not been conducted, possibly because of diverse methodologies.Brendler 2006, Brien 2006, Gagnier 2006, Grant 2007, Oltean 2014

Few quality double-blind, placebo-controlled, or comparator randomized trials have been conducted in osteoarthritis; however, there is general support for evidence of effect in pain reduction. Other clinical studies (open-label) are also supportive. Well-designed, adequately powered studies are required before definitive statements regarding optimal dose, efficacy, and duration of therapy can be made.Brien 2006, Gagnier 2006 The use of devil's claw in treating low back pain has been reviewed by a Cochrane group who found evidence to support a short-term reduction in pain greater than that of placebo, based on 2 low quality clinical trials.Gagnier 2006, Oltean 2014 Positive results from other less well-designed trials have been published.Brendler 2006, Grant 2007

Cardiac effects

Older animal studies demonstrated cardiac effects of extracts of H. procumbens, including dose-dependent reduction in blood pressure, decreased heart rate, and anti-arrhythmic activity, with mixed results or inotropic and chronotropic effects for different iridoids.Circosta 1984, Occhiuto 1985, Soulimani 1994 Clinical studies are lacking.

Central nervous system

A study in rats showed anticonvulsant effects of an extract of H. procumbens, possibly via CNS depression and gamma aminobutyric acid neurotransmission.Mahomed 2006 Anticholinesterase activity has also been described.Georgiev 2012

Dosing

Devil's claw has been studied for low back pain, muscle pain, and osteoarthritis using daily doses of crude tuber up to 9 g daily, 1 to 3 g of extract, and harpagoside 50 to 100 mg.Brendler 2006, Chrubasik 2004, Ouitas 2010 Commercial preparations are inconsistent in the composition of iridoid glycosides, with some products likely to be more effective than others. Harpagoside is considered the key ingredient for anti-inflammatory effect.Ouitas 2010

Devil's claw is not recommended for use in children due to lack of safety or clinical trial data.Brendler 2006 It is also not recommended for long-term use (more than 3 to 4 months) because of a lack of data.Brendler 2006, Thanner 2009

Pregnancy / Lactation

Avoid use. Oxytocic adverse effects have been documented.Brendler 2006, WHO 2007 H. procumbens extract produced rhythmic contractions in isolated rat uterine tissue.Mahomed 2009 Case reports indicate the potential to stimulate uterine contractions.Newall 1996

Interactions

A poorly documented case report of an interaction with warfarin manifesting as purpura exists.Brendler 2006, Fugh-Berman 2000, Heck 2000 However, devil's claw does not affect blood eicosanoid production.Izzo 2005 Use with antiarrhythmic, chronotropic, or inotropic medicines should not be used because of decreased heart rate observed in rats and mild positive inotropic effects in rabbits in older studies.Brendler 2006, Circosta 1984, Shaw 1997, Soulimani 1994 Devil's claw may also potentiate antidiabetic therapy.Brendler 2006, Grant 2007, WHO 2007

Based on pharmacologic activity and alterations in hemostasis, this agent should not be used in individuals with active bleeding (eg, peptic ulcer, intracranial bleeding). Use with caution in individuals with a history of bleeding, hemostatic disorders, or drug-related hemostatic problems; or in individuals taking anticoagulant medications, including warfarin, aspirin, aspirin-containing products, NSAIDs, or antiplatelet agents (eg, ticlopidine, clopidogrel, dipyridamole).Ernst 2003, Heck 2000

Screening studies report that H. procumbens is unable to inhibit cytochrome P450 enzymes and is unlikely to have any clinically relevant effect on the cytochrome system.Grant 2007, Modarai 2011 It is possible that devil's claw may affect multidrug P-glycoprotein (P-gp) drug transporter.Romiti 2009

Devil's claw drug interactions (more detail)

Adverse Reactions

Rare, GI-related adverse effects have been reported in clinical trials, including mild GI upset, anorexia, and loss of taste. Rarely, unspecified serious GI events have been reported. Headache and tinnitus have been reported.Devil's claw 2013, Vlachojannis 2008, Warnock 2007 Cardiovascular adverse events are theoretically possible based on older studies in rodents.Vlachojannis 2008 A case of symptomatic hypertension has been documented in a 62-year-old healthy woman who consumed 500 mg/day of a product containing Devil’s claw. Blood pressure returned to normal and complaints of headache and dizziness subsided in the 2 weeks following discontinuation of the product.Cuspidi 2015

Anecdotal reports suggest devil's claw may increase stomach pH due to its bitter taste, so it should be avoided in people with gastric or duodenal ulcers.Brendler 2006, Duke 2002 Devil's claw should also be used with caution in patients with gallstones.Brendler 2006, WHO 2007 Unsubstantiated reports of possible hypoglycemic effects should be considered for diabetic patients.Brendler 2006 Nephrotoxicity is rare, but devil’s claw may impede P-gp excretion of toxins, which could contribute to kidney injury.Allard 2013

Toxicology

Harpagoside has been found to be of low toxicity, with a median lethal dose of more than 13.5 g/kg in mice. Although no long-term toxicity studies have been reported, rats given oral doses of harpagoside 7.5 g/kg/day showed no clinical, hematologic, or gross pathologic changes.Brendler 2006, Duke 2002

Index Terms

References

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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