Fumaria
Scientific Name(s): Fumaria officinalis L.
Common Name(s): Common fumitory, Drug fumitory, Earth smoke, Fumaderm (Germany), Fumitory, Pitpapara
Medically reviewed by Drugs.com. Last updated on Jul 29, 2022.
Clinical Overview
Use
Fumaria has been traditionally used as a laxative and diuretic, and as a treatment for dermatologic conditions such as eczema. Limited evidence suggests that it may be beneficial in hepatobiliary disorders, and F. officinalis is approved in Germany for colic pain. The potential for use of fumaric acid derivatives in the management of multiple sclerosis and psoriasis has been reported, but sufficient clinical evidence is lacking.
Dosing
Therapeutic studies of plant extracts to provide dosage guidance are lacking. A German preparation of fumaric acid derivatives is used in psoriasis at dosages up to 720 mg/day.
Contraindications
None well documented.
Pregnancy/Lactation
Avoid use of Fumaria during pregnancy and lactation because of the lack of pharmacological and toxicity data.
Interactions
None well documented.
Adverse Reactions
GI complaints and flushing have been reported with use of fumaric acid derivatives.
Toxicology
Fumaria is not associated with clinically important toxicity, although studies are limited. However, alkaloids such as protopine may exhibit toxicity.
Scientific Family
- Papaveraceae, poppies (Fumariaceae)
Botany
Fumaria is an annual plant of somewhat variable characteristics, often resembling a bush but also growing as a low, trailing shrub. It has gray, pointed leaves that, at a distance, give the plant a wispy appearance like smoke (hence the common name "earth smoke") and pink-purple flowers that bloom in spring. The plant is widely dispersed and can be found in gardens, on slopes, and in wastelands. There are approximately 46 different Fumaria species, including Fumaria occidentalis, Fumaria parviflora (syn. Fumaria indica), Fumaria vaillantii, and Fumaria reuteri, which are difficult to differentiate. In a debate regarding the classification of Fumitoria, some botanists distinguish the Fumitoriaceae subfamily as distinct from the Papaveraceae family. The climbing fumitory, or Allegheny vine, is a North American plant of another genus (Adlumia).Gupta 2012, Schauenberg 1977, USDA 2013
History
Fumaria has been known since antiquity and was traditionally used by expressing and evaporating the plant's juice. It has a long history of use as a blood purifier in traditional medicine, including the Ayurvedic system, and has been investigated for its therapeutic potential in the management of cardiovascular and hepatobiliary disorders, psoriasis, eczema, and other dermatologic conditions, as well as a laxative and diuretic. Fumaria is included in the British Herbal Pharmacopoeia and in The Complete German Commission E Monographs.Gupta 2012, Singh 2011, USDA 2013
Chemistry
Steroids (including sitosterol, stigmasterol, and campesterol) and many isoquinoline alkaloids have been described from all plant parts, including the root and seed.
The alkaloid content is approximately 0.87% to 1.27%, with protopine comprising 0.18% to 0.25% and fumoficinaline ranging from 0.16% to 0.2%. In addition, phospholipids and organic acids, including caffeic and fumaric, have been described. Methyl fumarate and protopine have been investigated for hepatoprotective activity. Pharmacologically active substances have also been isolated from other species (F. indica and F. parvifolia) and are the focus of research. The results of high pressure liquid chromatography methods to identify constituents have been published.Gupta 2012, Gupta 2012, Pandey 2008
Sanguinarine has been extracted from Fumaria species but is more commonly obtained from Sanguinaria canadensis.Burgeiro 2013, Jeng 2007
Uses and Pharmacology
GI effects
Animal data
Experiments using isolated GI tract tissue have demonstrated both antispasmodic and prokinetic activities of Fumaria extracts. Cholinergic, muscarinic, and calcium channel involvement has also been demonstrated, with a concentration-response relationship described.Gilani 2005, Najeeb-ur-Rehman 2012, Najeeb-ur-Rehman 2012
Clinical data
A randomized, placebo-controlled, blind clinical study found a decrease in irritable bowel syndrome (IBS)–associated pain with Fumaria; however, there was no difference over placebo using the global assessment measures of IBS. Increased abdominal distension was also associated with the use of Fumaria.Gilani 2005, Rahimi 2012
Hepatobiliary disorders
Animal data
Hepatoprotective properties of Fumaria species have been reported in animal studies; however, a precise mechanism of action has not been elucidated.Hentschel 1995, Hussain 2012, Orhan 2012, Tripathi 2010 Monomethyl fumarate demonstrated hepatoprotective activity against thioacetamide in vitro; in carbon tetrachloride, acetaminophen, and rifampin in vivo; and was comparable with silymarin, a recognized hepatoprotective.Rathi 2008
Clinical data
F. officinalis is approved in Germany for colic pain affecting the gallbladder and biliary system, in addition to the GI tract; however, quality clinical trials are lacking.Zacharewicz 1979
Dermatological effects
Animal data
An anti-inflammatory mechanism has been proposed in combination with inhibition of the proliferation of keratinocytes, but there are few experiments in animals.Nibbering 1997
Clinical data
A derivative of fumaric acid is approved in Germany for systemic treatment of psoriasis vulgaris.Altmeyer 1996, Altmeyer 1994, Mrowietz 1998, Papadopoulou 2010 One clinical study evaluated the effect of F. parviflora 4% topical cream in eczema, with reduction in area and severity scores noted for the Fumaria preparation.Jowkar 2011
Other uses
The potential for fumaric acid derivatives in the management of multiple sclerosis has been reported.Papadopoulou 2012
Anxiolytic effects have been reported in studies conducted in rats,Singh 2013 as well as bronchodilatory effects in vitro.Gilani 2005 Anti-inflammatory and antinociceptive effects have been studied in rodents.Molokhova 1973, Rao 2007
Antibacterial, antifungal, and antitrematode activity has been described for some Fumaria species.Gupta 2012, Ferreira 2011
A protective effect of F. parviflora ethanolic extracts on lead-induced testicular toxicity was demonstrated in rats.Dorostghoal 2013
Older studies described improved biochemical indices in diabetic rats fed a Fumaria dietJelodar 1998 and reduced experimental ischemia and arrhythmias in dogs.Rao 1998
Dosing
Specific therapeutic studies using plant extracts to provide dosage guidance are limited.
A German preparation of dimethyl ester fumarate and ethyl hydrogen fumarate salts is used in psoriasis at dosages up to 720 mg/day.Papadopoulou 2010
Pregnancy / Lactation
Avoid use of Fumaria during pregnancy and lactation because of the lack of pharmacological and toxicity data.
Interactions
None well documented.
The chemical constituent sanguinarine, found in S. canadensis and Fumaria species, has been suggested to have an antiplatelet effect,Molokhova 1973 but this effect has not been associated with Fumaria and case reports are lacking.
Adverse Reactions
Information is limited. Increased abdominal distension was associated with the use of Fumaria in 1 study, and GI complaints and flushing were reported in other clinical studies.Brinkhaus 2005, Papadopoulou 2010
Toxicology
A single case report of acute hepatotoxicity, possibly associated with Fumaria, has been published.Bonnet 2007 Monomethyl fumarate was found to be nonhepatocytotoxic in rat studies.Rao 1998
Researchers using a 50% ethanol extract of F. indica found no evidence of hematological, biochemical, or histological toxicity in both short-term and long-term studies in rodents.Gupta 2012, Singh 2013, Singh 2011 However, some Fumariaceae alkaloids (eg, protopine) may exhibit toxicity.Singh 2011
Index Terms
- Fumaria indica
- Fumaria occidentalis
- Fumaria parviflora
- Fumaria reuteri
- Fumaria vaillantii
References
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