Fumitory

Scientific Name(s): Fumaria officinalis L. Family: Fumariaceae

Common Name(s): Fumitory , common fumitory , earth smoke

Uses

Fumitory has been traditionally used as a laxative, diuretic, and as a treatment for dermatologic conditions such as eczema. Limited evidence suggests that it benefits those with hepatobiliary disorders.

Dosing

None well documented.

Contraindications

None well documented.

Pregnancy/Lactation

Because of the lack of pharmacological and toxicity data for this plant, avoid use of fumitory during pregnancy and lactation.

Interactions

None well documented.

Adverse Reactions

In one clinical study, adverse effects occurred in up to 69% of patients, with GI complaints (56%) and flushing (31%) being the most common symptoms.

Toxicology

Fumitory is not associated with clinically important toxicity, but large quantities of other members of the family have caused fatal outcomes.

Botany

Fumitory 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 of smoke (hence the common name). 1 The pink-purple flower blooms in spring. The plant is widely dispersed and can be found in gardens, on slopes, and in wastelands. The flowering plant (aerial parts) has traditionally been used in herbal medicine.

History

Fumitory has been known since antiquity and was described in herbals from the Middle Ages. Fumaria is a predominantly Mediterranean genus that was once used medicinally. The climbing fumitory, or Allegheny vine, is a North American plant of another genus ( Adlumia ). Traditional preparation involved expressing the juice and evaporating it. In traditional medicine, the plant has been used to treat eczema and other dermatologic conditions. It has been used as a laxative and diuretic. Fumaria species are used in Turkish folk medicine as a blood purifier and an anti-allergic agent. 2 Fumaria extracts may be useful in the management of disorders of the cardiovascular system and hepatobiliary tract. Work has focused on extracts from other Fumaria species, noting their antihepatotoxic activity and their potential as antipsoriatic agents. 3 , 4 , 5 , 6

Chemistry

The chemical composition of active compounds in F. officinalis is not well documented. A number of flavone heterosides have been identified. 7 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%. 8 An alkaloidal fraction is likely responsible for the cardiovascular activity of the plant. 9 Pharmacologically active substances have been isolated from other species ( F. indica , F. parvifolia ) and are therefore the focus of research. In 1998, monomethyl fumarate was isolated from F. indica . This compound has important antihepatotoxic activity in vitro and in vivo. 3

Uses and Pharmacology

Investigations in animals and humans have identified several pharmacologic actions of fumitory extracts. Fumitory monographs are in the British Herbal Pharmacopoeia and in the German Commission E. It has a long history of use in traditional medicine and has been investigated for its therapeutic potential in the management of cardiovascular and hepatobiliary disorders and psoriasis.

Cardiovascular disorders
Animal data

IV injection of 1 to 2 mg/kg in dogs reduced ischemia caused by experimental ligation of the circumflex artery. A dose of 5.2 mg/kg prevented ischemic-induced arrhythmias for up to 87 minutes. 3

Protopine inhibited the exudative phase of dextran inflammation at 100 mg/kg and that of serotonin inflammation at 50 mg/kg. Fumoficinaline inhibited serotonin inflammation at 50 mg/kg. Both alkaloids decreased vascular permeability to a similar extent at the 50 mg/kg dose. 10

Clinical data

Research reveals no clinical data regarding the use of fumitory for cardiovascular effects.

Diabetes
Animal data

Diabetes mellitus was induced in 20 of 25 adult male albino rats using an intraperitoneal injection of alloxan. The rats were then divided into 4 groups; 3 of the 4 groups were fed a diet containing 6.25% body weight fumitory and coriander seed for 15 days. The fourth group received a normal diet. The concentration of glucose, cholesterol, creatinine, and the results of liver tests were lower ( P < 0.05) in the group consuming fumitory when compared with the control group. 11

Clinical data

Research reveals no clinical data regarding the use of fumitory for diabetes.

Hepatobiliary disorders
Animal data

The antihepatotoxic activity of several Fumaria species warrants further investigation. 12 Monomethyl fumarate, found in F. indica , demonstrated antihepatotoxic activity against thioacetamide in vitro and carbon tetrachloride, acetaminophen, and rifampin in vivo. This activity is comparable with silymarin, a known antihepatotoxic agent. 10 In another study, an aqueous-methanolic extract of F. parvifolia administered prophylactically protected against acetaminophen-induced liver injuries by reducing the toxin-induced rise in serum enzymes. 13 Fumitory extracts have been shown to ameliorate bile duct blockage in animals. Fumaria extract typically has been administered by nebulizer and has been investigated in gallbladder calculi in mice and rats. 14 , 15 , 16

Clinical data

Fumitory extracts have been shown to ameliorate bile duct blockage in animals and assist in the management of similar disorders in humans. When investigated in 85 patients with cholecystopathies, a Fumaria -containing preparation improved patient status in 70% of the cases overall and in more than 80% of the cases of biliary dyskinesia. Optimum results were obtained following 10 days of therapy and the difference was statistically greater than observed with placebo. 16 F. officinalis is approved in Germany for the colicky pain affecting the gallbladder and biliary system, in addition to the GI tract. 4

Psoriasis

The mechanism of action attributed to the stimulation of an anti-inflammatory mediator profile in human leukocytes and inhibition of the proliferation of keratinocytes. 5 Fumaric acid esters have been used as a treatment for psoriasis for nearly 30 years. This treatment is regaining interest by dermatologists as more active compounds and derivatives are being developed. Monomethyl fumarate is the most active metabolite in a German antipsoriasis drug, Fumaderm . 10 , 6

Animal/Clinical data

Research reveals no animal/clinical data regarding the use of fumitory for dermatologic effects.

Dosage

None well documented.

Pregnancy/Lactation

Because of the lack of pharmacological and toxicity data for this particular species, avoid use of fumitory during pregnancy and lactation.

Interactions

None well documented.

Adverse Reactions

A large percentage of patients experienced side effects. 6 , 17 , 18 In 1 clinical study, adverse effects occurred in up to 69% of patients, with GI complaints (56%) and flushing (31%) being the most common symptoms. 10 In 1 clinical study, 4 no adverse events were reported.

Toxicology

Fumitory has not been associated with clinically important toxicity. Monomethyl fumarate was found to be nonhepatocytotoxic in doses up to 1 mg/mL in vitro and up to 50 mg/kg in in vivo studies in albino rats. 3 Alkaloids found in other members of the Fumariaceae family (eg, protopine) have caused trembling, convulsions, and death when consumed in large quantities. 19

Bibliography

1. Schauenberg P, Paris F. Guide to Medicinal Plants . New Canaan, CT: Keats Publishing; 1977.
2. Aktay G, Deliorman D, Ergun E, Ergun F, Yesilada E, Cevik C. Hepatoprotective effects of Turkish folk remedies on experimental liver injury. J Ethnopharmacol . 2000;73:121-129.
3. Rao KS, Mishra SH. Antihepatotoxic activity of monomethyl fumarate isolated from Fumaria indica . J Ethnopharmacol . 1998;60:207-213.
4. Zacharewicz M, Chorazy W, Mossor S, Zacharewicz M Jr. Treatment of cholecystopathies by Fumaria nebulisate [in German]. Wien Med Wochenschr . 1979;129:221-224.
5. Nibbering P, Thio B, Bezemer A, Beijersbergen R, Zomerdijk T. Intracellular signalling by binding sites for the antipsoriatic agent monomethylfumarate on human granulocytes. Br J Dermatol . 1997;137:65-75.
6. Mrowietz U, Christophers E, Altmeyer P. Treatment of psoriasis with fumaric acid esters: results of a prospective multicentre study. German Multicentre Study. Br J Dermatol . 1998;138:456-460.
7. Torck M, Pinkas M, Bezanger-Beauquesne L. The flavone heterosides of the fumitory. Fumitoria officinalis L., Fumariaceae [in French]. Ann Pharm Fr . 1971;29:591-596.
8. Molokhova LG, Figurkin BA. Isolation of fumitory alkaloids [in Russian]. Tr Permsk Gos Med Inst . 1973;118:33-34.
9. Gorbunov NP, Sukhanov AA, Bolotova MF. Pharmacological correction of myocardial ischemia and arrhythmias in reversible coronary blood flow disorders and experimental myocardial infarct in dogs [in Russian]. Kardiologiia . 1980;20:84-87.
10. Molokhova LG, Suslina ML, Datskovskii SB, Figurkin BA. Antiinflammatory effect of fumitory alkaloids [in Russian]. Tr Permsk Gos Med Inst . 1973;118:26-28.
11. Jelodar GH, Nazifi S. Effects of fumitory, coriander seed and madder on serum biochemical parameters of diabetic rats. Pathophysiology . 1998;5[suppl 1]:175.
12. Hentschel C, Dressler S, Hahn EG. Fumitory officinalis (fumitory) clinical applications. Fortschr Med . 1995;113:291-292.
13. Gilani AH, Janbaz KH, Akhtar MS. Selective protective effect of an extract from Fumaria parviflora on paracetamol-induced hepatotoxicity. Gen Pharmacol . 1996;27:979-983.
14. Largrange E, Auousseau M. Effect of nebulized Fumaria officinalis on experimental gallbladder calculi in mice [in French]. J Med Bord . 1967;144:918-920.
15. Dubarry JJ. Clinical study on the use of fumitory nebulizer in hepato-biliary pathology [in French]. J Med Bord . 1967;144:918-920.
16. Boucard M, Laubenheimer B. Action of fumitory spray on biliary output in rats [in French]. Therapie . 1966;21:903-911.
17. Altmeyer P, Hartwig R, Matthes U. Efficacy and safety profile of fumaric acid esters in oral long-term therapy with severe treatment refractory psoriasis vulparis. A study of 83 patients [in German]. Hautarzt . 1996;47:190-196.
18. Altmeyer PJ, Mattes U, Pawlak F, et al. Antipsoriatic effect of fumaric acid derivatives. Results of a multicenter double-blind study in 100 patients. J Am Acad Dermatol . 1994;30:977-981.
19. Hardin JW, Arena JM. Human Poisoning from Native and Cultivated Plants . 2nd ed. Durham, NC: Duke University Press; 1974.

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