Butcher's Broom

Scientific Name(s): Ruscus aculeatus
Common Name(s): Box holly, Butcher's broom, Jew's myrtle, Knee holly, Kneeholm, Pettigree, Rusci rhizoma, Sweet broom

Medically reviewed by Drugs.com. Last updated on Nov 21, 2023.

Clinical Overview

Use

Butcher's broom has been used traditionally for its laxative and mild diuretic effects, and for treatment of circulatory disease, chronic venous insufficiency, atherosclerosis, hemorrhoids, and varicose veins. Positive findings for vascular insufficiency and related conditions have been reported; however, clinical trials using R. aculeatus alone are generally lacking. Therefore, butcher's broom cannot be recommended for any indication.

Dosing

The European Scientific Cooperative on Phytotherapy recommends a daily intake of Rusci rhizoma corresponding to a ruscogenins dose of 7 to 11 mg.

For the treatment of chronic venous insufficiency, R. aculeatus has typically been used as part of a commercial combination product (eg, Cyclo 3 Fort). Various multi-ingredient commercial products contain between 30 and 150 mg of R. aculeatus per capsule in combination with hesperidin methyl chalcone and ascorbic acid. The usual dosage is 2 to 3 capsules per day.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Allergic contact dermatitis has been reported with topical formulations, whereas oral administration has been associated with GI adverse effects.

Toxicology

A possible case of precipitation of diabetic ketoacidosis was reported with oral ingestion of butcher's broom.

Scientific Family

• Asparagaceae (asparagus)

Botany

Butcher's broom is a low-growing, common evergreen shrub. It is widely distributed, from Iran to the Mediterranean(Tyler 1987) and the southern United States.(ElSohly 1975) The plant develops edible shoots from rhizomes that are similar to asparagus in form.(Mabberly 1987) Butcher's broom has tough, erect, striated stems with false thorny leaves called cladophylles.(Di Lazzaro 2001) R. aculeatus belongs to the Asparagaceae family, formerly known as the Liliaceae (lily) family. The nomenclature of this plant should not be confused with broom (Cytisus scoparius L.) or Spanish broom (Spartium junceum L.).

History

The common name "butcher's broom" derives from a practice by butchers in Europe in which they bound together the stiff twigs of R. aculeatus and used them to keep their cutting boards clean.(Redman 2000) R. aculeatus has a long tradition of use in Europe as a diuretic and mild laxative, as well as a remedy for diseases of the circulatory system. Written record of use as a phlebotherapeutic agent dates back at least 2,000 years. During the Middle Ages, the young shoots of R. aculeatus were used as food, and also for the treatment of heavy legs, urinary disorders, and abdominal pain. The hydroalcoholic extract of R. aculeatus rhizomes is traditionally used as a vascular preventive and tonic in preparations for disorders involving the venous system, including venous fragility and varicose veins. The underground parts of R. aculeatus have been used for diuretic and anti-inflammatory purposes, as well as for the treatment of hemorrhoids and atherosclerosis. R. aculeatus preparations are widely distributed in Europe and have been used for more than 40 years to treat chronic venous insufficiency and vasculitis. A decoction of the roots of R. aculeatus is widely used internally as a diuretic and for the treatment of urinary system disorders in Turkey. In Palestinian folk medicine, a rhizome extract is used externally in skin diseases. In Italy, uses include for treatment of warts and chilblains, colitis, diarrhea, inflammation, and arthritis.(Masullo 2016)

Chemistry

A variety of compounds have been isolated from butcher's broom, the 2 primary saponin compounds being ruscogenin and neoruscogenin.(Pourrat 1983) The ruscogenin content in underground and aboveground parts is approximately 0.12% and 0.08%, respectively.(ElSohly 1974) The plant also contains numerous furanostanol and spirostanol saponins.(Mimaki 1998a, Mimaki 1998b, Mimaki 1998c, Mimaki 1999) Two bisdesmosidic spirostanol saponins, aculeoside A and aculeoside B, also have been isolated.(Mimaki 1999) In addition, a variety of flavonoids, a fatty acid mixture composed primarily of tetracosanoic acid and related compounds, chrysophanic acid, sitosterol, campesterol and stigmasterol, have been isolated from the roots.(Mabberly 1987) Butcher's broom also contains triterpenes, coumarins, sparteine, tyramine, and glycolic acid.(Ruscus 2001) The benzofuran euparone(ElSohly 1974) and the phenolic ruscodibenzofuran(ElSohly 1977) have been isolated. Plant extracts have revealed the presence of sulfated steroid saponins(Oulad-Ali 1996) and the steroid glycosides rusin and ruscoside.(Di Lazzaro 2001)

Uses and Pharmacology

Constituents of butcher's broom display alpha-adrenergic stimulating properties. The vasoconstrictive actions of ruscogenin and neoruscogenin have been attributed to the release of norepinephrine stored in the adrenergic nerve endings.(Sadarmin 2013) Researchers have found that when Ruscus extract is applied topically, a dose-dependent inhibition of the macromolecular permeability-increasing effect of histamine occurs.(Peneva 2000) Ruscus extract given intravenously (IV) (5 mg/kg) inhibits the macromolecular permeability-increasing effect of bradykinin, leukotriene B₄, and histamine.(Peneva 2000) Butcher's broom has been shown to reduce vascular permeability. In addition, Ruscus extract led to a decrease in the venous diameter of deep veins and at the same time to an increase in flow parameters.(Lichota 2019)

Anti-inflammatory activity

Animal data

The combined action of flavonoids, sterols, and proteolytic enzymes found in R. aculeatus root has reduced dextran- and carrageenan-induced rat paw edema, indicating the extract may have anti-inflammatory activity.(Tarayre 1979)

Cytotoxic activity

In vitro data

In vitro studies indicate that compounds found in butcher's broom may possess cytotoxic activity towards various human cancer cell lines.(Bilušić 2019, Mimaki 1998a, Mimaki 1998b, Mimaki 1998c)

Hemorrhoids

Formulations of Ruscus extract are being investigated for the treatment of hemorrhoids. The use of butcher's broom for hemorrhoids is approved by the German Commission E.(Abascal 2005)

Orthostatic hypotension

Clinical data

A case report notes the potential use of butcher's broom extract in orthostatic hypotension.(Redman 2000)

Osteoporosis

Animal data

The demonstrated bone protective effects of a purified extract from R. aculeatus in rats with ovariectomy-induced osteoporosis suggest that R. aculeatus extract could be developed as a potential candidate for the prevention of postmenopausal osteoporotic complications.(Chakuleska 2019)

Retinopathy

Clinical data

An older, small study in patients with nonproliferative diabetic retinopathy (N=60) reported positive findings for the use of R. aculeatus extract in microvascular-associated retinopathy.(Archimowicz-Cyrylowska 1996)

Venous insufficiency

Animal and in vitro data

A group of researchers reporting on animal studies conducted in the 1990s suggested that compounds in Ruscus activate alpha-1 and alpha-2 receptors in smooth muscle, with resultant vasoconstrictive effects.(Bouskela 1993a, Bouskela 1993b, Marcelon 1983, Redman 2000, Rubanyi 1984) Ruscogenins present in R. aculeatus are ineffective regarding hyaluronidase activity but show exceptional anti-elastase activity.(Facino 1995)

Clinical data

The number of quality clinical studies evaluating the effectiveness of R. aculeatus in venous insufficiency is increasing. Studies evaluating multi-ingredient preparations (commonly Ruscus extract, hesperidin, and ascorbic acid) report positive findings.(Aguilar 2007, Allaert 2011, Berg 1990, Cappelli 1988, ElSohly 1975, Reuter 2010) Ruscus extract in combination with hesperidin methyl chalcone and ascorbic acid (vitamin C) has proven efficacy in randomized controlled trials; the combination received a strong recommendation (grade 1A) by the 2018 European Venous Forum guidelines for treatment of pain, heaviness, feeling of swelling, paresthesia, and edema, and should be considered one of the preferred treatments to relieve such symptoms in patients with chronic venous disease.(Kakkos 2017, Senra Barros 2019)

One open-label, randomized clinical trial showed the combination product Cyclo 3 Fort (R. aculeatus, hesperidin methyl chalcone, and ascorbic acid) to be safe and more effective than rutoside in the treatment of patients with chronic venous insufficiency.(Beltramino 1999)

Dosing

The European Scientific Cooperative on Phytotherapy recommends a daily intake of Rusci rhizoma corresponding to a ruscogenins dose of 7 to 11 mg.(Masullo 2016)

For the treatment of chronic venous insufficiency, R. aculeatus has typically been used as part of a commercial combination product (eg, Cyclo 3 Fort). Various multi-ingredient commercial products contain between 30 and 150 mg of R. aculeatus per capsule in combination with hesperidin methyl chalcone and ascorbic acid. The usual dosage is 2 to 3 capsules per day.(Ruscus aculeatus 2001)

Pregnancy / Lactation

Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.

Preparations have been studied in pregnancy-related varicosities; however, safety has not been established.(Abascal 2005)

Interactions

None well documented. Theoretically, interactions with alpha-adrenergic–stimulating agents are possible. Butcher's broom is used in various medicinal preparations and contains substances with alpha-adrenergic stimulating activity.(Sadarmin 2013)

Adverse Reactions

In a clinical trial in patients with chronic phlebopathy of the lower limbs (N=40), no adverse events were attributable to R. aculeatus therapy(Cappelli 1988); however, reports of edema, nausea, and abdominal pain from multi-ingredient preparations exist. Allergic contact dermatitis has been reported with topical formulations, whereas oral administration has been associated with GI adverse effects (ie, chronic diarrhea, lymphocytic colitis, cytolytic hepatitis).(Sadarmin 2013)

Toxicology

Oral ingestion of butcher's broom was suspected to have led to precipitation of diabetic ketoacidosis in a 39-year-old woman with poorly controlled diabetes previously in good health. The patient was admitted 5 days after starting butcher's broom for mild ankle swelling; 48 hours prior to admission, she experienced vomiting and diarrhea before becoming acutely ill. Improvement was noted within 12 hours of supportive treatment (IV fluids, insulin drip, and calcium gluconate) followed by full recovery.(Sadarmin 2013)

In animal studies, adverse events appear to be associated with the route of administration and the use of roots versus rhizomes. A root extract was more toxic than an extract from rhizomes and led to convulsions, paralysis, GI inflammation, and dysentery. Severe visceral congestion led to fatal respiratory failure.(Sadarmin 2013)

Index Terms

• Liliaceae (lily)

References

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