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Butcher's Broom

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

Medically reviewed by Drugs.com. Last updated on Oct 4, 2021.

Clinical Overview

Use

Butcher's broom has been used traditionally as a laxative, mild diuretic, treatment for circulatory disease, chronic venous insufficiency, atherosclerosis, hemorrhoids, varicose veins, and as a cytotoxic agent. Positive findings for vascular insufficiency and related conditions are reported; however, quality clinical trials are generally lacking.

Dosing

Butchers broom has been used in clinical trials for chronic venous insufficiency standardized to 7 to 11 mg of ruscogenin. Extracts have been dosed at 16 mg daily for chronic phlebopathy, while a topical cream formulation was used to apply 64 to 96 mg of extract daily.

Contraindications

Contraindications have not yet been identified.

Pregnancy/Lactation

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

Interactions

None well documented. Theoretical interactions with alpha-adrenergic stimulating medicines may exist.

Adverse Reactions

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

Toxicology

The extract from roots has been shown to be more toxic than from rhizomes and, in animal studies, led to convulsions, paralysis, GI inflammation, and dysentery. Severe visceral congestion eventually led to fatal respiratory failure.

Scientific Family

  • Asparagaceae

Botany

Butcher's broom is a low-growing common evergreen shrub. It is widely distributed, from Iran to the Mediterranean1 and the southern United States.2 The plant develops edible shoots from rhizomes that are similar to asparagus in form.3 Butcher's broom has tough, erect, striated stems with false thorny leaves called cladophylles.4 The Asparagaceae family is formerly known as Liliaceae (lily). The nomenclature of this plant should not be confused with broom (Cytisus scoparius L.) or Spanish broom (Spartium junceum L.).

History

R. aculeatus was given its common name, butcher's broom, because its stiff twigs were bound together and used by butchers in Europe to keep their cutting boards clean. The plant has a long history of use; more than 2000 years ago, it was noted as a laxative, diuretic, and a phlebotherapeutic agent.5 Extracts, decoctions, and poultices have been used throughout the ages, but the medicinal use of this plant did not become common until the last century. Early investigations during the 1950s indicated that extracts of the rhizomes of butcher's broom could induce vasoconstriction and therefore might have use in the treatment of circulatory diseases. The increasing popularity of natural and herbal remedies in Europe in the 1970s reaffirmed its position in modern medicine. Novel uses for this plant have included its use as an anti-inflammatory agent and to prevent atherosclerosis. Butcher's broom is the active component in several drug formulations and topical treatments for venous disease. Structural elucidation of active compounds and the discovery of new pharmacological activity, particularly as a cytotoxic agent, demonstrate the need for continued research on butcher's broom.

Chemistry

A variety of compounds have been isolated from butcher's broom. The 2 primary saponin compounds are ruscogenin and neoruscogenin.6 The ruscogenin content in underground and aboveground parts is approximately 0.12% and 0.08%, respectively.7 The plant also contains numerous furanostanol and spirostanol saponins.8, 9 Two bisdesmosidic spirostanol saponins, aculeoside A and aculeoside B, also have been isolated.9 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.3 Butcher's broom also contains triterpenes, coumarins, sparteine, tyramine, and glycolic acid.10 The benzofuran euparone7 and the phenolic ruscodibenzofuran11 have been isolated. Plant extracts have revealed the presence of sulfated steroid saponins12 and the steroid glycosides, rusin and ruscoside.4

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.13

Uses and Pharmacology

Cardiovascular effects

Animal data

A group of researchers reported on animal studies conducted in the 1990s, suggesting that compounds in Ruscus activated alpha-1 and alpha-2 receptors in smooth muscle, with resultant vasoconstrictive effects.5, 14, 15, 16, 17 Ruscogenins present in the extracts are ineffective on hyaluronidase activity but show exceptional anti-elastase activity.18

Clinical data

Quality clinical studies evaluating the effectiveness in venous insufficiency are limited. Studies evaluating multi-ingredient preparations (commonly Ruscus extract, hesperidin, and ascorbic acid) report positive findings.2, 19, 20, 21, 22, 23 A case report notes the potential use for butcher’s broom extract in orthostatic hypotension.5

Formulations of Ruscus extract are being investigated for the treatment of hemorrhoids, and the use of butcher's broom for haemorrhoids is approved by the German Commission E.24 An older study reported positive findings for the use of butcher’s broom extract in microvascular-associated retinopathy.25

Other uses

Researchers have found that when a Ruscus extract is applied topically, a dose-dependent inhibition of the macromolecular permeability-increasing effect of histamine occurs.26Ruscus extract given IV (5 mg/kg) inhibits the macromolecular permeability-increasing effect of bradykinin, leukotriene B4, and histamine.26

In vitro studies indicate that compounds found in butcher's broom may possess cytotoxic activity.8, 27, 28

The combined action of flavonoids, sterols, and proteolytic enzymes found in the root has been shown to reduce dextran and carrageenan-induced rat paw edema, indicating that the extract may have anti-inflammatory activity.29

Dosing

Butchers broom has been used in clinical trials for chronic venous insufficiency standardized to 7 to 11 mg of ruscogenin.30 Hesperidin methyl chalcone has also been used as a marker for standardization in certain commercial multi-ingredient preparations. Extracts have been dosed at 16 mg daily for chronic phlebopathy, while a topical cream formulation was used to apply 64 to 96 mg of extract daily.20, 31, 32

A 100 mg extract is reported to contain 0.5 mg of active ruscogenins.17

Pregnancy / Lactation

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

Preparations have been studied in pregnancy-related variscosities; however, safety has not been established.24

Interactions

None well documented. However, Ruscus extract exhibits alpha-adrenergic stimulating activity.13

Adverse Reactions

The German Commission E approves oral use of the rhizome for supportive therapy for the discomfort of chronic venous insufficiency and complaints of hemorrhoids and reports no known interactions.30 In a clinical trial, no adverse events were attributable to therapy by the 40 patients evaluated19; 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 side effects (ie, chronic diarrhea, lymphocytic colitis, and cytolytic hepatitis).13

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. She was admitted 5 days after she started Butcher’s broom for mild ankle swelling; 48 hours prior to admission she experienced vomiting and diarrhea before becoming acutely unwell. Improvement was noted within 12 hours of supportive treatment with IV fluids, an insulin drip, and calcium gluconate; she recovered fully.13

In animal studies, adverse events appear to be associated with the route of administration and the use of roots versus rhizomes. The extract from roots was found to be more toxic than from rhizomes and led to convulsions, paralysis, GI inflammation, and dysentery. Severe visceral congestion led to fatal respiratory failure.13

Index Terms

  • Liliaceae (lily)

References

1. Tyler VE. The New Honest Herbal. Philadelphia, PA: G.F. Stickley Co.; 1987.
2. ElSohly M, Knapp JE, Slatkin KF, Schiff PL Jr, Doorenbos NJ, Quimby MW. Constituents of Ruscus aculeatus. Lloydia. 1975;38:106-108.237169
3. Mabberly DJ. The Plant-book. New York, NY: Cambridge University Press; 1987.
4. Di Lazzaro A, Morana A, Schiraldi C, Martino A, Ponzone C, De Rosa M. An enzymatic process for the production of the pharmacologically active glycosides desglucodesrhamnoruscin from Ruscus aculeatus L. J Mol Catal, B Enzym. 2001;11:307-314.
5. Redman DA. Ruscus aculeatus (butcher's broom) as a potential treatment for orthostatic hypotension, with a case report. J Altern Complement Med. 2000;6:539-549.11152059
6. Pourrat H, Lamaison JL, Gramain JC, Remuson R. Isolation and confirmation of the structure by 13C-NMR of the main prosapogenin from Ruscus aculeatus L [in French]. Ann Pharm Fr. 1983;40:451-458.6847078
7. ElSohly MA, Doorenbos NJ, Quimby MW, Knapp JE, Slatkin DJ, Schiff PL Jr. Euparone, a new benzofuran from Ruscus aculeatus L. J Pharm Sci. 1974;63:1623-1624.4436800
8. Mimaki Y, Kuroda M, Kameyama A, Yokosuka A, Sashida Y. Steroidal saponins from the underground parts of Ruscus aculeatus and their cytostatic activity on HL-60 cells. Phytochemistry. 1998;48:485-493.9654776
9. Mimaki Y, Kuroda M, Yokosuka A, Sashida Y. A spirostanol saponin from the underground parts of Ruscus aculeatus. Phytochemistry. 1999;51:689-692.10392471
10. Ruscus aculeatus (butcher's broom). Altern Med Rev. 2001;6:608-612.
11. ElSohly MA, Slatkin DJ, Knapp JF, Doorenbos NJ, Quimby MW, Schiff PI Jr. Ruscodibenzofuran, a new dibenzofuran from Ruscus aculeatus L. (Liliaceae). Tetrahedron. 1977;33:1711-1715.
12. Oulad-Ali A, Guillaume D, Belle R, David B, Anton R. Sulphated steroidal derivatives from Ruscus aculeatus. Phytochemistry. 1996;42:895-897.
13. Sadarmin PP, Timperley J. An unusual case of butcher’s broom precipitating diabetic ketoacidosis. J Emerg Med. 2013;45(3):e63-e65.23849361
14. Marcelon G, Verbeuren TJ, Lauressergues H, Vanhoutte PM. Effect of Ruscus aculeatus on isolated canine cutaneous veins. Gen Pharmacol. 1983;14:103-106.6298054
15. Rubanyi G, Marcelon G, Vanhoutte PM. Effect of temperature on the responsiveness of cutaneous veins to the extract of Ruscus aculeatus. Gen Pharmacol. 1984;15:431-434.6150876
16. Bouskela E, Cyrino FZ, Marcelon G. Effect of Ruscus extract on the internal diameter of arterioles and venules of the hamster cheek pouch microcirculation. J Cardiovasc Pharmacol. 1993;22:221-224.7692161
17. Bouskela E, Cyrino FZ, Marcelon G. Inhibitory effect of Ruscus extract and of the flavonoid hesperidine methylchalcone on increased microvascular permeability induced by various agents in the hamster cheek pouch. J Cardiovasc Pharmacol. 1993;22:225-230.7692162
18. Facino RM, Carini M, Stefani R, Aldini G, Salbene L. Anti-elastase and anti-hyaluronidase activities of saponins and sapogenins from Hedra helix, Aesculus hippocastanum, and Ruscus aculeatus: factors contributing to their efficacy in the treatment of venous insufficiency. Arch Pharm. 1995;328:720-724.8554461
19. Cappelli R, Nicora M, Di Perri T. Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res. 1988;14:277-283.3048951
20. Berg D. Venous constriction by local administration of Ruscus extract [in German]. Fortschr Med. 1990;108:473-476.2227746
21. Aguilar Peralta GR, Arévalo Gardoqui J, Llamas Macías FJ, et al. Clinical and capillaroscopic evaluation in the treatment of chronic venous insufficiency with Ruscus aculeatus, hesperidin methylchalcone and ascorbic acid in venous insufficiency treatment of ambulatory patients. Int Angiol. 2007;26(4):378-84.18091707
22. Allaert FA, Hugue C, Cazaubon M, et al. Correlation between improvement in functional signs and plethysmographic parameters during venoactive treatment (Cyclo 3 Fort). Int Angiol. 2011;30(3):272-277.21617611
23. Reuter J, Wölfle U, Korting HC, Schempp C. Which plant for which skin disease? Part 2: Dermatophytes, chronic venous insufficiency, photoprotection, actinic keratoses, vitiligo, hair loss, cosmetic indications. J Dtsch Dermatol Ges. 2010;8(11):866-873.20707877
24. Abascal K, Yarnell E. Botanical Treatments for Hemorrhoids. Altern Complement Ther. 2005;11(6):285-289.15865494
25. Archimowicz-Cyrylowska B, Adamek B, Drozdzik M, et al. Clinical effect of buckwheat herb, Ruscus extract and troxerutin on retinopathy and lipids in diabetic patients. Phytotherapy Res. 1996;10:659-662.
26. Peneva B, Krasteva I, Nikolov S, Minkov E. Formulation and in vitro release of suppositories containing dry extract of Ruscus aculeatus L. Pharmazie. 2000;55:956.11189878
27. Mimaki Y, Kuroda M, Kameyama A, Yokosuka A, Sashida Y. Aculeoside B, a new bisdesmosidic spirostanol saponin from the underground parts of Ruscus aculeatus. J Nat Prod. 1998;61:1279-1282.9784168
28. Mimaki Y, Kuroda M, Kameyama A, Yokosuka A, Sashida Y. New steroidal constituents of the underground parts of Ruscus aculeatus and their cytostatic activity on HL-60 cells. Chem Pharm Bull. 1998;46:298-303.9501465
29. Tarayre JP, Lauressergues H. The anti-edematous effect of an association of proteolytic enzymes, flavonoids, sterolic heteroside of Ruscus aculeatus and ascorbic acid [in French]. Ann Pharm Fr. 1979;37:191-198.396842
30. Blumenthal M, ed. The Complete German Commission E Monographs. Austin, TX: American Botanical Council; 1998.
31. Vanscheidt W, Jost V, Wolna P, et al. Efficacy and safety of a Butcher's broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency. Arzneimittelforschung. 2002;52(4):243-50.12040966
32. Cappelli R, Nicora M, Di Perri T. Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res. 1988;14(4):277-83.3048951

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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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