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Coltsfoot

Scientific Name(s): Tussilago farfara L.
Common Name(s): Folia farfarae, Coltsfoot, Filius ante patrem, Kuan Don Hua, Kuandong Hua

Clinical Overview

Use

Information to support traditional uses (eg, antioxidant, antitussive, antimicrobial, pressor effects) is limited to in vitro and animal studies.

Dosing

Clinical trials are lacking to provide dosage recommendations.

Contraindications

Information is lacking. Avoid in pregnancy and in patients with hepatic disease.

Pregnancy/Lactation

Avoid use. Preparations may contain hepatotoxic pyrrolizidine alkaloids with carcinogenic and mutagenic potential.

Interactions

None well documented. Caution is warranted if used concurrently with anticoagulants (eg, warfarin) or antiplatelet agents (eg, aspirin, clopidogrel, prasugrel).

Adverse Reactions

Clinical trials are lacking. Allergic and hypertensive effects are possible.

Toxicology

Carcinogenicity, mutagenicity, and phototoxicity have been described for various chemical constituents.

Botany

Coltsfoot is an invasive, perennial plant growing up to 30 cm tall. Golden flowers that look similar to dandelions appear and die before leaves are produced, hence the name Filius ante patrem (the son before the father). The seeds of the plant are soft, hair-like tufts often used by birds to build nests, and the leaves are broad and hoof-shaped, with hairs on upper and lower surfaces. The leaves and flowering buds are of primary medicinal interest. Although related to Petasites (butterbur), activities of coltsfoot should be regarded separately.USDA.2014, Duke.2002, Shikov 2014 Although sometimes considered synonymous with Petasites Mill., butterbur and coltsfoot are monographed separately (see Butterbur monograph).

History

Coltsfoot has been widely used for multiple indications, including the treatment of bronchitis, lung cancer, emphysema, inflammation, rheumatism, swelling and water retention, and tuberculosis. It is listed in the Chinese and Russian pharmacopoeias as having been used for centuries for coughs.Duke 2002, Kim 2013, Shikov 2014

Chemistry

Pyrrolizidine alkaloids, especially senkirkine, are present; however, the total alkaloid content is lower than in butterbur.Duke 2002, Shikov 2014

Sequiterpenes, including tussilagone, bisabolene, triterpenes, flavonoids, and pyrrolizidine alkaloids, are well described.Li 2012, Liu 2011, Liu 2008, Park 2008 An overview of the chemical constituents in the flowers, leaves, and whole plant is available.Duke 2014

Uses and Pharmacology

Cardiovascular effects

Animal data

In dogs, cats, and rats, an alcoholic extract produced a pressor effect similar to that of dopamine, but without tachyphylaxis. Increased heart rate was observed.Shikov 2014, Li 1988

Clinical data

Research reveals no clinical data regarding the use of coltsfoot in cardiovascular conditions.

Respiratory effects

Animal data

Antitussive and expectorant effects of coltsfoot flowers have been investigated in mice.Li 2012, Li 2013

Clinical data

Despite traditional use for coughs, research reveals no clinical data regarding the use of coltsfoot in respiratory conditions.

Other uses

Antimicrobial effects have been shown against Bacillus cereus, Mycobacterium tuberculosis, and Staphylococcus aureus.Kokoska 2002, Zhao 2014

Several studies have demonstrated antioxidant effects for coltsfoot; clinical applications are lacking, but may relate to anti-inflammatory and chemo- and neuroprotective effects.Cho 2005, Kim 2006, Li 2012, Lim 2008

Further in vitro studies suggest extracts of coltsfoot may have applications in diabetes and cancer.Li 2014, Park 2008

Dosing

Clinical trials are lacking to provide dosage recommendations.

Traditional dosage: 2 to 4 mL liquid leaf extract or 0.6 to 2 mL liquid flower extract.Duke 2002

No more than 4.5 to 6 g/day for no longer than 4 to 6 weeks per year in total, due to pyrrolizidine alkaloid content.Duke 2002, Blumenthal 2000

Pregnancy / Lactation

Avoid use. Preparations may contain hepatotoxic pyrrolizidine alkaloids with carcinogenic and mutagenic potential.Blumenthal 2000, Duke 2002, Ernst 2002

Interactions

None well documented.Chen 2012, Ulbricht 2008 High doses of coltsfoot may interact with cardiovascular medicines.Duke 2002 The constituent tussilagone demonstrates weak antiplatelet and calcium channel blocking activity.Hwang 1987, Liu 2008 Caution is warranted if coltsfoot is used concurrently with anticoagulants (eg, warfarin) or antiplatelet agents (eg, aspirin, clopidogrel, prasugrel).

Adverse Reactions

Animal studies reported allergenic potential.Duke 2002 A warning label regarding the presence of potentially hepatotoxic pyrrolizidine alkaloids has been recommended for all coltsfoot preparations.Kim 2013, Dangerous supplements 2010

Toxicology

Pyrrolizidine alkaloids are liver toxins with carcinogenic and mutagenic potential.Blumenthal 2000, Shikov 2014 Phototoxicity has been reported in guinea pig skin.Duke 2002 Development of hepatic tumors in rats has been reported.Duke 2002, Hirono 1976 Case reports exist of both fatal (in a newborn) and reversible (in an 18-month-old) hepatic vaso-occlusive disease; causality was suspected but not established.Shikov 2014, Sperl 1995 Coltsfoot was implicated in another case report of deep vein thrombosis and pulmonary embolism in an adult consuming a combination of herbal preparations.Freshour 2012

References

Blumenthal M, Goldberg A, Brinckmann J. Herbal medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000.
Chen X, Sneed K, Pan S, et al. Herb-drug interactions and mechanistic and clinical considerations. Curr Drug Metab. 2012;13(5):640-651.22292789
Cho J, Kim HM, Ryu JH, Jeong YS, Lee YS, Jin C. Neuroprotective and antioxidant effects of the ethyl acetate fraction prepared from Tussilago farfara L. Biol Pharm Bull. 2005;28(3):455-460.15744068
Dangerous supplements: what you don't know about these 12 ingredients could hurt you. Consum Rep. 2010;75(9):16-20.
Duke J, Bogenschutz-Godwin M, duCellier J, Duke P. Handbook of Medicinal Herbs. 2nd ed. Boca Raton, FL: CRC Press; 2002.
Ernst E. Herbal medicinal products during pregnancy: Are they safe? BJOG. 2002;109(3):227-235.11950176
Freshour JE, Odle B, Rikhye S, Stewart DW. Coltsfoot as a potential cause of deep vein thrombosis and pulmonary embolism in a patient also consuming kava and blue vervain. J Diet Suppl. 2012;9(3):149-154.22876743
Hirono I, Mori H, Culvenor CC. Carcinogenic activity of coltsfoot, Tussilago farfara L. Gann. 1976;67(1):125-129.1269853
Hwang SB, Chang MN, Garcia ML, et al. L-652,469 — a dual receptor antagonist of platelet activating factor and dihydropyridines from Tussilago farfara L. Eur J Pharmacol. 1987;141(2):269-281.2824219
Kim EJ, Chen Y, Huang JQ, et al. Evidence-based toxicity evaluation and scheduling of Chinese herbal medicines. J Ethnopharmacol. 2013;146(1):40-61.23286904
Kim MR, Lee JY, Lee HH, et al. Antioxidative effects of quercetin-glycosides isolated from the flower buds of Tussilago farfara L. Food Chem Toxicol. 2006;44(8):1299-1307.16574296
Kokoska L, Polesny Z, Rada V, Nepovim A, Vanek T. Screening of some Siberian medicinal plants for antimicrobial activity. J Ethnopharmacol. 2002;82(1):51-53.12169406
Li H, Lee HJ, Ahn YH, et al. Tussilagone suppresses colon cancer cell proliferation by promoting the degradation of beta-catenin. Biochem Biophys Res Commun. 2014;443(1):132-137.24269588
Li W, Huang X, Yang XW. New sesquiterpenoids from the dried flower buds of Tussilago farfara and their inhibition on NO production in LPS-induced RAW264.7 cells. Fitoterapia. 2012;83(3):318-322.22120501
Li YP, Wang YM. Evaluation of tussilagone: a cardiovascular-respiratory stimulant isolated from Chinese herbal medicine. Gen Pharmacol. 1988;19(2):261-263.3350333
Li ZY, Zhi HJ, Xue SY, et al. Metabolomic profiling of the flower bud and rachis of Tussilago farfara with antitussive and expectorant effects on mice. J Ethnopharmacol. 2012;140(1):83-90.22210102
Li ZY, Zhi HJ, Zhang FS, et al. Metabolomic profiling of the antitussive and expectorant plant Tussilago farfara L. by nuclear magnetic resonance spectroscopy and multivariate data analysis. J Pharm Biomed Anal. 2013;75:158-164.23261808
Lim HJ, Lee HS, Ryu JH. Suppression of inducible nitric oxide synthase and cyclooxygenase-2 expression by tussilagone from Farfarae flos in BV-2 microglial cells. Arch Pharm Res. 2008;31(5):645-652.18481023
Liu LL, Yang JL, Shi YP. Sesquiterpenoids and other constituents from the flower buds of Tussilago farfara. J Asian Nat Prod Res. 2011;13(10):920-929.21972807
Liu YF, Yang XW, Lu W, Xin XL. Determination and pharmacokinetic study of tussilagone in rat plasma by RP-HPLC method. Biomed Chromatogr. 2008;22(11):1194-1200.18651585
Park HR, Yoo MY, Seo JH, et al. Sesquiterpenoids isolated from the flower buds of Tussilago farfara L. inhibit diacylglycerol acyltransferase. J Agric Food Chem. 2008;56(22):10493-10497.18937486
Shikov AN, Pozharitskaya ON, Makarov VG, Wagner H, Verpoorte R, Heinrich M. Medicinal plants of the Russian Pharmacopoeia; their history and applications. J Ethnopharmacol. 2014;154(3):481-536.24742754
Sperl W, Stuppner H, Gassner I, Judmaier W, Dietze O, Vogel W. Reversible hepatic veno-occlusive disease in an infant after consumption of pyrrolizidine-containing herbal tea. Eur J Pediatr. 1995;154(2):112-116.7720737
Tussilago farfara. Dr. Duke's Phytochemical and Ethnobotanical Databases. http://www.ars-grin.gov/duke. Accessed November 6, 2014.
Tussilago farfara L. USDA, NRCS. 2014. The PLANTS Database. (http://plants.usda.gov, 4 August 2014). National Plant Data Team, Greensboro, NC 27401-4901 USA. Accessed November 6, 2014.
Ulbricht C, Chao W, Costa D, Rusie-Seamon E, Weissner W, Woods J. Clinical evidence of herb-drug interactions: A systematic review by the natural standard research collaboration. Curr Drug Metab. 2008;9(10):1063-1120.19075623
Zhao J, Evangelopoulos D, Bhakta S, Gray AI, Seidel V. Antitubercular activity of Arctium lappa and Tussilago farfara extracts and constituents. J Ethnopharmacol. 2014;155(1):796-800.24955560

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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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