Medically reviewed on March 19, 2018
Scientific Name(s): Harpagophytum procumbens , subsp. procumbens DC. ex Meisn. Family: Pediliaceae (sesame).
Common Name(s): Devil's claw , grapple plant , grapple vine , Radix Harpagophyti , wood spider , xwate .
Devil's claw is a folk remedy used for an extensive range of diseases, including arthritis and rheumatism. Clinical trials are generally supportive of its use as an anti-inflammatory and analgesic in low back pain and osteoarthritis.
Devil's claw has been studied for low back pain, muscle pain, and osteoarthritis using daily doses of crude tuber up to 9 g, 1 to 3 g of extract, or harpagoside 50 to 100 mg.
Because of the bitterness of the preparation and consequent increase in gastric secretion, devil's claw is contraindicated in patients with gastric or duodenal ulcers.
Documented oxytoxic adverse effects. Avoid use.
None well documented.
Rare, generally consisting of headache, tinnitus, or anorexia.
Clinically important toxicity has not been observed in limited, short-term use.
Devil's claw grows naturally in the Kalahari Desert and Namibian steppes of southwest Africa. The plant is a weedy perennial bearing small, claw-like protrusions on the fruit and a strong central taproot growing up to 2 m deep. The secondary roots are used in decoctions and teas. The plant's leaves are large and grey-green in color, and it produces pink, red, or purple, trumpet-shaped flowers. 1 , 2 Devil's claw is also known as Uncaria procumbens and Harpagophytum burchellii Decne.
Devil's claw has been widely used among indigenous people of South Africa as a folk remedy for diseases ranging from liver and kidney disorders to allergies, headaches, and most commonly, rheumatism. Devil's claw was reportedly introduced to Europe by a German soldier in the mid-1900s, and thereafter its popularity increased among British, Canadian, and European herbalists. Devil's claw is marketed in Canada and Europe as a home remedy for the relief of arthritic diseases. 1 , 2 , 3
The major chemical component thought to be responsible for the anti-inflammatory activity of devil's claw is harpagoside, a monoterpene glucoside. Other iridoid glycosides include procumbide, harpagide, 8-para-coumaroyl-harpagide, and verbascoside. Harpagoside is found primarily in the roots; secondary tubers contain twice as much glucoside as the primary roots. Flowers, stems, and ripe fruits are essentially devoid of the compound, while traces have been isolated from the leaves. Harpagoside can be progressively hydrolyzed to harpagid and harpagogenin. Commercial sources of devil's claw extract contain 1.4% to 2% of harpagoside.
Other constituents include carbohydrates, flavonoids (kaempferol, luteolin), aromatic acids, phytosterols, and triterpenes. High-performance liquid chromatography methods for identification have been reported. 2 , 4 , 5
Uses and PharmacologyAnti-inflammatory/analgesic effects
In vitro studies are largely supportive of anti-inflammatory action. Mechanisms elucidated include inhibition of COX-2 enzymes and proinflammatory enzymes, antioxidant activity, reductions in expression of prostaglandin PGE 2 , and inhibition of cysteinyl-leukotrienes. 3 , 4 , 6 , 7 , 8 , 9Animal data
Most animal studies support the anti-inflammatory and analgesic effects of devil's claw extracts. Studies have included oral, intraperitoneal, and intraduodenal routes of administration, with oral use having the most negative findings. Inhibition of carrageenin-induced paw edema by devil's claw was comparable with that of phenylbutazone, indomethacin, and acetyl salicylic acid. A dose-dependent effect has also been described. 3 , 4 , 10 , 11 , 12 , 13 , 14Clinical data
Reviews of clinical trials have focused primarily on arthritic conditions (hip and knee) and low back pain. A meta-analysis of available data has not been conducted, possibly because of diverse methodologies. 3 , 4 , 15 , 16
Few quality double-blind, placebo-controlled, or comparator randomized trials have been conducted in osteoarthritis; however, there is general support for evidence of effect in pain reduction. Other clinical studies (open-label) are also supportive. Well-designed, adequately powered studies are required before definitive statements regarding optimal dose, efficacy, and duration of therapy can be made. 15 , 16 The use of devil's claw in treating low back pain has been reviewed by a Cochrane group who found evidence to support a short-term reduction in pain greater than that of placebo, based on 2 quality clinical trials. 15 Positive results from other less well-designed trials have been published. 3 , 4Other uses
Older animal studies demonstrated cardiac effects of extracts of H. procumbens , including dose-dependent reduction in blood pressure, decreased heart rate, and anti-arrhythmic activity, with mixed results or inotropic and chronotropic effects for different iridoids. 17 , 18 , 19 Clinical studies are lacking.Central nervous system
A study in rats showed anticonvulsant effects of an extract of H. procumbens , possibly via CNS depression and gamma aminobutyric acid neurotransmission. 20 Anticholinesterase activity has also been described. 21
Devil's claw has been studied for low back pain, muscle pain, and osteoarthritis using daily doses of crude tuber up to 9 g daily, 1 to 3 g of extract, and harpagoside 50 to 100 mg. 3 , 22 , 23 Commercial preparations are inconsistent in the composition of iridoid glycosides, with some products likely to be more effective than others. Harpagoside is considered the key ingredient for anti-inflammatory effect. 23
Devil's claw is not recommended for use in children due to lack of safety or clinical trial data. 3 It is also not recommended for long-term use (more than 3 to 4 months) because of a lack of data. 3 , 24
A poorly documented case report of an interaction with warfarin manifesting as purpura exists. 3 , 26 , 27 However, devil's claw does not affect blood eicosanoid production. 28 Use with antiarrhythmic, chronotropic, or inotropic medicines is contraindicated because of decreased heart rate observed in rats and mild positive inotropic effects in rabbits in older studies. 3 , 18 , 19 Devil's claw may also potentiate antidiabetic therapy. 2 , 3 , 4
Screening studies report that H. procumbens is unable to inhibit cytochrome P450 enzymes and is unlikely to have any clinically relevant effect on the cytochrome system. 4 , 29 It is possible that devil's claw may affect multidrug P-glycoprotein drug transporter. 30
Rare, GI-related adverse effects have been reported in clinical trials, including mild GI upset, anorexia, and loss of taste. Headache and tinnitus have been reported. 31 , 32 Cardiovascular adverse events are theoretically possible based on older studies in rodents; however, case reports are lacking. 32
Anecdotal reports suggest devil's claw may increase stomach pH due to its bitter taste, and is thus contraindicated in people with gastric or duodenal ulcers. 3 , 33 Cautious use by patients with gallstones is likewise advised. 2 , 3 For diabetic patients, consider the unsubstantiated reports of possible hypoglycemic effects of devil's claw. 3
Harpagoside has been found to be of low toxicity, with a median lethal dose of more than 13.5 g/kg in mice. Although no long-term toxicity studies have been reported, rats given oral doses of harpagoside 7.5 g/kg/day showed no clinical, hematologic, or gross pathologic changes. 3 , 33
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23. Ouitas NA, Heard C. Estimation of the relative antiinflammatory efficacies of six commercial preparations of Harpagophytum procumbens (Devil's Claw). Phytother Res . 2010;24(3):333-338.
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25. Mahomed IM, Ojewole JA. Uterotonic effect of Harpagophytum procumbens DC ( Pedaliaceae ) secondary root aqueous extract on rat isolated uterine horns. J Smooth Muscle Res . 2009;45(5):231-239.
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