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Fumaria

Scientific Name(s): Fumaria officinalis L.
Common Name(s): Common fumitory, Drug fumitory, Earth smoke, Fumaderm (Germany), Fumitory, Pitpapara

Clinical Overview

Use

Fumaria has been traditionally used as a laxative and diuretic, and as a treatment for dermatologic conditions such as eczema. Limited evidence suggests that it may be beneficial in hepatobiliary disorders, and F. officinalis is approved in Germany for colic pain. The potential for use of fumaric acid derivatives in the management of multiple sclerosis and psoriasis has been reported, but sufficient clinical evidence is lacking.

Dosing

Therapeutic studies of plant extracts to provide dosage guidance are lacking. A German preparation of fumaric acid derivatives is used in psoriasis at dosages up to 720 mg/day.

Contraindications

None well documented.

Pregnancy/Lactation

Avoid use of Fumaria during pregnancy and lactation because of the lack of pharmacological and toxicity data.

Interactions

None well documented.

Adverse Reactions

GI complaints and flushing have been reported with use of fumaric acid derivatives.

Toxicology

Fumaria is not associated with clinically important toxicity, although studies are limited. However, alkaloids such as protopine may exhibit toxicity.

Botany

Fumaria 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 like smoke (hence the common name "earth smoke") and pink-purple flowers that bloom in spring. The plant is widely dispersed and can be found in gardens, on slopes, and in wastelands. There are approximately 46 different Fumaria species, including Fumaria occidentalis, Fumaria parviflora (syn. Fumaria indica), Fumaria vaillantii, and Fumaria reuteri, which are difficult to differentiate. In a debate regarding the classification of Fumitoria, some botanists distinguish the Fumitoriaceae subfamily as distinct from the Papaveraceae family. The climbing fumitory, or Allegheny vine, is a North American plant of another genus (Adlumia).Gupta 2012, Schauenberg 1977, USDA 2013

History

Fumaria has been known since antiquity and was traditionally used by expressing and evaporating the plant's juice. It has a long history of use as a blood purifier in traditional medicine, including the Ayurvedic system, and has been investigated for its therapeutic potential in the management of cardiovascular and hepatobiliary disorders, psoriasis, eczema, and other dermatologic conditions, as well as a laxative and diuretic. Fumaria is included in the British Herbal Pharmacopoeia and in The Complete German Commission E Monographs.Gupta 2012, Singh 2011, USDA 2013

Chemistry

Steroids (including sitosterol, stigmasterol, and campesterol) and many isoquinoline alkaloids have been described from all plant parts, including the root and seed.

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%. In addition, phospholipids and organic acids, including caffeic and fumaric, have been described. Methyl fumarate and protopine have been investigated for hepatoprotective activity. Pharmacologically active substances have also been isolated from other species (F. indica and F. parvifolia) and are the focus of research. The results of high pressure liquid chromatography methods to identify constituents have been published.Gupta 2012, Gupta 2012, Pandey 2008

Sanguinarine has been extracted from Fumaria species but is more commonly obtained from Sanguinaria canadensis.Burgeiro 2013, Jeng 2007

Uses and Pharmacology

GI effects

Animal data

Experiments using isolated GI tract tissue have demonstrated both antispasmodic and prokinetic activities of Fumaria extracts. Cholinergic, muscarinic, and calcium channel involvement has also been demonstrated, with a concentration-response relationship described.Gilani 2005, Najeeb-ur-Rehman 2012, Najeeb-ur-Rehman 2012

Clinical data

A randomized, placebo-controlled, blind clinical study found a decrease in irritable bowel syndrome (IBS)–associated pain with Fumaria; however, there was no difference over placebo using the global assessment measures of IBS. Increased abdominal distension was also associated with the use of Fumaria.Gilani 2005, Rahimi 2012

Hepatobiliary disorders

Animal data

Hepatoprotective properties of Fumaria species have been reported in animal studies; however, a precise mechanism of action has not been elucidated.Hentschel 1995, Hussain 2012, Orhan 2012, Tripathi 2010 Monomethyl fumarate demonstrated hepatoprotective activity against thioacetamide in vitro; in carbon tetrachloride, acetaminophen, and rifampin in vivo; and was comparable with silymarin, a recognized hepatoprotective.Rathi 2008

Clinical data

F. officinalis is approved in Germany for colic pain affecting the gallbladder and biliary system, in addition to the GI tract; however, quality clinical trials are lacking.Zacharewicz 1979

Dermatological effects

Animal data

An anti-inflammatory mechanism has been proposed in combination with inhibition of the proliferation of keratinocytes, but there are few experiments in animals.Nibbering 1997

Clinical data

A derivative of fumaric acid is approved in Germany for systemic treatment of psoriasis vulgaris.Altmeyer 1996, Altmeyer 1994, Mrowietz 1998, Papadopoulou 2010 One clinical study evaluated the effect of F. parviflora 4% topical cream in eczema, with reduction in area and severity scores noted for the Fumaria preparation.Jowkar 2011

Other uses

The potential for fumaric acid derivatives in the management of multiple sclerosis has been reported.Papadopoulou 2012

Anxiolytic effects have been reported in studies conducted in rats,Singh 2013 as well as bronchodilatory effects in vitro.Gilani 2005 Anti-inflammatory and antinociceptive effects have been studied in rodents.Molokhova 1973, Rao 2007

Antibacterial, antifungal, and antitrematode activity has been described for some Fumaria species.Gupta 2012, Ferreira 2011

A protective effect of F. parviflora ethanolic extracts on lead-induced testicular toxicity was demonstrated in rats.Dorostghoal 2013

Older studies described improved biochemical indices in diabetic rats fed a Fumaria dietJelodar 1998 and reduced experimental ischemia and arrhythmias in dogs.Rao 1998

Dosing

Specific therapeutic studies using plant extracts to provide dosage guidance are limited.

A German preparation of dimethyl ester fumarate and ethyl hydrogen fumarate salts is used in psoriasis at dosages up to 720 mg/day.Papadopoulou 2010

Pregnancy / Lactation

Avoid use of Fumaria during pregnancy and lactation because of the lack of pharmacological and toxicity data.

Interactions

None well documented.

The chemical constituent sanguinarine, found in S. canadensis and Fumaria species, has been suggested to have an antiplatelet effect,Molokhova 1973 but this effect has not been associated with Fumaria and case reports are lacking.

Adverse Reactions

Information is limited. Increased abdominal distension was associated with the use of Fumaria in 1 study, and GI complaints and flushing were reported in other clinical studies.Brinkhaus 2005, Papadopoulou 2010

Toxicology

A single case report of acute hepatotoxicity, possibly associated with Fumaria, has been published.Bonnet 2007 Monomethyl fumarate was found to be nonhepatocytotoxic in rat studies.Rao 1998

Researchers using a 50% ethanol extract of F. indica found no evidence of hematological, biochemical, or histological toxicity in both short-term and long-term studies in rodents.Gupta 2012, Singh 2013, Singh 2011 However, some Fumariaceae alkaloids (eg, protopine) may exhibit toxicity.Singh 2011

References

Altmeyer P, Hartwig R, Matthes U. Efficacy and safety profile of fumaric acid esters in oral long-term therapy with severe treatment refractory psoriasis vulgaris. A study of 83 patients [in German]. Hautarzt. 1996;47(3):190-196.8647701
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(6):977-981.8188891
Bonnet D, Mejdoubi S, Sommet A, Alric L. Acute hepatitis probably induced by Fumaria and Vitis vinifera tinctoria herbal products. Gastroenterol Clin Biol. 2007;31(11):1041-1042.18166905
Brinkhaus B, Hentschel C, Von Keudell C, et al. Herbal medicine with curcuma and fumitory in the treatment of irritable bowel syndrome: a randomized, placebo-controlled, double-blind clinical trial. Scand J Gastroenterol. 2005;40(8):936-943.16173134
Burgeiro A, Bento AC, Gajate C, Oliveira PJ, Mollinedo F. Rapid human melanoma cell death induced by sanguinarine through oxidative stress. Eur J Pharmacol. 2013;705(1-3):109-118.23499690
Dorostghoal M, Seyyednejad SM, Jabari A. Protective effects of Fumaria parviflora L. on lead-induced testicular toxicity in male rats [published online ahead of print April 24, 2013]. Andrologia. 2013.23611729
Ferreira JF, Peaden P, Keiser J. In vitro trematocidal effects of crude alcoholic extracts of Artemisia annua, A. absinthium, Asimina triloba, and Fumaria officinalis: trematocidal plant alcoholic extracts. Parasitol Res. 2011;109(6):1585-1592.21562762
Fumaria L. USDA, NRCS. 2012. The PLANTS Database (http://plants.usda.gov, 18 April 2013). National Plant Data Team, Greensboro, NC 27401-4901 USA. Accessed April 18, 2013.
Gilani AH, Bashir S, Janbaz KH, Khan A. Pharmacological basis for the use of Fumaria indica in constipation and diarrhea. J Ethnopharmacol. 2005;96(3):585-589.15619582
Gupta PC, Rao ChV. Morpho-anatomical and physicochemical studies of Fumaria indica (Hausskn.) Pugsley. Asian Pac J Trop Biomed. 2012;2(10):830-834.23569856
Gupta PC, Sharma N, Rao ChV. A review on ethnobotany, phytochemistry and pharmacology of Fumaria indica (Fumitory). Asian Pac J Trop Biomed. 2012;2(8):665-669.23569991
Hardin JW, Arena JM. Human Poisoning from Native and Cultivated Plants. 2nd ed. Durham, NC: Duke University Press; 1974.
Hentschel C, Dressler S, Hahn EG. Fumitory officinalis (fumitory) clinical applications. Fortschr Med. 1995;113(19):291-292.7672742
Hussain T, Siddiqui HH, Fareed S, Vijayakumar M, Rao CV. Evaluation of chemopreventive effect of Fumaria indica against N-nitrosodiethylamine and CCl4-induced hepatocellular carcinoma in Wistar rats. Asian Pac J Trop Med. 2012;5(8):623-629.22840450
Jelodar GH, Nazifi S. Effects of fumitory, coriander seed and madder on serum biochemical parameters of diabetic rats. Pathophysiology. 1998;5(suppl 1):175.
Jeng JH, Wu HL, Lin BR, et al. Antiplatelet effect of sanguinarine is correlated to calcium mobilization, thromboxane and cAMP production. Atherosclerosis. 2007;191(2):250-258.16797553
Jowkar F, Jamshidzadeh A, Mirzadeh Yazdi A, Pasalar M. The effects of Fumaria parviflora L extract on chronic hand eczema: a randomized double-blind placebo controlled clinical trial. Iran Red Crescent Med J. 2011;13(11):824-828.22737422
Molokhova LG, Figurkin BA. Isolation of fumitory alkaloids [in Russian]. Tr Permsk Gos Med Inst. 1973;118:33-34.
Molokhova LG, Suslina ML, Datskovskii SB, Figurkin BA. Antiinflammatory effect of fumitory alkaloids [in Russian]. Tr Permsk Gos Med Inst. 1973;118:26-28.
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(3):456-460.9580799
Najeeb-ur-Rehman, Bashir S, Al-Rehaily AJ, Gilani AH. Mechanisms underlying the antidiarrheal, antispasmodic and bronchodilator activities of Fumaria parviflora and involvement of tissue and species specificity. J Ethnopharmacol. 2012;144(1):128-137.22975416
Najeeb-ur-Rehman, Mehmood MH, Al-Rehaily AJ, Mothana RA, Gilani AH. Species and tissue-specificity of prokinetic, laxative and spasmodic effects of Fumaria parviflora. BMC Complement Altern Med. 2012;12:16.22405321
Nibbering PH, Thio B, Bezemer AC, Beijersbergen RL, Zomerdijk TP. Intracellular signalling by binding sites for the antipsoriatic agent monomethylfumarate on human granulocytes. Br J Dermatol. 1997;137(1):65-75.9274627
Orhan IE, Sener B, Musharraf SG. Antioxidant and hepatoprotective activity appraisal of four selected Fumaria species and their total phenol and flavonoid quantities. Exp Toxicol Pathol. 2012;64(3):205-209.20829009
Pandey MB, Singh AK, Singh JP, Singh VP, Pandey VB. Fuyuziphine, a new alkaloid from Fumaria indica. Nat Prod Res. 2008;22(6):533-536.18415862
Papadopoulou A, D'Souza M, Kappos L, Yaldizli O. Dimethyl fumarate for multiple sclerosis. Expert Opin Investig Drugs. 2010;19(12):1603-1612.21067468
Rahimi R, Abdollahi M. Herbal medicines for the management of irritable bowel syndrome: a comprehensive review. World J Gastroenterol. 2012;18(7):589-600.22363129
Rao CV, Verma AR, Gupta PK, Vijayakumar M. Anti-inflammatory and anti-nociceptive activities of Fumaria indica whole plant extract in experimental animals. Acta Pharm. 2007;57(4):491-498.18165192
Rao KS, Mishra SH. Antihepatotoxic activity of monomethyl fumarate isolated from Fumaria indica. J Ethnopharmacol. 1998;60(3):207-213.9613834
Rathi A, Srivastava AK, Shirwaikar A, Singh Rawat AK, Mehrotra S. Hepatoprotective potential of Fumaria indica Pugsley whole plant extracts, fractions and an isolated alkaloid protopine. Phytomedicine. 2008;15(6-7):470-477.18164606
Schauenberg P, Paris F. Guide to Medicinal Plants. New Canaan, CT: Keats Publishing; 1977.
Singh GK, Chauhan SK, Rai G, Chatterjee SS, Kumar V. Potential antianxiety activity of Fumaria indica: A preclinical study. Pharmacogn Mag. 2013;9(33):14-22.23661988
Singh GK, Chauhan SK, Rai G, Kumar V. Fumaria indica is safe during chronic toxicity and cytotoxicity: A preclinical study. J Pharmacol Pharmacother. 2011;2(3):191-192.21897716
Singh GK, Kumar V. Acute and sub-chronic toxicity study of standardized extract of Fumaria indica in rodents. J Ethnopharmacol. 2011;134(3):992-995.
Torck M, Pinkas M, Bézanger-Beauquesne L. The flavone heterosides of the fumitory. Fumitoria officinalis L., Fumariaceae [in French]. Ann Pharm Fr. 1971;29(12):591-596.5149947
Tripathi M, Singh BK, Mishra C, Raisuddin S, Kakkar P. Involvement of mitochondria mediated pathways in hepatoprotection conferred by Fumaria parviflora Lam. extract against nimesulide induced apoptosis in vitro. Toxicol In Vitro. 2010;24(2):495-508.19772912
Zacharewicz M, Chorazy W, Mossor S, Zacharewicz M Jr. Treatment of cholecystopathies by Fumaria nebulisate [in German]. Wien Med Wochenschr. 1979;129(8):221-224.377819

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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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