Petasites extract supplement studies, benefits and side effects
February 1 2017 by Ray Sahelian, M.D.

Petasites hybridus (butterbur) is a shrub found throughout Europe as well as parts of Asia and North America. Petasites that has been used medicinally for centuries to treat cough, asthma, and skin wounds. The plant can grow to a height of three feet and is usually found in wet, marshy ground, in damp forests, and adjacent to rivers or streams.

Active ingredients in Petasites
Petasin, a kind of sesquiterpene ester, appears to be a major active compound of petasites hybridus extract. It has inhibitory activities on leukotriene generation in eosinophils and neutrophils. This indicates that it may have anti-inflammatory and anti-allergy properties. Petasites may be helpful for seasonal allergic rhinitis. Petasites also helps reduce smooth muscle spasm.

Petasites safety , is it safe?
Petasites has not been studied extensively enough or for a long enough period to determine its side effects. Burping was the only side effect noted in a study published in the December 2004 issue of Neurology (see below).

Petasites dosage
Typically, Petasites extracts are standardized to contain a minimum of 7.5 mg of petasin and isopetasin. The adult dosage ranges from 50-100 mg twice daily.

Medical uses
See also additional information at butterbur web page.

Migraine Headache
Clinical studies using 50 mg and 75 mg of a standardized Petasites extract twice daily for 12 weeks demonstrated its effectiveness as a prophylactic treatment for migraines. When used to treat migraines, administration is prophylactic and supplementation should be carried out daily for a few weeks and then tapered until migraine incidence begins to increase. Petasites may work by preventing peptidoleukotriene biosynthesis.
See also Feverfew  supplement information.

Complement Ther Clin Pract. 2014. Butterbur extract: prophylactic treatment for childhood migraines. The incidence of migraine headaches in childhood is increasing. Migraines are often difficult to diagnose in pediatrics and even more difficult to treat and prevent. In order to decrease the impact of the condition on the child and the family, prophylactic treatment is recommended if the child is experiencing disabling migraines. The medications currently prescribed for the prevention of pediatric migraines often have significant side effects and are of questionable therapeutic value. For those patients and parents who are interested in alternative therapies and natural remedies for preventive treatment of pediatric migraines, butterbur extract derived from the butterbur plant, Petasites hybridus, has emerged as a promising treatment.

Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review.
Phytomedicine. 2006. Agosti R, Duke RK, Chrubasik JE. Headache Center Hirslanden, Münchhaldenstr., Zürich, Switzerland.
The objective of this review was to evaluate the strength of evidence of effectiveness for Petasites hybridus in the prophylaxis of migraine. Several databases and other sources were searched to identify randomised-controlled trials investigating Petasites hybridus preparations. Two trials totalling 293 patients (60 and 233 patients) were included in this review. Both trials investigated the proprietary Petasites root extract Petadolex. The extract at higher dose (150 mg) showed a greater decreased frequency of migraine attacks and a greater number of responders (improvement>50%) after treatment over 3-4 months than the extract at lower dose (100 mg) and placebo. Moderate evidence of effectiveness is, thus, available for a higher than the recommended dose of the proprietary Petasites root extract Petadolex in the prophylaxis of migraine. Further rigorous studies are required to confirm effectiveness and safety in long-term use before treatment with Petasites root extract can be recommended as an alternative option in the treatment schedule for the prophylaxis of migraine.

Asthma or Bronchitis
Various parts of the petasites plant have been used for centuries to treat bronchial asthma and whooping cough. Petasites’ possible effectiveness in treating respiratory disorders such as asthma and bronchitis is attributed to the antispasmodic and anti-inflammatory properties of the petasin constituent. 

Petasites extract Ze 339 (PET) inhibits allergen-induced Th2 responses, airway inflammation and airway hyperreactivity in mice.
Phytother Res. 2009. Brattström A, Schapowal A, Ryffel B, Moser R. Max Zeller Söhne AG Romanshorn, Switzerland.
The herbal Petasites hybridus extract (Ze 339, PET) is known to have leukotriene inhibiting properties, and therefore might inhibit allergic diseases. The effect of this product was investigated in ovalbumin immunized BALB/c mice given intranasally together with antigen challenge in the murine model of allergic airway disease (asthma) with the analysis of the inflammatory and immune parameters in the lung. Petasites reduced allergic airway inflammation and airway hyperresponsiveness by inhibiting the production of the Th2 cytokines IL-4 and IL-5, and RANTES.

Gastrointestinal Disorders
A German study found extracts of Petasites blocked ethanol-induced gastric damage and reduced ulcerations of the small intestine caused by indomethacin, an anti-inflammatory drug used to treat arthritic conditions. The results of this study were attributed to inhibition of lipoxygenase activity and leukotriene biosynthesis.

Research studies
An extract of the root of a plant called butterbur ( Petasites hybridus ) significantly reduces the frequency of migraine headaches. An article published in the December issue of Neurology reports a trial that compared petasites with an inactive placebo. Researchers compared the efficacy of two different doses of petsites extract to that of a placebo in about 230 migraine patients. They had experienced two to six attacks per month for the 3 months prior to the study. The number of migraine headache attacks per month was reduced by 45 percent in the group that took 75 milligrams of petasites twice daily, compared with a reduction of 28 percent in the placebo group during the 16-week trial. A group that took 50 milligrams of peatsites twice daily experienced a 32 percent decrease, not significantly different from placebo. The butterbur extract was well tolerated, the team reports, with burping as the only adverse event occurring more frequently in the active treatment groups. There were no changes in blood pressure, heart rate, or routine laboratory tests.

Petasites hybridus root is an effective preventive treatment for migraine.
Neurology. 2004.
To evaluate the clinical efficacy of a standardized special root extract from the plant Petasites hybridus as a preventive therapy for migraine. This is a three-arm, parallel-group, randomized trial comparing Petasites extract 75 mg bid, Petasites extract 50 mg bid, or placebo bid in 245 patients with migraine. Eligible patients met International Headache Society criteria for migraine, were ages 18 to 65, and had at least two to six attacks per month over the preceding 3 months. The main outcome measure was the decrease in migraine attack frequency per month calculated as percentage change from baseline over a 4-month treatment period. Over 4 months of treatment, in the per-protocol analysis, migraine attack frequency was reduced by 48% for Petasites extract 75 mg bid, 36% for Petasites extract 50 mg bid, and 26% for the placebo group. The proportion of patients with a > or =50% reduction in attack frequency after 4 months was 68% for patients in the Petasites extract 75-mg arm and 49% for the placebo arm. Results were also significant in favor of Petasites 75 mg at 1, 2, and 3 months based on this endpoint. The most frequently reported adverse reactions considered possibly related to treatment were mild gastrointestinal events, predominantly burping. Petasites extract 75 mg bid is more effective than placebo and is well tolerated as a preventive therapy for migraine. Petasites 50 mg PO bid was not significantly more effective than placebo on the primary study endpoints.

Petasites hybridus extract in the treatment of asthma - an open trial.
Danesch UC.
Altern Med Rev. 2004.
The efficacy and tolerability of a petasites root extract (Petadolex) for the treatment of asthma was analyzed in a prospective, non-randomized, open trial. Subjects included 64 adults and 16 children/adolescents treated for two months with the extract, followed by two months during which the intake of the extract was optional. Concomitant asthma medication was permitted. The number, duration, and severity of asthma attacks decreased, while peak flow, forced expiratory volume (FEV1), and all measured symptoms improved during therapy. In addition, more than 40 percent of patients using asthma medications at baseline reduced intake of these medications by the end of the study. This study suggests the Petasites hybridus extract is an effective and safe therapy for the treatment of asthma.

A placebo-controlled evaluation of petasites and fexofenadine on objective and subjective outcomes in perennial allergic rhinitis.
Clin Exp Allergy. 2004.
Summary Background There are presently no placebo-controlled data regarding the effects of petasites on subjective and objective outcomes in patients with perennial allergic rhinitis. Objective We performed a placebo-controlled evaluation of the effects of petasites and fexofenadine (FEX) on subjective and objective outcomes in patients with perennial allergic rhinitis. Methods Sixteen patients with perennial allergic rhinitis and house dust mite sensitization were randomized in double-blind cross-over fashion to receive for 1 week either petasites 50 mg twice daily, FEX 180 mg once daily and placebo (PL) once daily, or PL twice daily. The peak nasal inspiratory flow (PNIF) response to adenosine monophosphate (AMP) challenge administered as a single 400 mg/mL dose was measured over a 60-min period after challenge, and domiciliary total nasal symptom score was recorded. Results Pre-challenge values for mean+/-SEM PNIF were not significantly different comparing all groups. The maximum % PNIF fall from baseline after nasal AMP challenge was significantly attenuated compared to PL, with petasites and FEX. The area under the 60-min time-response curve (%.min) was also significantly attenuated compared to PL, with petasites and FEX. There was also a significant reduction in total nasal symptom score with petasites and FEX, compared to PL. There were no significant differences between petasites and FEX for any outcomes. petasites and FEX, in comparison to PL, were equally effective in attenuating the nasal response to AMP and in improving nasal symptoms, highlighting a potential role for petasites in the treatment of allergic rhinitis.

Safety of a patented special petasites root extract for migraine prevention.
Headache. 2003.
To report on the safety of a patented special petasites root extract used for migraine prevention. Two placebo-controlled clinical trials have been conducted supporting the beneficial use in humans. Results from acute, subchronic and chronic animal toxicity studies as well as from mutagenicity studies are reported. Safety data gained from clinical trials, postmarketing surveillance studies and pharmacovigilance are evaluated and discussed. The patented special petasites root extract is safe for the treatment in humans.

Petasites hybridus -- 60 patients received randomly either the Petasites preparation (50 mg BID) or placebo for 12 weeks. A total of 33 patients were allocated to the petasites group and 27 patients to the placebo group. In all, 58 patients completed the study. Compared to placebo, treatment significantly reduced the frequency of migraine attacks and days with migraine per month as well as the frequency of accompanying symptoms. Petasites hybridus reduced the frequency of attacks by 46% after 4 weeks, 60% after 8 weeks and 50% after 12 weeks of treatment (placebo group: 24%, 17% and 10%, respectively). No adverse drug reactions were reported in either the drug or placebo group. The efficacy and excellent tolerability of the Petasites hybridus extract observed in this study suggest that this plant preparation can be of clinical benefit to migraine patients.

Different varieties
Petasites hybridus - japonicus or Japonica - vulgaris

Enzymatic Therapy - Petadolex product with 60 Softgels
Petadolex contains the patented extract of Petasites hybridus that supports healthy blood vessel tone in the brain, as well as normal blood flow in the brain.* It has been the subject of two placebo-controlled clinical studies. In the most recent, participants reported a 62% improvement.

Petadolex is standardized to contain 15% of butterbur's key ingredient, petasin. It's also guaranteed to be pyrrolizidine alkaloid (PA) free, so you can use it with confidence. PA's are toxic compounds that can harm the liver.
Supplement Facts
Purple Butterbur (Petasites hybridus) 50 mg Root Extract, standardized to contain 7.5 mg petasins and to be free of pyrrolizidine alkaloids (PAs).

Recommendations: One petasites softgel three times daily, or 2 softgels 2 times daily for the first few weeks. Thereafter, one softgel twice daily. However, these are rough guidelines since each person is unique in their response.