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Butterbur (Petasites hybridus)


Also listed as: Petasites hybridus
Related terms

Related Terms
  • Blatterdock, bog rhubarb, bogshorns, butcher's rhubarb, butterbur coltsfoot, butterburr, butter-dock, butterdock, butterfly dock, capdockin, coughwort, donnhove, European pestroot, exwort, flapper-bags, flapperdock, fuki, horsehoof, langwort, paddy's rhubarb, pestwurz, Petadolex®, Petadolor H, Petaforce®, petasites, petasites flower, petasites leaf, petasites rhizome, petasites root, Petasites hybridus, P. officinalis, P. ovatus, P. vulgaris, petasitidis folium (flower), Petasitidis hybridus, Petasitidis rhizoma (rhizome), plaguewort, purple butterbur, sweet coltsfoot, Tesalin®, Tussilago farfara, Tussilago hybrida, Tussilago petasites, umbrella leaves, umbrella plant, western coltsfoot, wild rhubarb, ZE 339.

  • Butterbur is a perennial shrub, found throughout Europe as well as parts of Asia and North America. It is usually found in wet, marshy ground, in damp forests, and adjacent to rivers or streams. The leaves of the plant are responsible for its botanical and common names. The common name is attributed to the large leaves being used to wrap butter during warm weather.
  • Butterbur has been traditionally used as an antispasmodic and pain reliever. Butterbur is believed to help strengthen digestion and improve obstructed bile flow. Butterbur has also been given for inflammation of the urinary tract and cramps. There is evidence supporting the use of butterbur for migraine prophylaxis and for allergic rhinitis. Strong evidence for other conditions is lacking.
  • Use should be limited to commercially available products free of pyrrolizidine alkaloids that are generally believed to be well-tolerated. Ingestion of raw, unprocessed butterbur plant is unsafe and may damage the liver.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *

Pain relief and headache prevention are traditional uses of butterbur. Research has shown that butterbur is effective in preventing migraines when taken regularly for up to four months. Further research comparing butterbur to other agents used for preventing migraines is needed.


Comparisons of butterbur to prescription drugs such as fexofenadine (Allegra®) and cetirizine (Zyrtec®) have reported similar effectiveness for allergic rhinitis. These results suggest benefits of butterbur for allergic rhinitis, or nose congestion and inflammation. Additional study is warranted before a strong conclusion can be made.


Butterbur was used historically to treat asthma, and early research suggests possible benefits. However, additional study is needed to make a firm conclusion.


Early evidence shows that butterbur in combination with other herbs helped decrease depression and anxiety in people with somatoform disorders, which are a group of mental disorders that cause unexplained physical symptoms. Further research is needed to draw conclusions.


Early research shows that butterbur lacks an effect in reducing allergic skin reactions. Additional study is needed to draw conclusions.

* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Anti-inflammatory, antispasmodic, anxiety, appetite stimulant, bladder disorders, bubonic plague (deadly bacterial infection), cancer, chronic cough, chronic obstructive pulmonary disease (COPD), colds, cramps, diuretic (increases urine flow), fever, gastric ulcers, headache, heart disease, indigestion, insomnia, ocular allergy (eye allergy), pain, shivering, urinary complaints, vasodilatation (widening of blood vessels), whooping cough, wound healing.


Adults (18 years and older)

  • Butterbur comes in various forms and is an ingredient in many products. According to secondary sources, for making a tea, one teaspoonful of the root in one cup of boiling water, three times daily has been used. One to two milliliters of tincture has been used three times daily. Adult dosage may range from 50-100 milligrams twice daily with meals. Raw, unprocessed butterbur plant should be avoided due to the liver toxicity of pyrrolizidine alkaloids. Therefore, use of butterbur should be limited to commercially available products that are free of pyrrolizidine alkaloids.
  • For allergic rhinitis, 50 milligrams butterbur (Petaforce®) or 8.0mg petasin (Tesalin®) tablets have been taken by mouth 2-4 daily for 1-2 weeks.
  • For allergic skin disease, 50 milligrams butterbur extract (Petaforce®) has been taken by mouth twice daily for one week with lack of benefit and two tablets of 8mg butterbur has been taken by mouth as a single treatment with lack of benefit.
  • For asthma, 50-150 milligrams of standardized butterbur (Petaforce®) has been taken in two to three divided doses daily for 2-4 months with beneficial effects.
  • For migraine prophylaxis, 50-75 milligrams butterbur capsules containing extracts of purified Petasites (including Petadolex® or Petaforce®) were taken by mouth twice daily for up to four months.

Children (younger than 18 years)

  • For asthma, 50-150 milligrams butterbur extract (Petadolex®) has been taken by mouth daily for two months.
  • For migraine prevention, 50-150 milligrams butterbur root extract (Petadolex®) was taken by mouth daily in two divided doses for up to four months.


The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.


  • Avoid in individuals with a known allergy or sensitivity to butterbur or other plants from its plant family such as ragweed, marigolds, daisies, and chrysanthemums.

Side Effects and Warnings

  • Butterbur products are likely safe if they are free of toxic pyrrolizidine alkaloids and when used by mouth in recommended doses for up to 16 weeks.
  • Butterbur may cause burping, bitter taste, constipation, diarrhea, difficulty breathing, difficulty swallowing, discoloration of stools, drowsiness, eye discoloration, fatigue, gas, headache, hot flushes, increased cancer risk, increased liver enzyme levels, indigestion, itch, itchy eyes, limb pain, joint pain, nausea, nose inflammation, pain, rash, skin discoloration, sleep disorders, stomach upset or pain, throat tightness, vomiting, and wheezing.
  • Use cautiously in people with skin, stomach, intestine, nervous system, muscle, bone, eye, breathing, or liver disorders.
  • Use cautiously in people taking anticholinergic agents.
  • Avoid ingesting raw, unprocessed butterbur plant.
  • Avoid during pregnancy and when breastfeeding due to a lack of safety studies.

Pregnancy and Breastfeeding

  • Avoid during pregnancy and when breastfeeding due to a lack of safety studies.


Interactions with Drugs

  • Butterbur may interact with agents for the skin, agents for the stomach and intestines, agents that affect blood vessel width, agents that affect the eyes, agents that affect the nervous system, agents that cause liver toxicity, agents that dilate the bronchioles, analgesic agents, anti-asthmatic agents, anti-cancer agents, anticholinergic agents, antihistamines, anti-inflammatories, anxiolytics, and sedatives.

Interactions with Herbs and Dietary Supplements

  • Butterbur may interact with analgesic herbs and supplements, anti-asthmatic herbs and supplements, anti-cancer herbs and supplements, anticholinergic herbs and supplements, antihistamines, anti-inflammatories, anxiolytics, herbs and supplements for the skin, herbs and supplements for the stomach and intestines, herbs and supplements that affect blood vessel width, herbs and supplements that affect the eyes, herbs and supplements that affect the nervous system, herbs and supplements that cause liver toxicity, herbs and supplements that dilate the bronchioles, pyrrolizidine alkaloid-containing herbs, and sedatives.

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (

  1. Aydin AA, Zerbes V, Parlar H, et al. The medical plant butterbur (Petasites): analytical and physiological (re)view. J Pharm Biomed.Anal. 3-5-2013;75:220-229.
  2. Holland S, Silberstein SD, Freitag F, et al. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 4-24-2012;78(17):1346-1353.
  3. Lee JS, Yang EJ, Yun CY, et al. Suppressive effect of Petasites japonicus extract on ovalbumin-induced airway inflammation in an asthmatic mouse model. J Ethnopharmacol. 1-27-2011;133(2):551-557.
  4. Levin M. Herbal treatment of headache. Headache 2012;52 Suppl 2:76-80.
  5. Lovell BV and Marmura MJ. New therapeutic developments in chronic migraine. Curr Opin.Neurol. 2010;23(3):254-258.
  6. Mauskop A. Nonmedication, alternative, and complementary treatments for migraine. Continuum (Minneap.Minn.) 2012;18(4):796-806.
  7. Posadzki P, Watson LK, and Ernst E. Adverse effects of herbal medicines: an overview of systematic reviews. Clin Med 2013;13(1):7-12.
  8. Posadzki P, Watson L, and Ernst E. Herb-drug interactions: an overview of systematic reviews. Br J Clin Pharmacol 2013;75(3):603-618.
  9. Pringsheim T, Davenport W, Mackie G, et al. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol.Sci 2012;39(2 Suppl 2):S1-59.
  10. Ross SM. Clinical applications of integrative therapies for prevention and treatment of migraine headaches. Holist.Nurs.Pract. 2011;25(1):49-52.
  11. Schiapparelli P, Allais G, Castagnoli, et al. Non-pharmacological approach to migraine prophylaxis: part II. Neurol.Sci 2010;31 Suppl 1:S137-S139.
  12. Shukla R and Sinh M. Migraine: prophylactic treatment. J Assoc.Physicians India 2010;58 Suppl:26-29.
  13. Sun-Edelstein C and Mauskop A. Alternative headache treatments: nutraceuticals, behavioral and physical treatments. Headache 2011;51(3):469-483.
  14. Sutherland A and Sweet BV. Butterbur: an alternative therapy for migraine prevention. Am J Health Syst.Pharm 5-1-2010;67(9):705-711.
  15. Taylor FR. Nutraceuticals and headache: the biological basis. Headache 2011;51(3):484-501.

Copyright © 2011 Natural Standard (

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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