Diuretic Herbs

Summary

Diuretic Herbs

introduction:
Diuretic herbs were historically used somewhat differently than pharmaceutical diuretics, as a mild alternative to purgative remedies for correcting oliguria or edema in a wide range of conditions, including "dyscrasias," such as rheumatic and gouty disorders. Some remedies classified as "diuretic" actually have more of an antimicrobial and antiseptic action on the urinary tract rather than causing frank diuresis e.g., Arctostaphylos uva-ursi (Bearberry). Herbal diuretics are generally mild, gentle remedies, and operate by a variety of mechanisms which have been little studied; little is known too about the active constituents responsible for causing diuresis in most cases. It is quite possible that even in cases where herb constituents are known to parallel those of pharmaceutical diuretics, that the mechanism of action is not necessarily the same; for example, Agropyron repens (Couch Grass rhizome) contains mannitol, an osmotic diuretic agent, but this is not regarded as its primary active mechanism. Synergistic action of multiple constituents may also reduce potential toxicity of herbal diuretics, a well known example being the presence of high concentrations of potassium in Taraxacum (dandelion) leaf, which is considered by herbalists to offset potential hypokalemic effects as a result of its diuretic actions.

overview of interactions:
• mechanism: It is a prudent, but not proven, assumption that excessive use of herbal diuretics could potentially cause imbalances in electrolyte homeostasis (with symptoms such as arrhythmias and tetany) or reduction of extracellular fluid (leading to volume depletion sequela such as hypotension and reduced GFR). Presumably by extrapolation from the characteristics of most pharmaceutical diuretics, some writers have given the impression that perturbances of potassium homeostasis will inevitably occur with the use of herbal diuretics, leading to the possibility of pharmacokinetic interactions.
(Brinker F. 1998, 160.)

• research: Published evidence for toxic hypokalemic effects of herbal diuretics is not available, and studies of diuretic herb pharmacology tend to be dated, with possible methodological flaws. Several herbal diuretics are considered to be salidiuretic, particularly Taraxacum officinale (Dandelion leaf). Dandelion leaf is also a rich source of potassium, (<4.5% dry weight) and while pharmacological studies in animals suggest that its diuretic activity is equivalent to that of furosemide (Lasix), the potassium content of the leaf will tend to compensate for depletion of potassium associated with saliuresis, making Dandelion leaf the diuretic of choice for many herbalists. Ononis spinosa (Spiny Restharrow), a diuretic favored in Germany, also has a salidiuretic action, but once again its precise pharmacology and active constituents have not been isolated.
(Bisset NG, Wichtl M.1994, 356; Hook I, et al. Int J Pharmacog 1993,31(1): 29-34; Racz-Kotilla E, et al. Planta Med 1974;26:212-217.)

overview of interactions:

• herb potentially affecting drug toxicity: Digoxin

• herb-herb synergy possibly affecting drug toxicity: Glycyrrhiza glabra (Licorice Root)

• herb-herb synergy possibly affecting drug toxicity: Herb Group: GI Modifiers: Irritants

• herb-herb synergy possibly affecting drug toxicity: Herb Group: Neuroendocrine: Xanthine-containing Herbs



Herbs

herb potentially affecting drug toxicity: Digoxin

• mechanism: Extended use of herbal diuretics may cause electrolyte imbalance, including hypokalemia.

• herbal concern: Patients using cardiac glycosides, such as digoxin, should be monitored closely for signs of increased digitalis toxicity during administration of herbal diuretics.

herb-herb synergy possibly affecting drug toxicity: Glycyrrhiza glabra (Licorice Root)

• mechanism: Excessive consumption of Licorice root (Glycyrrhiza glabra) can cause pseudoaldosteronism, with consequent hypokalemia due to interference with steroid degradation pathways.

• herbal concern: Concurrent use of herbal diuretics may increase the possibility of hypokalemia and sequelae of possible arrythymias and increased digoxin toxicity.

herb-herb synergy possibly affecting drug toxicity: Herb Group: GI Modifiers: Irritants

• mechanism: Chronic or excessive use of gastro-intestinal irritant herbs such as anthraquinone laxatives may cause electrolyte loss through the increase in colonic motility and reduced transit times for re-absorption.

• herbal concern: Concurrent use of herbal diuretics may increase the possibility of arrythymias and increase digoxin toxicity.

herb-herb synergy possibly affecting drug toxicity: Herb Group: Neuroendocrine: Xanthine-containing Herbs

• mechanism: Xanthine-containing herbs have diuretic activity as well as being cardiac stimulants and potentially arrythmic due to sympathomimetic activity.

• herbal concern: Consumption of Xanthine-containing herbs, particularly in beverage form, concurrently with use of herbal diuretics may increase the possibility of hypokalemia and sequelae of possible arrythmias and increased digoxin toxicity.

Common herbs with diuretic activity:
• Achillea millefolium (Yarrow)
• Agropyron repens (Couch Grass rhizome)
• Arctium lappa (Burdock)
• Arctostaphylos uva-ursi (Bearberry)
• Aphanes arvensis (Parsley Piert)
• Apium graveolens (Celery Seed)
• Barosma betulina (Buchu)
• Camellia sinensis (Tea)
• Chimaphila umbellata (Pipsissewa)
• Coffea arabica (Coffee beans)
• Cola nitida (Kola)
• Collinsonia canadensis (Stone Root)
• Cytisus scoparius (Scotch Broom)
• Daucus carota (Wild Carrot)
• Equisetum spp. (Horsetail)
• Eupatorium perfoliatum (Boneset)
• Eupatorium purpureum (Gravel Root)
• Galium aparine (Cleavers)
• Herniaria glabra (Rupturewort)
• Ilex paraguariensis (Maté)
• Juniperis communis (Juniper berries)
• Ononis spinosa (Spiny Restharrow)
• Orthosiphon spp. (Java Tea)
• Parietaria diffusa (Pellitory of the Wall)
• Paullinia cupana (Guarana)
• Petroselinum crispum (Parsley)
• Peumus boldo (Boldo)
• Rehmannia glutinosa (Chinese Foxglove)
• Sambucus nigra (Elder)
• Serenoa repens (Saw Palmetto)
• Solidago virgaurea (Golden Rod)
• Taraxacum officinale (Dandelion leaf)
• Theobroma cacao (Cacao)
• Tilia europaea (Linden flower)
• Urtica spp. (Stinging Nettle)
• Zea mays (Cornsilk)

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Do not rely solely on the information in this article.

The information presented in Interactions is for informational and educational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, case reports, and/or traditional usage with sources as cited in each topic. The results reported may not necessarily occur in all individuals and different individuals with the same medical conditions with the same symptoms will often require differing treatments. For many of the conditions discussed, treatment with conventional medical therapies, including prescription drugs or over-the-counter medications, is also available. Consult your physician, an appropriately trained healthcare practitioner, and/or pharmacist for any health concern or medical problem before using any herbal products or nutritional supplements or before making any changes in prescribed medications and/or before attempting to independently treat a medical condition using supplements, herbs, remedies, or other forms of self-care.


References

Bisset NG (ed.), Wichtl M. Herbal Drugs and Phytopharmaceuticals, Boca Raton, FL: CRC Press, 1994.

Brinker F. Herb Contraindications and Drug Interactions. 2nd edition., Sandy, OR; Eclectic Institute Inc, 1998.

Hook I, McGee A, Henmann M. Evaluation of dandelion leaf for diuretic activity and variation in potassium content. Int J Pharmacog 1993;31 (1); 29-34.

Racz-Kotilla E, Racz G, Solomon A. The action of Taraxacum officinale extracts on bodyweight and diuresis of laboratory animals. Planta Med 1974;26:212-217.