Be aware that the U. S. Food and Drug Administration does not strictly
regulate herbs and dietary supplements. There is no guarantee of strength,
purity or safety of products containing or claiming to contain valerian.
Decisions to use herbs or supplements should be carefully considered. Individuals
using prescription drugs should discuss taking herbs or supplements with
their pharmacists or health care providers before starting.
Scientists have studied horse chestnut seed extract for the following health
Chronic venous insufficiency
Horse chestnut seed extract is most studied for a condition called chronic
venous insufficiency. This term is more common in Europe than the United
States. It describes several different problems that may be caused by the
failure of lower leg veins to work correctly. These problems include leg
swelling (edema), pain, itching, varicose veins, breakdown of skin and skin
ulcers. Multiple studies suggest that horse chestnut seed extract may help
these problems, possibly as well as other treatments, such as compression
stockings. However, these studies are small, low quality and not fully
convincing. Better research is necessary to provide a clear answer. If you
experience sudden leg swelling, consult your health care provider immediately.
Horse chestnut seed extract has been suggested for many other uses, based
on tradition or on scientific theories. However, these uses have not been
thoroughly studied in humans, and there is limited scientific evidence about
safety or effectiveness. Some of these suggested uses are for conditions
that are potentially very serious and even life-threatening. You should consult
with a health care provider before using horse chestnut seed extract for
any unproven use.
Fluid in the lungs (pulmonary edema)
Nerve pain (neuropathy)
Nighttime leg cramps
Prostate enlargement (benign prostatic hypertrophy)
Ringing in the ears (tinnitus)
Varicose leg ulcers
Whooping cough (pertussis)
People with known allergies to horse chestnut or any of the chemicals found
in horse chestnut (such as esculin, flavonoids, biosides, triosides of quercitins
and oligosaccharides, including 1-ketose or 2-ketose) should avoid using
horse chestnut seed extract products. Allergic skin rashes (contact dermatitis)
have been reported after the use of a skin cream containing horse chestnut
seed extract. Intravenous or injected horse chestnut seed extract may cause
anaphylactic shock (a severe allergic reaction) or other serious reactions
and should be avoided.
Few side effects have been reported from horse chestnut seed extract when
taken by mouth at recommended doses. The most common problems are upset stomach
and muscle spasms. Less common side effects are headache, skin rash, dizziness,
liver problems and kidney problems. Based on animal studies, horse chestnut
seed extract may lower blood sugar levels. In theory, horse chestnut seed
extract may increase the risk of bleeding. You may need to stop taking horse
chestnut seed extract before some surgeries; discuss this with your health
care provider. Horse chestnut seed extract should not be used as an injection
because it may cause serious side effects. Also avoid using other forms of
horse chestnut, such as the flower, branch bark, leaf or raw seeds, because
of possible serious side effects or death if eaten.
Several studies report the development of psuedolupus (a syndrome characterized
by recurrent fever, muscle pain, and lung and heart muscle inflammation)
in patients taking Venocuran or Venopyronum containing phenopyrazone, horse
chestnut extract, and cardiac glycosides. Because these are combination products,
these effects cannot be blamed on horse chestnut alone.
Pregnancy And Breast-Feeding
Horse chestnut seed extract cannot be recommended for use during pregnancy
or breast-feeding because of limited safety data. Although no adverse effects
were reported in a study of 52 pregnant women taking horse chestnut seed
extract for two weeks, more studies are needed before safety can be established.
Interactions with drugs, supplements and other herbs have not been thoroughly
studied. The interactions listed below have been reported in scientific
publications. If you are taking prescription drugs, speak with your health
care provider or pharmacist before using herbs or dietary supplements.
Interactions With Drugs
Although no adverse drug interactions have been reported, horse chestnut
seed extract may theoretically increase the risk of bleeding when used with
anticoagulants or antiplatelet drugs. Examples include warfarin (Coumadin),
heparin and clopidogrel (Plavix). Some pain relievers may also increase the
risk of bleeding if used with horse chestnut seed extract, such as aspirin,
ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve, Anaprox). Based
on animal research, horse chestnut seed extract may lower blood sugar levels.
Caution is advised if you are also taking drugs that may lower blood sugar
levels. Patients taking oral drugs for diabetes or using insulin should be
monitored closely by their health care provider while using horse chestnut
seed extract. Dosing adjustments may be necessary. Because of its effects
on how drugs are carried in the blood, horse chestnut seed extract may increase
the side effects associated with "protein-bound" drugs, such as amiodarone
(Cordarone) and phenytoin (Dilantin). The risk of an interaction with these
drugs is theoretical and has not been shown in humans.
Interactions With Herbs And Dietary Supplements
In theory, horse chestnut seed extract may increase the risk of bleeding
when taken with other products that are also believed to increase the risk
of bleeding. Examples include
(Allium sativum). Based on animal studies, horse chestnut seed extract
may lower blood sugar levels. People using other herbs or supplements that
may alter blood sugar levels, such as
melon (Momordica charantia), should be monitored closely by their
health care provider while using horse chestnut seed extract. Dosing adjustments
may be necessary.
The doses listed below are based on scientific research, publications
or traditional use. Because most herbs and supplements have not been thoroughly
studied or monitored, safety and effectiveness may not be proven. Brands
may be made differently, with variable ingredients even within the same brand.
Combination products often contain small amounts of each ingredient and may
not be effective. Appropriate dosing should be discussed with a health care
provider before starting therapy; always read the recommendations on a product's
label. The dosing for unproven uses should be approached cautiously, because
scientific information is limited in these areas.
One small study concluded that there is no difference between the absorption
rates for the retarded versus nonretarded preparation and that daytime absorption
was slightly better than nighttime absorption.
Adults (Aged 18 Or Older)
Horse chestnut seed extract: A dose of 300 milligrams every 12 hours,
for up to 12 weeks (containing 50 to 75 milligrams of escin per dose), has
been taken by mouth. A dose of 600 milligram of chestnut seed extract per
day has also been studied.
Children (Younger Than 18): Horse chestnut seed extract should
not be given to children because of a lack of research. Death has occurred
when children have eaten raw horse chestnut seeds or tea made from horse
chestnut leaves and twigs.
Although horse chestnut seed extract has been suggested for many conditions,
the most promising use supported by science is the treatment of chronic venous
insufficiency. Evidence does not support the use of horse chestnut seed extract
for other health problems. Horse chestnut seed extract should be avoided
by pregnant or breast-feeding women and by children, and it should be used
cautiously by patients taking anticoagulants or drugs that affect blood sugar
levels. Horse chestnut seed extract should be used only at recommended doses
for up to 12 weeks. Consult your health care provider immediately if you
experience side effects.
The information in this monograph was prepared by the professional staff
at Natural Standard, based on thorough systematic review of scientific evidence.
The material was reviewed by the Faculty of the Harvard Medical School with
final editing approved by Natural Standard.
Standard: An organization that produces scientifically based reviews
of complementary and alternative medicine (CAM) topics
for Complementary and Alternative Medicine (NCCAM): A division of the
U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Horse Chestnut Seed Extract
Natural Standard reviewed more than 215 articles to prepare the professional
monograph from which this version was created.
Some of the more recent studies are listed below:
Diehm C, Trampisch HJ, Lange S, et al. Comparison of leg compression stocking
and oral horse-chestnut seed extract therapy in patients with chronic venous
insufficiency. Lancet 1996;347(8997):292-294.
Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous
insufficiency. Cochrane Database Syst Rev 2004;(2):CD003230.
Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous
insufficiency: a criteria-based systematic review. Arch Dermatol
Popp W, Horak F, Jager S, et al. Horse chestnut (Aesculus hippocastanum)
pollen: a frequent cause of allergic sensitization in urban children. Allergy
1992;Aug, 47(4 Pt 2):380-383.
Siebert U, Brach M, Sroczynski G, Berla K. Efficacy, routine effectiveness,
and safety of horse chestnut seed extract in the treatment of chronic venous
insufficiency: a meta-analysis of randomized controlled trials and large
observational studies. Int Angiol 2002;Dec, 21(4):305-315.
Simini B. Horse-chestnut seed extract for chronic venous insufficiency. Lancet
Vayssairat M, Debure C, Maurel A, et al. Horse-chestnut seed extract for
chronic venous insufficiency. Lancet 1996;347(9009):1182.
Last updated June 14, 2005