Published: 12 December 2013

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Harpagophytum and Valerian, a Pain in the Pancreas

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Prescriber Update 34(4): 48 - 49
December 2013

Healthcare professionals are reminded that herbal formulations, like conventional medicines, have both benefits and risks associated with use. Healthcare professionals are reminded to ask patients about their use of herbal and complementary medicines, and to report any adverse reactions to the Centre for Adverse Reactions Monitoring (CARM).

Acute pancreatitis has a variety of causes including alcohol abuse and gallstones, as well as medicines such as thiazide diuretics, azathioprine and corticosteroids.

A recently published case-control study determined that the risk of acute pancreatitis is also increased with the use of some plant extracts, in particular Harpagophytum procumbens (also known as 'devil's claw') and Valerian radix¹.

Harpagophytum procumbens has traditionally been used for its anti-inflammatory and analgesic properties in arthritis, gout and rheumatic disease². It has also been used to alleviate post-partum and menstrual pain, and used topically for sprains, ulcers and boils³.

Valerian radix is commonly used as a mild sedative and hypnotic for those who have difficulty in falling asleep and to support mental relaxation².

The exact mechanism of action of Harpagophytum procumbens is not fully understood. Valerian radix is reported to increase GABA concentrations, an inhibitory neurotransmitter, which decreases central nervous system activity.

Both plant extracts contain the secondary metabolites, iridoids. Iridoids increase the volume of bile secretion, which may increase the risk of gallstone formation and increase the risk of acute pancreatitis¹.

The hospital-based case-control study showed a significantly increased risk of acute pancreatitis associated with Harpagophytum procumbens (odds ratio 12.0, 95% confidence interval 1.9–74.3) and an increased risk associated with Valerian radix (10.3, 1.7–53.4), when adjusted for age, sex and all drugs¹.

As with conventional medicines, please report any adverse reactions associated with herbal or complementary medicines to CARM.

References

1. Douros A, Bronder E, Andersohn F, et al. 2013. Drug-induced acute pancreatitis: results from the hospital-based Berlin case-control surveillance study of 102 cases. Alimentary Pharmacology and Therapeutics 38: 825–834.
2. Barnes J, Anderson LA, Phillipson JD. 2007. Herbal Medicines (3rd Edition) London: Pharmaceutical Press.
3. Grant L, McBean DE, Fyfe L, et al. 2007. A review of the biological and potential therapeutic actions of Harpagophytum procumbens. Phytotherapy Research 21: 199–209.