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Overview: Butterbur is a plant called Petasites hybridus. Butterbur dietary supplements may be made from the plant’s roots or leaves and are usually taken by mouth. Butterbur is taken for migraine prevention and seasonal allergies, although safety concerns limit its use. Common side effects may include digestive problems, headache, and tiredness. Before taking butterbur, make sure to tell your health care provider about any health conditions you have or medicines you are taking.

Uses

What is butterbur used for?

Butterbur (Petasites hybridus) is commonly used for migraine prevention. Butterbur has also been used for seasonal allergies, also called hay fever or allergic rhinitis. There is some evidence that butterbur can help with these. However, most experts no longer recommend butterbur because of serious safety concerns.

People may also take butterbur for the following reasons, but there is not enough evidence to know if it offers benefits for these uses.

  • Asthma or bronchitis
  • Spasms of the stomach, bowel, or urinary tract
  • High blood pressure
  • Pain or fever
  • Menstrual cramps

Note: The FDA has not reviewed butterbur for safety and effectiveness. Learn more about dietary supplements here.

How does butterbur work (mechanism of action)?

Butterbur is a plant called Petasites hybridus. It also goes by many other names, such as butter dock. Butterbur supplements may be made from the root or leaf of the plant.

Butterbur contains natural plant compounds called petasins. Two of the main petasins are called petasin and isopetasin. These compounds are thought to be the active ingredients in butterbur.

Some research suggests that butterbur root extract may lower how often migraine attacks happen. To prevent migraines, petasins may affect pain and inflammation pathways involved in migraine attacks. They may reduce the release of a natural body chemical called calcitonin gene-related peptide (CGRP). CGRP is involved in migraine pain and swelling of blood vessels in the head.

Butterbur may also have anti-inflammatory effects. This means it may lower the activity of body chemicals that play a role in swelling. These effects may explain how butterbur can help with symptoms of allergic rhinitis.

Butterbur may also relax smooth muscle tissue, which is found in places such as the stomach, intestines, urinary tract, blood vessels, and airways. This may help explain why butterbur has been used for asthma, bronchitis, spasms, blood pressure, and cramps. Petasins may also affect certain pain-sensing parts of nerves. But these uses are not proven.

Herbal products like butterbur naturally contain many different chemicals, such as petasins. The amounts of each chemical in a specific butterbur product may vary. Some, none, or all of these chemicals may have effects on the body. These effects may change depending on how much of each chemical is found in the product you are using.

How should I store butterbur?

You should store butterbur according to the product label. Most dietary supplements should be kept in a cool, dry location that is out of the reach of children and pets and not in direct sunlight.

Side Effects

What are the most common side effects of butterbur?

The most common side effects of butterbur are listed below. These side effects may vary depending on the dose you are taking or the specific product you are using. Tell your health care provider if you have any of these side effects that bother you.

  • Belching or burping
  • Nausea
  • Upset stomach
  • Diarrhea
  • Headache
  • Tiredness

There may be other side effects of butterbur that are not listed here. Contact your health care provider if you think you are having a side effect of a supplement. In the U.S., you can report side effects to the FDA at www.safetyreporting.hhs.gov or by calling 888-SAFEFOOD (888-723-3366). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of butterbur?

While less common, the most serious side effects of butterbur are described below, along with what to do if they happen.

Severe Allergic Reactions. Butterbur may cause allergic reactions, which can be serious. Stop taking butterbur and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Liver Damage. Liver damage, also called hepatotoxicity, has been reported in people taking butterbur. Raw or poorly processed butterbur may contain harmful chemicals called pyrrolizidine alkaloids, which can damage the liver. Stop taking butterbur and call your health care provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Warnings & Precautions

Who should not use butterbur?

Allergies to Ingredients. People who are allergic to any of the following should not take butterbur.

  • Butterbur
  • Petasites
  • Petasites hybridus
  • Any of the ingredients in the specific product

Your pharmacist can tell you all of the ingredients in the specific butterbur products they stock.

What should I know about butterbur before using it?

Butterbur is a dietary supplement. It cannot be marketed to treat or cure a disease.

Keep butterbur out of the reach of children.

Butterbur is available in different forms, including capsules, tablets, teas, tinctures, powders, and extracts. Read and follow the directions on the specific product you are taking, or take it as recommended by your health care provider.

Raw or poorly processed butterbur products may contain harmful chemicals called pyrrolizidine alkaloids. These chemicals can damage the liver and may raise the risk of cancer. Only butterbur products that are labeled or certified as pyrrolizidine alkaloid-free (PA-free) should be considered. However, product quality may vary. Some cases of liver damage involved butterbur products that were processed to remove these harmful chemicals.

The FDA has not tested butterbur products to confirm that they contain the ingredients stated on their labels. Some dietary supplements have been tested by third-party organizations to confirm that they contain the ingredients listed on their labels and do not contain any harmful chemicals. Learn more about how to choose a safe dietary supplement product here.

Herbal products, such as butterbur, naturally contain many different chemicals. The amount of each chemical in a specific butterbur product can change for many reasons, including the area where the plant was grown, the weather during growth, the time of year it was harvested, and the way the plant was processed after it was harvested. If you switch to a new bottle or a different brand, you may not have the same effects or side effects because of this variability. Contact your health care provider if you have questions or concerns.

What should I tell my health care provider before using butterbur?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. Also, tell them if you have an upcoming surgery planned. Sharing this information will help your health care provider know if this or other supplements are right for you.

In particular, make sure that you discuss any of the following.

Allergies to Related Plants. People who are allergic to plants in the daisy family may also react to butterbur. Examples of other plants in this family include daisies, ragweed, chrysanthemums, and marigolds. Talk to your health care provider if you have known allergies to any of these plants before taking butterbur.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Liver problems
  • Kidney problems

Pregnancy. It is not known if or how butterbur could affect pregnancy or harm a fetus. Butterbur is generally not recommended during pregnancy unless your health care provider says it is OK. Some butterbur products may also contain harmful chemicals. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. It is not known if butterbur passes into breast milk or how it could affect a breastfed baby. Butterbur is generally not recommended while breastfeeding unless your health care provider says it is OK. Some butterbur products may also contain harmful chemicals. Tell your health care provider if you are breastfeeding or plan to breastfeed.

Interactions

Does butterbur interact with foods or drinks?

There are no known interactions between butterbur and foods or drinks.

It is unknown if drinking alcohol will affect butterbur. The risk of liver damage may increase if you drink alcohol while taking butterbur.

Does butterbur interact with medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

The interactions between butterbur and medicines are not fully understood. As with most dietary supplements, the research on drug interactions with butterbur is incomplete. Always check with your health care provider before taking butterbur with any medicines.

Overdose/Missed Dose

What should I do if I accidentally use too much butterbur?

If you or someone else has used too much butterbur, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

Butterbur is available as an over-the-counter dietary supplement in the form of capsules and tablets. Speak to a health care provider about how to use butterbur safely. Do not take double or extra doses, even if you miss a dose.