Ben Muir

S3322648

Phytotherapy in the osteopathic

setting

Oenothora biennis/Evening
Primrose oil
Family
Onagraceae
Parts used
Seed

Active constituents
The seeds contain essential fatty acids omega-6, linoleic acid and gamolinoleic
acid(GLA) (5).

Relevant actions
Anti-inflammatory, anti-allergic, omega-6 supplementation (1)

Relevant indications

Rheumatoid arthritis (14)

Diabetic neuropathy

Fatty acid supplement

Eczema (11)

It has other uses for menopausal symptoms and premenstrual symptoms

Mechanisms of action
Anti-inflammatory: GLA has been shown to increase the uptake of dihomo-GLA
(DGLA) into cell membranes, this inhibits the uptake of arachodonic acid
metabolites, promoting anti-inflammatory actions (5). A metabolite of DGLA is
prostaglandin E1, which has been shown to decrease inflammation, reduce blood
pressure through vasodilation, and inhibit platelet aggregation (12,15,16).

Herb-drug interactions, cautions, adverse events, toxicity

Limited data suggest interaction with anticoagulant and antiplatelet drugs. It can
inhibit platelet aggregation through increasing prostaglandin E1, which has
antiplatelet properties and is formed from gamma-linoleic (13).

Dosage (and extraction ratio)

1300-600mg per day

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4500-600 mg GLA

5.2 to 6.3 per day of EPO (1)

Specify whether topical or internal administration

Topical cream for eczema sufferers

Used in soaps and cosmetics

The root is also ingestible as a vegetable

Evidence
Vasiljevic D, Veselinovic M, Jovanovic M, Jeremic N, Arsic A, Vucic V, et
al. Evaluation of the effects of different supplementation on oxidative
status in patients with rheumatoid arthritis. Clinical rheumatology.
2016;35(8):1909-15.
A prospective, randomized control trial with 60 postmenopausal women with
rheumatoid arthritis participated over a three-month period. The investigation
was based on omega-3 cardio capsules (containing 1000mg of concentrated fish
oil, 300mg DHA, 200mg EPA, 100mg of other omega-3 fatty acids) in
combination with two gel capsules of evening primrose oil (containing 1300mg
evening primrose oil, 949mg linoleic acid and 117mg of gamma linoleic acidGLA) with regular rheumatoid therapy; compared with a high concentration fish
oil only group and a placebo group, measuring the effect on oxidative stress
biomarkers in patients with rheumatoid arthritis. It was found that group three
containing the evening primrose and cardio-3 capsules had significant effects on
reduction in oxidative stress biomarkers (thiobarbituric acid-reactive substances
-TBARS, No2 {nitric oxide}) and reduced plasma levels of H 2O2 in comparison with
the fish oil only and placebo groups. The conclusions suggest that due to
evening primrose oil having an effect on prostaglandin E1 via GLA, with its
proposed anti-inflammatory effect, it can help maintain the balance between free
radicals and antioxidants in rheumatoid arthritis. The P-value of p<0.05 was
considered statistically significant. There were no adverse events or safety issues
acknowledged within the study.
Bamford JT, Ray S, Musekiwa A, van Gool C, Humphreys R, Ernst E. Oral
evening primrose oil and borage oil for eczema. Cochrane Database
Syst Rev. 2013(4).
A Cochrane review of RCT, parallel and cross-over trials were selected, with 27
studies (1596 participants) meeting the criteria, of which there were 19 studies
assessing evening primrose oil. Data was collected from studies dating back to
1946. Intervention varied from 3 weeks to 24 weeks. There were several
placebos used such as paraffin, sunflower oil and olive oil. The dosage used in
the interventions were varied across all studies; consistencies were 500mg of
EPO that ranged from 2-12 capsules twice daily. The intervention was found to
have global improvement across 24 studies. Of the 19 looking at the effect of
EPO versus placebo for the treatment of eczema, nine of the studies using
patient-centered VAS scores concluded that EPO did not significantly improve
eczema symptoms against placebo. Physician-reported results also showed that
EPO failed to significantly reduce symptoms against placebo. The P-value of the
studies was p<0.05. The study identified adverse events as being headaches,

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gastrointestinal reactions such as abdominal pain, nausea, diarrhea, most of
these were mild in presentation.

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References:
Bone, Kerry. In: Mills S, editor. Principles and Practice of Phytotherapy
(Second Edition). Saint Louis: Churchill Livingstone; 2013.
MacKay D. Hemorrhoids and varicose veins: a review of treatment
options. Alternative medicine review: a journal of clinical therapeutic.
2001;6(2):126-40.
European Medicines Agency: EMEA/HMPC/261939/2007- Assessment
report on Ruscus Aculeatus L., Rhizoma. report of the European Medicines
Agency
2008.
http://www.ema.europa.eu/docs/en_GB/document_library/Herbal__HMPC_assessment_report/2009/12/WC500018288.pdf, September 2016
Vanscheidt W, Jost V, Wolna P, Lucker PW, Muller A, Theurer C, et al.
Efficacy and safety of a Butcher's broom preparation (Ruscus aculeatus L.
extract) compared to placebo in patients suffering from chronic venous
insufficiency. Arzneimittel-Forschung. 2002;52(4):243-50.
Braun L, Cohen M. Herbs & Natural Supplements: An Evidence-based
Guide: Elsevier Australia; 2010.
Hoffmann D. Medical Herbalism: The Science and Practice of Herbal
Medicine: Inner Traditions/Bear; 2003.
Sirtori CR. Aescin: pharmacology, pharmacokinetics and therapeutic
profile. Pharmacological research. 2001;44(3):183-93.
Dudek-Makuch M, Studziska-Sroka E. Horse chestnut efficacy and
safety in chronic venous insufficiency: an overview. Revista Brasileira de
Farmacognosia. 2015;25(5):533-41
Guillaume M, Padioleau F. Veinotonic effect, vascular protection,
antiinflammatory and free radical scavenging properties of horse chestnut
extract. Arzneimittel-Forschung. 1994;44(1):25-35.
Xin W, Zhang L, Sun F, Jiang N, Fan H, Wang T, et al. Escin exerts
synergistic anti-inflammatory effects with low doses of glucocorticoids in
vivo and in vitro. Phytomedicine : international journal of phytotherapy
and phytopharmacology. 2011;18(4):272-7.
Bamford JT, Ray S, Musekiwa A, van Gool C, Humphreys R, Ernst E. Oral
evening primrose oil and borage oil for eczema. Cochrane Database Syst
Rev. 2013(4).
Horrobin DF. Omega-6 essential fatty acids: pathophysiology and roles in
clinical medicine: Wiley-Liss; 1990.
Stonemetz D. A review of the clinical efficacy of evening primrose. Holistic
nursing practice. 2008;22(3):171-4
Vasiljevic D, Veselinovic M, Jovanovic M, Jeremic N, Arsic A, Vucic V, et al.
Evaluation of the effects of different supplementation on oxidative status

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15.

16.

17.

in
patients
with
rheumatoid
arthritis.
Clinical
rheumatology.
2016;35(8):1909-15.
Guivernau M, Meza N, Barja P, Roman O. Clinical and experimental study
on the long-term effect of dietary gamma-linolenic acid on plasma lipids,
platelet
aggregation,thromboxane
formation,
and
prostacyclin
production.Prostaglandins Leukot EssentFatty Acids(1994) 51, 31116.
De La, Cruz JP, Martn-Romero M, Carmona JA, Villalobos MA, Snchez de
la CuestaF. Effect of evening primrose oil on platelet aggregation in
rabbits fed an a therogenicdiet.Thromb Res(1997) 87, 1419.
Porto, C. L. L., Milhomens, A. L. M., Pires, C. E., Xavier, S. S., Sicuro, F.,
Bottino, D. A., & Bouskela, E. (2009). Changes on venous diameter and leg
perimeter with different clinical treatments for moderate chronic venous
disease: Evaluation using duplex scanning and perimeter measurements.
International Angiology, 28(3), 222-31.