Blatterdock, Bog Rhubarb, Bogshorns, Butter Bur, Butterburr, Butter-Dock, Butterfly Dock, Capdockin, Chapelière, Contre-Peste, Exwort, Flapperdock, Feuille de Pétasite, Fleur de Pétasite, Grand Bonnet, Herbe à la Peste, Herbe aux Teigneux, Japanese Butterbur, Japonica Petasites, Langwort, Pestwurz, Pétasite, Pétasite du Japon, Pétasite Hybride, Pétasite Japonaise, Pétasite Officinal, Pétasite Vulgaire, Petasites, Petasites hybridus, Petasites officinalis, Petasitidis Folium, Petasitidis Rhizoma, Petasitidis hybridus, Petasites Japonicus, Petasites Vulgaris, Plague Root, Purple Butterbur, Racine de Pétasite, Rhizome de Pétasite, Tussilago hybrida, Umbrella Leaves.


Overview Information

Butterbur is an herb. People use the leaf, root, and bulb to make medicine. Some butterbur preparations contain chemicals called pyrrolizidine alkaloids (PAs), which can damage the liver and cause other serious harm. Only butterbur products that are certified and labeled “PA-free” should be used.

Butterbur is used for pain, upset stomach, stomach ulcers, migraine and other headaches, ongoing cough, chills, anxiety, plague, fever, trouble sleeping (insomnia), whooping cough, asthma, hay fever (allergic rhinitis), and for irritable bladder and urinary tract spasms. Butterbur is also used to stimulate the appetite.

Some people apply butterbur to the skin to improve wound healing.

How does it work?

Butterbur contains chemicals that might relieve spasms and decrease swelling (inflammation).


Uses & Effectiveness?

Possibly Effective for

  • Preventing migraine headaches. Taking butterbur by mouth seems to prevent migraine headache. Using a specific extract from the butterbur root over 16 weeks can reduce the number and severity of migraine headaches and the length of time they last. This butterbur extract seems to reduce the number of migraine headaches by almost half. Doses of at least 75 mg twice daily seem to be necessary for best results. Lower doses of 50 mg twice daily may not be effective in adults. There is also some evidence that this butterbur extract can decrease the frequency of migraine headaches in children aged 6-17 years. The butterbur extract researchers used was standardized to 15% petasin and isopetasin (the active ingredients in butterbur) and was free of liver-damaging chemicals called pyrrolizidine alkaloids (PAs). It was made by Petadolex, Weber&Weber, GmbH & Co. of Germany.
  • Hay fever caused by grass pollen. Taking a specific butterbur leaf extract seems to decrease nose discomfort in people with hay fever. Some evidence also suggests that this extract might be as effective as 10 mg per day of cetirizine (Zyrtec) or 180 mg per day of fexofenadine (Allegra). The leaf extract used in the research was made by Tesalin, Ze 339, Zeller AG, was free of pyrrolizidine alkaloids (PAs), and was standardized to 8 mg total petasin, an active ingredient.
  • Mental illnesses that cause physical pain (somatoform disorders). A study found that taking a product containing butterbur, valerian root, lemon balm leaf, and passionflower reduces anxiety and depression in people with physical pain.

Possibly Ineffective for

  • Skin inflammation (dermatitis). Some research found that taking butterbur extract did not reduce skin inflammation caused by allergies.

Insufficient Evidence for

  • Pain.
  • Colic.
  • Cough.
  • Asthma.
  • Chronic bronchitis.
  • Irritable bladder.
  • Urinary tract spasms.
  • Wounds.
  • Other conditions.
More evidence is needed to rate the effectiveness of butterbur for these uses.

Side Effects

Side Effects & Safety

Some butterbur products may contain pyrrolizidine alkaloids (PAs), and that’s the major safety concern. PAs can damage the liver, lungs, and blood circulation, and possibly cause cancer. Butterbur products that contain pyrrolizidine alkaloids (PAs) are UNSAFE when taken by mouth or applied to broken skin. Broken skin allows chemicals to be absorbed into the body. Do not use butterbur products unless they are certified and labeled as free of PAs.

PA-free butterbur products are POSSIBLY SAFE for adults and children when taken by mouth appropriately. PA-free root extracts seem to be safe when used for up to 16 weeks in adults. There is some evidence that a specific PA-free butterbur extract (Petadolex, Weber&Weber, GmbH & Co, Germany) can be safely used in children who are 6-17 years old for up to 4 months.

Not enough is known about the safety of using PA-free butterbur products on unbroken skin. Don’t use it.

PA-free butterbur is generally well tolerated. It can cause belching, headache, itchy eyes, diarrhea, asthma, upset stomach, fatigue, and drowsiness. However, it seems to cause less drowsiness and fatigue than cetirizine (Zyrtec). Butterbur products might cause allergic reactions in people who are allergic to ragweed, marigolds, daisies, and other related herbs.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Taking butterbur by mouth is LIKELY UNSAFE. Butterbur preparations containing pyrrolizidine alkaloids (PAs) might cause birth defects and liver damage. Not enough is known about the safety of using butterbur products that do not contain PAs during pregnancy or breast-feeding. Don’t use it.

Allergy to ragweed and related plants: Butterbur may cause an allergic reaction in people who are sensitive to the Asteraceae/Compositae family. Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many others. If you have allergies, be sure to check with your healthcare provider before taking butterbur.

Liver disease: There is some concern that butterbur might make liver disease worse. Don’t take it.



Moderate Interaction

Be cautious with this combination

  • Medications that increase break down of other medications by the liver (Cytochrome P450 3A4 (CYP3A4) inducers) interacts with BUTTERBUR

    Butterbur is broken down by the liver. Some chemicals that form when the liver breaks down butterbur can be harmful. Medications that cause the liver to break down butterbur might enhance the toxic effects of chemicals contained in butterbur.

    Some of these medicines include carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin), rifampin, rifabutin (Mycobutin), and others.



The following doses have been studied in scientific research:


  • For preventing migraine headache: a specific butterbur rhizome extract (Petadolex, Weber&Weber, GmbH & Co, Germany) has been used in doses of 50 to 100 mg twice daily with meals. Higher doses seem to be work better. Lower doses of 50 mg twice daily may not be effective in adults. Some researchers suggest taking the extract for 4-6 months, then lowering the dose over time until the number of migraines begins to increase again. That dose would be the recommended one. In 6-9 year-old children with migraine, a dose of 25 mg twice daily has been used; 50 mg twice daily has been used in older children. Three times daily dosing has been used in children who don't respond to the twice daily dose.
  • For hay fever (allergic rhinitis): a specific butterbur extract (ZE 339, Zeller AG) one tablet 3-4 times daily has been used. A whole butterbur root extract (Petaforce) in a dose of 50 mg twice daily has also been used for hay fever.

View References


  • Holland S, Silberstein SD, Freitag F, et al. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 2012;78:1346-53. View abstract.
  • Jackson CM, Lee DK, and Lipworth BJ. The effects of butterbur on the histamine and allergen cutaneous response. Ann.Allergy Asthma Immunol. 2004;92:250-54. View abstract.
  • Kaufeler R, Polasek W, Brattstrom A, et al. Efficacy and safety of butterbur herbal extract Ze 339 in seasonal allergic rhinitis: postmarketing surveillance study. Adv.Ther 2006;23:373-84. View abstract.
  • Lee DK, Carstairs IJ, Haggart K, et al. Butterbur, a herbal remedy, attenuates adenosine monophosphate induced nasal responsiveness in seasonal allergic rhinitis. Clin Exp Allergy 2003;33:882-6.. View abstract.
  • Lee DK, Gray RD, Robb FM, et al. A placebo-controlled evaluation of butterbur and fexofenadine on objective and subjective outcomes in perennial allergic rhinitis. Clin Exp Allergy 2004;34:646-9. . View abstract.
  • Lee DK, Haggart K, Robb F M, and Lipworth BJ. Butterbur, a herbal remedy, confers complementary anti-inflammatory activity in asthmatic patients receiving inhaled corticosteroids. Clin.Exp.Allergy 2004;34:110-14. View abstract.
  • Lipton RB, Gobel H, Einhaupl KM, et al. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology 2004;63:2240-4. View abstract.
  • Mauz C, Candrian U, Luthy J, et al. [Method for the reduction of pyrrolizidine alkaloids from medicinal plant extracts]. Pharm Acta Helv 1985;60:256-9.
  • Melzer J, Schrader E, Brattström A, et al. Fixed herbal drug combination with and without butterbur (Ze 185) for the treatment of patients with somatoform disorders: randomized, placebo-controlled pharmaco-clinical trial. Phytother Res. 2009 Sep;23:1303-8. View abstract.
  • Oelkers-Ax R, Leins A, Parzer P, et al. Butterbur root extract and music therapy in the prevention of childhood migraine: an explorative study. Eur J Pain 2008;12:301-13. View abstract.
  • Ozarowski M, Przystanowicz J, Adamczak A. Phytochemical, pharmacological and clinical studies of Petasites hybridus (L.) P. Gaertn., B. Mey. & Scherb. A review. Herba Polonica. 2013;59(4):108-128.
  • Pothmann R, Danesch U. Migraine Prevention in Children and Adolescents: Results of an Open Study With a Special Butterbur Root Extract. Headache 2005;45:196-203.. View abstract.
  • Pringsheim T, Davenport W, Mackie G, et al. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol.Sci 2012;39:S1-59. View abstract.
  • Roeder E. Medicinal plants in Europe containing pyrrolizidine alkaloids. Pharmazie 1995;50:83-98.
  • Schapowal A, Study Group. Treating intermittent allergic rhinitis: a prospective, randomized, placebo and antihistamine-controlled study of Butterbur extract Ze 339. Phytother Res 2005;19:530-37. View abstract.
  • Schapowal A. Petasites Study Group. Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ 2002;324:144-6. View abstract.
  • Schapowal A. Butterbur Ze339 for the treatment of intermittent allergic rhinitis: dose-dependent efficacy in a prospective, randomized, double-blind, placebo-controlled study. Arch Otolaryngol.Head Neck Surg. 2004;130:1381-86. View abstract.
  • Scheidegger C, Dahinden C, Wiesmann U. Effects of extracts and of individual components from Petasites on prostaglandin synthesis in cultured skin fibroblasts and on leucotriene synthesis in isolated human peripheral leucocytes. Pharm Acta Helv 1998;72:376-8. View abstract.
  • Thomet OA, Schapowal A, Heinisch IV, et al. Anti-inflammatory activity of an extract of Petasites hybridus in allergic rhinitis. Int Immunopharmacol 2002;2:997-1006.. View abstract.
  • Wang YP, Yan J, Fu PP, Chou MW. Human liver microsomal reduction of pyrrolizidine alkaloid N-oxides to form the corresponding carcinogenic parent alkaloid. Toxicol Lett 2005;155:411-20. View abstract.
  • WHO working group. Pyrrolizidine alkaloids. Environmental Health Criteria, 80. WHO: Geneva, 1988.
  • Ziolo G, Samochowiec L. Study on clinical properties and mechanisms of action of Petasites in bronchial asthma and chronic obstructive bronchitis. Pharm Acta Helv 1998;72:378-80. View abstract.
  • Agosti, R., Duke, R. K., Chrubasik, J. E., and Chrubasik, S. Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review. Phytomedicine. 2006;13(9-10):743-746. View abstract.
  • Aydin, A. A., Zerbes, V., Parlar, H., and Letzel, T. The medical plant butterbur (Petasites): analytical and physiological (re)view. J Pharm Biomed.Anal. 3-5-2013;75:220-229. View abstract.
  • Bickel, D., Roder, T., Bestmann, H. J., and Brune, K. Identification and characterization of inhibitors of peptido-leukotriene-synthesis from Petasites hybridus. Planta Med. 1994;60(4):318-322. View abstract.
  • Brune, K., Bickel, D., and Peskar, B. A. Gastro-protective effects by extracts of Petasites hybridus: the role of inhibition of peptido-leukotriene synthesis. Planta Med. 1993;59(6):494-496. View abstract.
  • Debrunner, B. and Meier, B. Petasites hybridus: a tool for interdisciplinary research in phytotherapy. Pharm.Acta Helv. 1998;72(6):359-362. View abstract.
  • Degenring FH and Bommer S. Prevention de la migraine par Petadolor H (Petaforce
  • Diener, H. C. [Migraine prevention with Petasites]. Med Monatsschr.Pharm 2006;29(1):40. View abstract.
  • Evans, R. W. and Taylor, F. R. "Natural" or alternative medications for migraine prevention. Headache 2006;46(6):1012-1018. View abstract.
  • Evers, S. Treatment of migraine with prophylactic drugs. Expert.Opin.Pharmacother. 2008;9(15):2565-2573. View abstract.
  • Evers, S., Afra, J., Frese, A., Goadsby, P. J., Linde, M., May, A., and Sandor, P. S. EFNS guideline on the drug treatment of migraine - report of an EFNS task force. Eur J Neurol. 2006;13(6):560-572. View abstract.
  • Evers, S., Afra, J., Frese, A., Goadsby, P. J., Linde, M., May, A., and Sandor, P. S. EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force. Eur J Neurol. 2009;16(9):968-981. View abstract.
  • Fiebich, B. L., Grozdeva, M., Hess, S., Hull, M., Danesch, U., Bodensieck, A., and Bauer, R. Petasites hybridus extracts in vitro inhibit COX-2 and PGE2 release by direct interaction with the enzyme and by preventing p42/44 MAP kinase activation in rat primary microglial cells. Planta Med 2005;71(1):12-19. View abstract.
  • Grossman, W. and Schmidramsl, H. An extract of Petasites hybridus is effective in the prophylaxis of migraine. Altern.Med.Rev. 2001;6(3):303-310. View abstract.
  • Guo, R., Pittler, M. H., and Ernst, E. Herbal medicines for the treatment of allergic rhinitis: a systematic review. Ann Allergy Asthma Immunol. 2007;99(6):483-495. View abstract.
  • Lee, J. S., Yang, E. J., Yun, C. Y., Kim, D. H., and Kim, I. S. Suppressive effect of Petasites japonicus extract on ovalbumin-induced airway inflammation in an asthmatic mouse model. J Ethnopharmacol. 1-27-2011;133(2):551-557. View abstract.
  • Leimgruber, A. [Allergo-immunology]. Rev.Med Suisse 1-11-2006;2(48):89-92. View abstract.
  • Levin, M. Herbal treatment of headache. Headache 2012;52 Suppl 2:76-80. View abstract.
  • Lovell, B. V. and Marmura, M. J. New therapeutic developments in chronic migraine. Curr Opin.Neurol. 2010;23(3):254-258. View abstract.
  • Man, L. X. Complementary and alternative medicine for allergic rhinitis. Curr Opin.Otolaryngol.Head Neck Surg. 2009;17(3):226-231. View abstract.
  • Mauskop, A. Nonmedication, alternative, and complementary treatments for migraine. Continuum (Minneap.Minn.) 2012;18(4):796-806. View abstract.
  • Moyad, M. A. Conventional, complementary, and alternative options for seasonal allergies. Urol.Nurs. 2008;28(3):227-228. View abstract.
  • Ross, S. M. Clinical applications of integrative therapies for prevention and treatment of migraine headaches. Holist.Nurs.Pract. 2011;25(1):49-52. View abstract.
  • Sadler, C., Vanderjagt, L., and Vohra, S. Complementary, holistic, and integrative medicine: butterbur. Pediatr.Rev. 2007;28(6):235-238. View abstract.
  • Schiapparelli, P., Allais, G., Castagnoli, Gabellari, I, Rolando, S., Terzi, M. G., and Benedetto, C. Non-pharmacological approach to migraine prophylaxis: part II. Neurol.Sci. 2010;31 Suppl 1:S137-S139. View abstract.
  • Shukla, R. and Sinh, M. Migraine: prophylactic treatment. J Assoc.Physicians India 2010;58 Suppl:26-29. View abstract.
  • Sun-Edelstein, C. and Mauskop, A. Alternative headache treatments: nutraceuticals, behavioral and physical treatments. Headache 2011;51(3):469-483. View abstract.
  • Sun-Edelstein, C. and Mauskop, A. Foods and supplements in the management of migraine headaches. Clin J Pain 2009;25(5):446-452. View abstract.
  • Sutherland, A. and Sweet, B. V. Butterbur: an alternative therapy for migraine prevention. Am J Health Syst.Pharm 5-1-2010;67(9):705-711. View abstract.
  • Taylor, F. R. Nutraceuticals and headache: the biological basis. Headache 2011;51(3):484-501. View abstract.
  • Tepper, S. J. Complementary and alternative treatments for childhood headaches. Curr Pain Headache Rep. 2008;12(5):379-383. View abstract.
  • Anderson N, Meier T, and Borlak J. Toxicogenomics applied to cultures of human hepatocytes enabled an identification of novel petasites hybridus extracts for the treatment of migraine with improved hepatobiliary safety. Toxicol.Sci 2009;112:507-20. View abstract.
  • Anon. Petasites hybridus. Altern Med Rev 2001;6:207-9. View abstract.
  • Chojkier M. Hepatic sinusoidal-obstruction syndrome: toxicity of pyrrolizidine alkaloids. J Hepatol 2003;39:437-46. View abstract.
  • Danesch U, Rittinghausen R. Safety of a patented special butterbur root extract for migraine prevention. Headache 2003;43:76-8.. View abstract.
  • Danesch UC. Petasites hybridus (Butterbur root) extract in the treatment of asthma--an open trial. Altern.Med.Rev. 2004;9:54-62. View abstract.
  • Diener HC, Rahlfs VW, Danesch U. The first placebo-controlled trial of a special butterbur root extract for the prevention of migraine: reanalysis of efficacy criteria. Eur Neurol 2004;51:89-97. View abstract.
  • Food and Drug Administration. FDA Advises Dietary Supplement Manufacturers to Remove Comfrey Products From the Market. July 6, 2001. Available at: http://www.cfsan.fda.gov/~dms/dspltr06.html.
  • Gex-Collet C, Imhof L, Brattstrom A, et al. The butterbur extract petasin has no effect on skin test reactivity induced by different stimuli: a randomized, double-blind crossover study using histamine, codeine, methacholine, and aeroallergen solutions. J Investig.Allergol.Clin Immunol. 2006;16:156-61. View abstract.
  • Gray RD, Haggart K, Lee DK, Cull S, Lipworth BJ. Effects of butterbur treatment in intermittent allergic rhinitis: a placebo-controlled evaluation. Ann Allergy Asthma Immunol 2004;93:56-60. View abstract.
  • Grossmann WM, Schmidramsl H. An extract of Petasites hybridus is effective in the prophylaxis of migraine. Int J Clin Pharmacol Ther 2000;38:430-5.

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CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

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