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Overview InformationWillow bark is the bark from several varieties of the willow tree, including white willow or European willow, black willow or pussy willow, crack willow, purple willow, and others. The bark is used to make medicine.
Willow bark acts a lot like aspirin. It's most commonly used for pain and fever. But there is no good scientific evidence to show that it works as well as aspirin for these conditions.
Coronavirus disease 2019 (COVID-19): Some experts warn that willow bark may interfere with the body's response against COVID-19. There is no strong data to support this warning. But there is also no good data to support using willow bark for COVID-19.
How does it work?Willow bark contains a chemical called salicin that is similar to aspirin.
Uses & Effectiveness
Possibly Effective for
- Back pain. Willow bark seems to reduce lower back pain. Higher doses seem to be more effective than lower doses. It can take up to a week for significant improvement.
Insufficient Evidence for
- Joint pain. Research shows that taking a specific product containing white willow bark extract and other ingredients for 8 weeks reduces joint pain. But taking this product doesn't seem to help joint stiffness or function.
- Obesity. Early research suggests that taking willow bark in combination with ephedra and cola nut might cause slight weight loss in overweight and obese people. But it is not wise to use this combination because of safety concerns about ephedra. Ephedra has been banned in the United States due to severe harmful side effects.
- Osteoarthritis. Research on willow bark extract for osteoarthritis has produced conflicting results. Some research shows it can reduce osteoarthritis pain. In fact, there is some evidence suggesting that willow bark extract works as well as conventional medications for osteoarthritis. But other research shows no benefit.
- Rheumatoid arthritis (RA). Early research suggests that willow bark extract is not effective for RA.
- A type of arthritis that mainly affects the spine (ankylosing spondylitis).
- Common cold.
- Flu (influenza).
- Menstrual cramps (dysmenorrhea).
- Muscle pain.
- Swine flu.
- Other conditions.
Side Effects & SafetyWhen taken by mouth: Willow bark is POSSIBLY SAFE for most adults when taken for up to 12 weeks. It may cause headaches, stomach upset, and digestive system upset. It can also cause itching, rash, and allergic reactions, particularly in people allergic to aspirin.
Special Precautions & Warnings:Pregnancy: There isn't enough reliable information to know if willow bark is safe to use when pregnant. Stay on the safe side and avoid use.
Breast-feeding: Using willow bark while breast-feeding is POSSIBLY UNSAFE. Willow bark contains chemicals that can enter breast milk and have harmful effects on the nursing infant. Don't use it if you are breast-feeding.
Children: Willow bark is POSSIBLY UNSAFE n children when taken by mouth for viral infections such as colds and flu. There is some concern that, like aspirin, it might increase the risk of developing Reye's syndrome. Stay on the safe side and don't use willow bark in children.
Bleeding disorders: Willow bark might increase the risk of bleeding in people with bleeding disorders.
Kidney disease: Willow bark might reduce blood flow through the kidneys. This might lead to kidney failure in some people. If you have kidney disease, don't use willow bark.
Sensitivity to aspirin: People with ASTHMA, STOMACH ULCERS, DIABETES, GOUT, HEMOPHILIA, HYPOPROTHROMBINEMIA, or KIDNEY or LIVER DISEASE might be sensitive to aspirin and also willow bark. Using willow bark might cause serious allergic reactions. Avoid use.
Surgery: Willow bark might slow blood clotting. There is a concern it could cause extra bleeding during and after surgery. Stop using willow bark at least 2 weeks before a scheduled surgery.
Do not take this combination
Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) interacts with WILLOW BARK
Willow bark might slow blood clotting. Taking willow bark along with medications that also slow clotting might increase the chances of bruising and bleeding.
Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.
Be cautious with this combination
Aspirin interacts with WILLOW BARK
Willow bark contains chemicals similar to aspirin. Taking willow bark along with aspirin might increase the effects and side effects of aspirin.
Choline Magnesium Trisalicylate (Trilisate) interacts with WILLOW BARK
Willow bark contains chemicals that are similar to choline magnesium trisalicylate (Trilisate). Taking willow bark along with choline magnesium trisalicylate (Trilisate) might increase the effects and side effects of choline magnesium trisalicylate (Trilisate).
Salsalate (Disalcid) interacts with WILLOW BARK
Salsalate (Disalcid) is called a salicylate. It's similar to aspirin. Willow bark also contains a salicylate similar to aspirin. Taking salsalate (Disalcid) along with willow bark might increase the effects and side effects of salsalate (Disalcid).
The following doses have been studied in scientific research:
- For back pain: Willow bark extract providing 120-240 mg salicin has been used. The higher 240 mg dose might be more effective.
- Akao, T., Yoshino, T., Kobashi, K., and Hattori, M. Evaluation of salicin as an antipyretic prodrug that does not cause gastric injury. Planta Med 2002;68(8):714-718. View abstract.
- Black A, Künzel O, Chrubasik S, and et al. Economics of using willow bark extract in outpatient treatment of low back pain [abstract]. 8th Annual Symposium on Complementary Health Care, 6th-8th December 2001 2001.
- Cameron, M., Gagnier, J. J., Little, C. V., Parsons, T. J., Blumle, A., and Chrubasik, S. Evidence of effectiveness of herbal medicinal products in the treatment of arthritis. Part I: Osteoarthritis. Phytother.Res 2009;23(11):1497-1515. View abstract.
- Chrubasik, J. E., Roufogalis, B. D., and Chrubasik, S. Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytother Res 2007;21(7):675-683. View abstract.
- Chrubasik, S., Kunzel, O., Black, A., Conradt, C., and Kerschbaumer, F. Potential economic impact of using a proprietary willow bark extract in outpatient treatment of low back pain: an open non-randomized study. Phytomedicine 2001;8(4):241-251. View abstract.
- Clauson, K. A., Santamarina, M. L., Buettner, C. M., and Cauffield, J. S. Evaluation of presence of aspirin-related warnings with willow bark. Ann Pharmacother. 2005;39(7-8):1234-1237. View abstract.
- Dabrowska-Zamojcin EI, Glinko A, Samochowiec L, and et al. Willow bark extract and aspirin, their potential for gastric injury in mice and other toxicity aspects. 8th Annual Symposium on Complementary Health Care, 6th-8th December 2001 2001.
- Ernst, E. and Chrubasik, S. Phyto-anti-inflammatories. A systematic review of randomized, placebo-controlled, double-blind trials. Rheum.Dis Clin North Am 2000;26(1):13-27, vii. View abstract.
- Gagnier JJ, VanTulder MW, Berman B, and et al. Botanical medicine for low back pain: a systematic review [abstract]. 9th Annual Symposium on Complementary Health Care, December 4th-6th, Exter, UK 2002.
- Gagnier, J. J., van Tulder, M., Berman, B., and Bombardier, C. Herbal medicine for low back pain. Cochrane.Database.Syst.Rev. 2006;(2):CD004504. View abstract.
- Hyson MI. Anticephalgic photoprotective premedicated mask. A report of a successful double-blind placebo-controlled study of a new treatment for headaches with associated frontalis pain and photophobia. Headache 1998;38:475-477.
- Kammerer, B., Kahlich, R., Biegert, C., Gleiter, C. H., and Heide, L. HPLC-MS/MS analysis of willow bark extracts contained in pharmaceutical preparations. Phytochem Anal. 2005;16(6):470-478. View abstract.
- Khayyal, M. T., El Ghazaly, M. A., Abdallah, D. M., Okpanyi, S. N., Kelber, O., and Weiser, D. Mechanisms involved in the anti-inflammatory effect of a standardized willow bark extract. Arzneimittelforschung 2005;55(11):677-687. View abstract.
- Levesque, H. and Lafont, O. [Aspirin throughout the ages: a historical review]. Rev Med Interne 2000;21 Suppl 1:8s-17s. View abstract.
- Little CV, Parsons T, and Logan S. Herbal therapy for treating osteoarthritis. The Cochrane Library 2002;1.
- Loniewski I, Glinko A, and Samochowiec L. Standardised willow bark extract: a potent anti-inflammatory drug . 8th Annual Symposium on Complementary Health Care, 6th-8th December 2001 2001.
- Marson, P. and Pasero, G. [The Italian contributions to the history of salicylates]. Reumatismo. 2006;58(1):66-75. View abstract.
- Meier B, Shao Y, Julkunen-Tiitto R, and et al. A chemotaxonomic survey of phenolic compounds in Swiss willow species. Planta Medica 1992;58(suppl 1):A698.
- Schaffner W. Eidenrinde-ein antiarrheumatikum der modernen Phytotherapie? 1997;125-127.
- Steinegger, E. and Hovel, H. [Analytic and biologic studies on Salicaceae substances, expecially on salicin. II. Biological study]. Pharm Acta Helv. 1972;47(3):222-234. View abstract.
- Sweeney, K. R., Chapron, D. J., Brandt, J. L., Gomolin, I. H., Feig, P. U., and Kramer, P. A. Toxic interaction between acetazolamide and salicylate: case reports and a pharmacokinetic explanation. Clin Pharmacol Ther 1986;40(5):518-524. View abstract.
- Vane, J. R. The fight against rheumatism: from willow bark to COX-1 sparing drugs. J Physiol Pharmacol 2000;51(4 Pt 1):573-586. View abstract.
- Werner G, Marz RW, and Schremmer D. Assalix for chronic lower back pain and arthralgia: interim analysis of a post marketing surveillance study. 8th Annual Symposium on Complementary Health Care, 6th - 8th December 2001 2001.
Kenstaviciene P, Nenortiene P, Kiliuviene G, Zevzikovas A, Lukosius A, Kazlauskiene D. Application of high-performance liquid chromatography for research of salicin in bark of different varieties of Salix. Medicina (Kaunas). 2009;45(8):644-51.View abstract.
Little CV, Parsons T. Herbal therapy for treating osteoarthritis. Cochrane Database Syst Rev. 2001;(1):CD002947.View abstract.
Moro PA, Flacco V, Cassetti F, Clementi V, Colombo ML, Chiesa GM, Menniti-Ippolito F, Raschetti R, Santuccio C. Hypovolemic shock due to severe gastrointestinal bleeding in a child taking an herbal syrup. Ann Ist Super Sanita. 2011;47(3):278-83.View abstract.
Nahrstedt A, Schmidt M, Jäggi R, Metz J, Khayyal MT. Willow bark extract: the contribution of polyphenols to the overall effect. Wien Med Wochenschr. 2007;157(13-14):348-51.View abstract.
Vlachojannis JE, Cameron M, Chrubasik S. A systematic review on the effectiveness of willow bark for musculoskeletal pain. Phytother Res. 2009 Jul;23(7):897-900.View abstract.
- Andreev E, Koopman M, Arisz L. A rise in plasma creatinine that is not a sign of renal failure: which drugs can be responsible? J Intern Med 1999;246:247-52. View abstract.
- Beer AM, Wegener T. Willow bark extract (Salicis cortex) for gonarthrosis and coxarthrosis--results of a cohort study with a control group. Phytomedicine. 2008 Nov;15(11):907-13. View abstract.
- Biegert C, Wagner I, Ludtke R, et al. Efficacy and safety of willow bark extract in the treatment of osteoarthritis and rheumatoid arthritis: results of 2 randomized double-blind controlled trials. J Rheumatol 2004;31:2121-30. View abstract.
- Boullata JI, McDonnell PJ, Oliva CD. Anaphylactic reaction to a dietary supplement containing willow bark. Ann Pharmacother 2003;37:832-5.. View abstract.
- Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. Am J Med 2000;109:9-14. View abstract.
- Chrubasik S, Künzel O, Model A, and et al. Assalix® vs. Vioxx® for low back pain - a randomised open controlled study. 8th Annual Symposium on Complementary Health Care, 6th - 8th December 2001 2001.
- Chrubasik S, Kunzel O, Model A, et al. Treatment of low back pain with a herbal or synthetic anti-rheumatic: a randomized controlled study. Willow bark extract for low back pain. Rheumatology (Oxford) 2001;40:1388-93. View abstract.
- Clark JH, Wilson WG. A 16-day-old breast-fed infant with metabolic acidosis caused by salicylate. Clin Pediatr (Phila) 1981;20:53-4. View abstract.
- Coffey CS, Steiner D, Baker BA, Allison DB. A randomized double-blind placebo-controlled clinical trial of a product containing ephedrine, caffeine, and other ingredients from herbal sources for treatment of overweight and obesity in the absence of lifestyle treatment. Int J Obes Relat Metab Disord 2004;28:1411-9. View abstract.
- D'Agati V. Does aspirin cause acute or chronic renal failure in experimental animals and in humans? Am J Kidney Dis 1996;28:S24-9. View abstract.
- Dulloo AG, Miller DS. Ephedrine, caffeine and aspirin: "over-the-counter" drugs that interact to stimulate thermogenesis in the obese. Nutrition 1989;5:7-9.
- Dulloo AG, Miller DS. Aspirin as a promoter of ephedrine-induced thermogenesis: potential use in the treatment of obesity. Am J Clin Nutr 1987;45:564-9. View abstract.
- Fiebich BL, Appel K. Anti-inflammatory effects of willow bark extract. Clin Pharmacol Ther 2003;74:96. View abstract.
- Fiebich BL, Chrubasik S. Effects of an ethanolic salix extract on the release of selected inflammatory mediators in vitro. Phytomedicine 2004;11:135-8. View abstract.
- Food and Drug Administration, HHS. Final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk; Final rule. Fed Regist 2004;69:6787-6854. View abstract.
- Food and Drug Administration, HHS. Labeling for oral and rectal over-the-counter drug products containing aspirin and nonaspirin salicylates; Reye's Syndrome warning. Final rule. Fed Regist 2003;68:18861-9. View abstract.
- Gagnier JJ, van Tulder MW, Berman B, Bombardier C. Herbal medicine for low back pain. A Cochrane review. Spine 2007;32:82-92. View abstract.
- Horton TJ, Geissler CA. Aspirin potentiates the effect of ephedrine on the thermogenic response to a meal in obese but not lean women. Int J Obes 1991;15:359-66. View abstract.
- Krivoy N, Pavlotzky E, Chrubasik S, et al. Effect of salicis cortex extract on human platelet aggregation. Planta Med 2001;67:209-12. View abstract.
- Mills SY, Jacoby RK, Chacksfield M, Willoughby M. Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study. Br J Rheumatol 1996;35:874-8. View abstract.
- Nieman DC, Shanely RA, Luo B, Dew D, Meaney MP, Sha W. A commercialized dietary supplement alleviates joint pain in community adults: a double-blind, placebo-controlled community trial. Nutr J 2013;12(1):154. View abstract.
- Schmid B, Kotter I, Heide L. Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. Eur J Clin Pharmacol. 2001;57:387-91. View abstract.
- Schmid B, Ludtke R, Selbmann HK, et al. Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized placebo-controlled, double blind clinical trial. Phytother Res 2001;15:344-50. View abstract.
- Schwarz A. Beethoven's renal disease based on his autopsy: a case of papillary necrosis. Am J Kidney Dis 1993;21:643-52. View abstract.
- Uehleke B, Müller J, Stange R, Kelber O, Melzer J. Willow bark extract STW 33-I in the long-term treatment of outpatients with rheumatic pain mainly osteoarthritis or back pain. Phytomedicine. 2013 Aug 15;20(11):980-4. View abstract.
- Unsworth J, d'Assis-Fonseca A, Beswick DT, Blake DR. Serum salicylate levels in a breast fed infant. Ann Rheum Dis 1987;46:638-9. View abstract.
- Wagner I, Greim C, Laufer S, et al. Influence of willow bark extract on cyclooxygenase activity and on tumor necrosis factor alpha or interleukin 1 beta release in vitro and ex vivo. Clin Pharmacol Ther 2003;73:272-4. View abstract.
- Wuthold K, Germann I, Roos G, et al. Thin-layer chromatography and multivariate data analysis of willow bark extracts. J Chromatogr Sci. 2004;42(6):306-9. View abstract.
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