Evening Primrose Oil - cms.herbalgram.org

1 OVERVIEWE vening Primrose is a plant native to North America, with itstherapeutic use stemming from American indigenous Primrose oil (EPO) from the plant s seeds has been thesubject of hundreds of scientific studies, which led to it becom-ing one of the most widely used botanical supplements is sold in over 30 countries as a dietary supplement, drug,or food. In 2000, Evening Primrose oil ranked 10th of all herbaldietary supplements in food, drug, and mass-market retailoutlets. Clinical studies have focused on its use in treating prob-lems associated with essential fatty acid (EFA) deficiency: eczema,premenstrual syndrome (PMS), inflam-mation, and diabetic peripheral neuropa-thy. EPO is relatively high in EFAs, par-ticularly gamma-linolenic acid (GLA) ofwhich it contains 7 10%.

2 PRIMARYUSES Atopic dermatitis Mastalgia, cyclical LactationOTHERPOTENTIALUSES Atopic dermatitis in infants Diabetic neuropathy Dry eyes associated with Sj gren ssyndrome Infant formula fortification Nutritional deficiencies (EFAs) Premenstrual syndrome symptoms Raynaud s disease Rheumatoid arthritis Seborrhoeic dermatitis (milk crust) Uremic skin symptomsPHARMACOLOGICALACTIONSI mproves EFA composition of plasma, erythrocyte, and plateletlipids and -tocopherol levels in non-diabetic persons and Type1 diabetic patients; increases total fat and EFA content of moth-er s milk; affects fatty acid composition of serum lipids and adi-pose tissue in men with low dihomo-gamma-linolenic acid(DGLA) levels; helps maintain normal cellular structures; servesas prostaglandin ANDADMINISTRATIONEPO is a long-term therapy, so immediate results should not beexpected.

3 A patient may need to use EPO regularly for up tofour months before a clinical response is observed. EPO appearsto be safe for long-term use of at least one : 4 6 capsules (500 mg) twice daily (40 mgGLA per capsule). CYCLICAL MASTALGIA: 6 capsules (500 mg) daily (40 mg GLAper capsule) for 4 6 months. DIABETIC NEUROPATHY: 8 12 capsules (500 mg) AID: 4 capsules (500 mg)twice daily, morning and ARTHRITIS:10 20 capsules(500 mg) SKIN SYMPTOMS:2 capsules(500 mg) twice daily (45 mg GLA percapsule).NOTE:EPO may be swallowed directly ormay be taken with milk, another liquid, orwith food. EPO taken with food may minimize any potential gastrointestinalside effects. Concurrent ingestion of theantioxidant vitamin E will protect EFAsfrom free radical damage and also preventcreation of counterproductive ingestion of a daily multiplevitamin may also provide nutritional cofac-tors ( , B6 and magnesium) required forEFA :Water-in-oil emulsioncontaining 20% EPO, twice daily, appliedtopically to affected area for at least Primrose OilOenothera biennisL.

4 [Fam. Onagraceae]Clinical OverviewEvening Primrose OilClinical Overview123 The ABC Clinical Guide to HerbsPhoto 2003 reports suggested that patients diagnosed with schizo-phrenia and/or those already receiving epileptogenic drugs suchas phenothiazines should consult a healthcare provider beforeusing EPO. However, a recently published analysis of clinical tri-als involving polyunsaturated fatty acids in the treatment ofschizophrenia did not indicate a clear therapeutic or adverse effectof EPO supplements on schizophrenic ANDLACTATION:There are no known LA, GLA, and DGLA are important components ofhuman breast milk, EPO presumably may be taken while nurs-ing. According to the World Health Organization (WHO), preg-nant or lactating women should get 5% of their total daily caloricintake from effects are rare at recommended dosages, and are report-ed by less than 2% of people using EPO for extended periods oftime.

5 Occasional adverse effects include headache, mild nausea,and abdominal bloating. Overdose symptoms include loose stoolsand abdominal may exacerbate temporal lobe epilepsy in schizophrenicpatients being treated with epileptogenic drugs such as phenoth-iazines (however, this effect has not been confirmed). Steroidsand nonsteroidal anti-inflammatory drugs may interfere withGLA metabolism, though this theoretical concern has not beenproven. Steroids have been reported to inhibit the D6D enzyme,whereby the metabolism of LA to GLA is inhibited. For patientstaking steroidal drugs, supplementation with a source of GLAsuch as EPO, borage oil, or black current oil may be 22 clinical studies on Evening Primrose with a total of 1,154participants, all but six demonstrated positive effects for indica-tions including PMS, dermatological conditions, diabetic neuropathy, and arthritis.

6 Seven double-blind, placebo-controlled(DB, PC) studies investigated the use of EPO in dermatologicalconditions, including uremic skin symptoms, chronic hand der-matitis, atopic dermatitis, chronic stable-plaque psoriasis, andpsoriatic arthritis (PsA). Treatment of PMS symptoms was thesubject of two DB, PC studies. Other DB, PC studies evaluatedthe effects of EPO in the treatment of cyclic mastalgia, diabeticneuropathy, rheumatoid arthritis, and menopausal hot also was evaluated for its effect on fat composition and thecontent of human milk as well as on the survival time of patientswith primary liver cancer. A recent study on pregnant, low-risk,nulliparous women measured pregnancy length and active-phaselabor outcomes. A meta-analysis of nine PC studies on atopiceczema correlated clinical improvement with a rise in plasmaEFAs.

7 Improvement in reported itching symptoms was highlysignificant (p< ) compared to placebo. EPO showed a pro-gressive effect, as well as a dose/response relationship in the 311patients evaluated in the nine Overview124 The ABC Clinical Guide to Herbs Patient Information Sheet125 The ABC Clinical Guide to HerbsEvening Primrose OilOenothera biennisL.[ ]OVERVIEWE vening Primrose is a plant native to North America, withits therapeutic use stemming from American indigenousmedicine. Evening Primrose oil (EPO) from the plant sseeds has been the subject of hundreds of scientific stud-ies, which has led to it becoming one of the most widelyprescribed botanical Primrose oil (EPO) is relative-ly high in essential fatty acids, whichplay a major role in its effectiveness.

8 In2000, Evening Primrose oil ranked10th of all herbal dietary supplementsin food, drug, and mass-marketretail dermatitis; painful breasts during menstruation; lactation; uremicskin symptoms; nutritional deficien-cies (essential fatty acids); atopic der-matitis in infants; seborrhoeic dermati-tis (milk crust); infant formula fortifi-cation; dry eyes associated withSj gren s syndrome; Raynaud s disease;PMS symptoms; diabetic neuropathy;rheumatoid :4 6 capsules (500 mg) twice daily[containing 40 mg GLA (gamma-linolenic acid) per capsule].BREAST PAIN RELATED TO MENSTRUAL CYCLE:6 capsules(500 mg) daily for four to six months [40 mg GLA percapsule].DIABETIC NEUROPATHY: 8 12 capsules (500 mg) AID:4 capsules (500 mg) twice ARTHRITIS:10 20 capsules (500 mg) SKIN SYMPTOMS:2 capsules (500 mg) twice daily[45 mg GLA per capsule].

9 NOTE:EPO may be swallowed directly or may be takenwith milk, another liquid, or with food. EPO taken withfood may minimize any potential gastrointestinal sideeffects. Concurrent ingestion of the antioxidant vitamin Ewill protect essential fatty acids (EFAs) from free radicaldamage and also prevent creation of counterproductivesubstances. Concurrent ingestion of a daily multiplevitamin may also provide nutritional cofactors ( , B6and magnesium) required for EFA :EPO is a long-term therapy, so immediate resultsshould not be expected. A patientmay need to use EPO regularly for upto four months before a clinicalresponse is observed. EPO appears tobe safe for long-term use of at leastone reports suggest that individualsdiagnosed with schizophrenia and/orthose already receiving epileptogenicdrugs such as phenothiazines shouldconsult a healthcare provider beforeusing EPO.

10 However, a recently pub-lished analysis of clinical trials involv-ing polyunsaturated fatty acids in thetreatment of schizophrenia indicatesno clear positive effects of EPO sup-plementation on schizophrenicpatients, but no adverse effects ANDLACTATION: There are no known restric-tions during pregnancy or lactation, and GLA, the essen-tial fatty acid that EPO contains, is considered an impor-tant substance in human breast milk. According to theWorld Health Organization, 5% of pregnant women stotal caloric intake should be from essential fatty effects are rare at recommended , headache, mild nausea, and abdominalbloating may occur. Overdose symptoms include loosestools and abdominal are no known drug interactions.