Bupleurum (Bupleurum chinense L., Bupleurum falcatum) Dosing and Safety

safety

Allergies

Avoid in individuals with a known allergy or hypersensitivity to Bupleurum species, any of its constituents, the Apiaceae or Umbelliferae (carrot) families, snakeroot, cow parsnip, or poison hemlock. There are some reports that mention allergic reactions occurring in patients given intramuscular injections of Bupleurum.

Side Effects and Warnings

In recommended doses, many practitioners agree that Bupleurum is well tolerated. However, available safety data is lacking. Reports of adverse effects are largely theoretical and based on side effects from combination therapy; it is difficult to attribute the adverse effects to Bupleurum alone.
Reported side effects include decreased appetite, nausea, reflux, abdominal distension, gas, and increased bowel movements following large doses of Bupleurum. Rare instances of nausea, loss of appetite, and abdominal fullness have been reported following treatment with the combination therapy sho-saiko-to. Combinations containing Bupleurum have been associated with eosinophilic pneumonia, pulmonary edema, and multiple cases of pneumonitis (inflammation of the lungs). Use cautiously in patients with hypertension (high blood pressure), diabetes, or edema, due to possibility of adrenal stimulation.
Patients with autoimmune disease or in those taking immunosuppressants should use caution when taking Bupleurum, as saikosaponins in Bupleurum have been found to both stimulate and inhibit the immune system
There have been unverified reports of sedation, drowsiness, and lethargy, which are noted as frequent side effects. Rare instances of fatigue and paresthesia (abnormal sensations) were noted in one study that investigated the combination therapy sho-saiko-to. Use cautiously in patients operating motor vehicles or hazardous machinery, due to a possible risk of sedation.
Although not well studied in humans, Bupleurum may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
Use cautiously in patients with diabetes. Saikosaponins, constituents of Bupleurum, may increase blood sugar levels.

Pregnancy and Breastfeeding

Bupleurum is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence.

dosing

Adults (18 years and older)

There is no proven safe or effective dose for Bupleurum. Bupleurum is typically taken in combination formulas with other herbs, and has not been well studied alone. Traditionally, 1.5-9 grams of Bupleurum root have been used per day. Also, 1.5-3 milliliters of a fluid extract have been used daily. For hepatitis, doses of 5.4 grams of combination therapy sho-saiko-to daily have been studied for 12 weeks. For prevention of hepatocellular carcinoma, sho-saiko-to has been administered at a dose of 7.5 grams daily in combination with conventional treatment.

Children (younger than 18 years)

There is no proven safe or effective dose for Bupleurum in children, and use is not recommended. Bupleurum is typically taken in combination formulas with other herbs, and has not been well studied alone.

interactions

Interactions with Drugs

Bupleurum may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
Saikosaponins, constituents of Bupleurum, may increase blood sugar levels. Caution is advised when using medications that may alter blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
Bupleurum may stimulate the adrenals and may decrease the effects of antihypertensives (drugs for high blood pressure). Patients taking blood pressure medications, including beta-blockers or ACE inhibitors, should use cautiously.
Although not well-studied in humans, Bupleurum may reduce cholesterol levels. Caution is advised in patients taking cholesterol-lowering agents.
Due to the possibility of adrenal stimulation, Bupleurum may decrease the effects of diuretics or increase the effects of corticosteroids (steroids).
Bupleurum may have immune inhibitory effects and might additively or synergistically enhance immunosuppressant effects.
Sho-saiko-to, a combination herbal formula that contains Bupleurum, was found to enhance the anti-HIV-1 activity of lamivudine in laboratory study. Consult a qualified healthcare professional, including a pharmacist, before combining Bupleurum or combination formulas containing Bupleurum with antiviral or hepatitis B agents.
Bupleurum may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. The use of Bupleurum in combination with alcohol might additively or synergistically enhance sedation. Caution is advised while driving or operating machinery.
In theory, Bupleurum may interact with medications metabolized by the liver. There are mixed reports of Bupleurum acting as both a protective agent for the liver, and also an agent that has toxic effects on the liver. Additionally, combination products containing Bupleurum may interact with any medication taken by mouth and may alter the way medications are absorbed in the body.
Although human evidence is lacking, Bupleurum may also interact with Alzheimer's disease medications, antibiotics, anticancer medications, or HIV medications (antiretrovirals). Consult with a qualified healthcare professional, including a pharmacist, to check for interactions.

Interactions with Herbs and Dietary Supplements

Bupleurum may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
Saikosaponins, constituents of Bupleurum, may increase blood sugar levels. Caution is advised when using herbs or supplements that may alter blood sugar. Patients should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
Sho-saiko-to, a combination herbal formula that contains Bupleurum, was found to enhance the anti-HIV-1 activity of lamivudine in laboratory study. Consult a qualified healthcare professional, including a pharmacist, before combining Bupleurum or combination formulas containing Bupleurum with antiviral herbs or supplements.
Saikosaponins, constituents of Bupleurum, may decrease triglyceride concentrations or decrease the effects of blood pressure-lowering agents. Caution is advised in patients taking cholesterol-lowering herbs or supplements, such as red yeast rice, or herbs or supplements that lower blood pressure. Consult with a qualified healthcare professional, including a pharmacist, to check for interactions.
Bupleurum may stimulate the adrenals and may have additive effects with corticosteroids (steroids) or decrease the effects of diuretics (agents that increase urine flow).
Bupleurum may have immune inhibitory effects and may additively or synergistically enhance herbs or supplements with immunosuppressant effects.
Bupleurum may increase the amount of drowsiness caused by some herbs or supplements.
In theory, Bupleurum may interact with herbs or supplements metabolized by the liver. There are mixed reports of Bupleurum acting as both a protective agent for the liver, and also an agent that has toxic effects on the liver. Additionally, combination products containing Bupleurum may interact with any medication taken by mouth and may alter the way medications are absorbed in the body.
Although human evidence is lacking, Bupleurum may interact with herbs and supplements taken for Alzheimer's disease, cancer, or HIV. Bupleurum may interact with herbs or supplements with antibacterial effects as well. Consult with a qualified healthcare professional, including a pharmacist, to check for interactions.