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CMAJ
CMAJ - January 12, 1999JAMC - le 12 janvier 1999

Is feverfew a pharmacologic agent?

CMAJ 1999;160:21

See response from: W. Pryse-Phillips
In a 1998 CMAJ article1 [full text] William Pryse-Phillips and colleagues discuss alternative medical practices2 in the management of migraine. They suggest that "a trial of feverfew may be appropriate in prophylaxis (class B recommendation)." Feverfew, Tenacetum parthenium, contains parthenolide, a compound that acts as a serotonin antagonist3 and also inhibits serum proteases and leukotrienes.4 Thus, feverfew should be considered a pharmacologic rather than a nonpharmacologic agent.

There is wide variation in the quantities of active compound in individual plants, plant parts, and fresh and dried preparations. As is the case for other proprietary herbal medications, some commercial feverfew products have been found to contain little or no active phytocompounds. Therefore, only standardized extracts should be used.5

In the article by Pryse-Phillips and colleagues feverfew is recommended as an option for migraine prophylaxis, but there is no guideline with respect to the duration of the trial. Prolonged use may be a concern because, as the authors point out, "there are no studies documenting [feverfew's] long-term safety or efficacy." Because of its pharmacologic properties, feverfew should not be used in combination with other migraine medications or with aspirin.

H.C. George Wong, MD
Clinical Associate Professor of Medicine
Division of Allergy and Immunology
Department of Medicine
University of British Columbia
Vancouver, BC

Competing interests: None declared.

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References
  1. Pryse-Phillips WEM, Dodick DW, Edmeads JG, Gawel MJ, Nelson RF, Purdy RA, et al. Guidelines for the nonpharmacologic management of migraine in clinical practice. CMAJ 1998;159(1):47-54.
  2. Berman B, Larson D, co-chairs. Alternative medicine: expanding medical horizons. A report to the National Institutes of Health on alternative medical systems and practices in the United States. Workshop on Alternative Medicine; 1992 Sept 14­16; Chantilly (VA). Washington (DC): US Government Printing Office; 1994.
  3. Marles RJ, Kaminski J, Arnason JT, Pazoa-Sanou L, Heptinstall S, Fischer NH, et al. A bioassay for inhibition of serotonin release from bovine platelets. J Nat Prod 1992;55(8):1044-56.
  4. Sumner H, Salan U, Knight DW, Hoult JR. Inhibition of 5-lipoxygenase and cyclo-oxygenase in leukocytes by feverfew. Involvement of sesquiterpene lactones and other components. Biochem Pharmacol 1992;43(11):2313-20.
  5. Heptinstall S, Awang DV, Dawson BA, Kindack D, Knight DW, May J. Parthenolide content and bioactivity of feverfew (Tanacetum parthenium (L.) Shultz-Bip.). Estimation of commercial and authenticated feverfew products. J Pharm Pharmacol 1992;44(5):391-5.