Devil’s Claw

• How It Works

  Available evidence indicates that devil’s claw can benefit those with osteoarthritis of the hip or knee, and back pain.

  Devil’s claw is a plant native to South Africa and is used in traditional medicine to treat rheumatism, arthritis, inflammation, and stomach disorders. Currently, preparations of devil’s claw root are used as anti-inflammatory agents and to releive pain. Laboratory and animal studies show that devil’s claw has anti-inflammatory, pain releiving, antioxidant and appetite suppressant effects. It also helps slow bone loss caused by inflammation. Human studies indicate its benefits in patients with osteoarthritis of the hip or knee, and rheumatic disorders. More research is needed.

• Purported Uses
  • To suppress appetite
    Animal study suggests that devil’s claw can suppress appetite. Human data are lacking.
  • To treat gastrointestinal disorders
    No scientific evidence supports this use.
  • To reduce inflammation
    Lab and animal studies show that devil’s claw is effective against inflammation.
  • To relieve pain
    Clinical data indicate benefits of devil’s claw for relief of back pain.
  • To treat osteoarthritis
    Devil’s claw was shown effective against osteoarthritis of the hip and knee.
• Patient Warnings

  A case controlled study suggests increased risk of acute pancreatitis (inflammation of the pancreas) with use of devil’s claw.

• Do Not Take If
  • You are taking drugs that are substrates of Cytochrome P450 1A2/2C8/2C9/2C19/2D6 and 3A4 enzymes: Devil’s claw may increase the risk of side effects of these drugs. But according to another study, the interaction may not have any clinical significance.
  • You are taking drugs that are substrates of P-glycoprotein: Devil’s claw may increase the risk of side effects of these drugs.
• Side Effects
  • Dyspepsia (indigestion) has been reported following consumption of a devil’s claw extract.
  • Ulcers and gastrointestinal bleeding have occurred with use of devil’s claw root.
  • Intake of a product containing devil’s claw for osteoarthritis resulted in systemic hypertension in a 62-year-old healthy postmenopausal woman.
• Brand Name

  Doloteffin ™

• Scientific Name

  Harpagophytum procumbens

• Clinical Summary

  Devil’s claw is a plant native to South Africa and is used in traditional medicine to treat rheumatism, arthritis, inflammation, and stomach disorders. Currently, preparations of devil’s claw root are used as anti-inflammatory agents and to releive pain.

  In vitro and animal studies indicate that devil’s claw has antioxidant ⁽⁵⁾, anti-inflammatory ^(9) (15), analgesic ⁽¹⁶⁾, anti-osteoporotic ^(17) (18) and appetite suppressant ⁽¹⁹⁾ effects.

  Limited data from clinical studies suggest benefits of devil’s claw for osteoarthritis of the hip or knee ⁽⁶⁾, back pain ^(7) (20) and rheumatic disorders ⁽²¹⁾. Additional well-designed clinical trials are needed to determine the potential of devil’s claw for arthritic conditions.

• Purported Uses
  • Anorexia
  • GI disorders
  • Inflammation
  • Muscle pain
  • Osteoarthritis
  • Pain
• Mechanism of Action

  Harpagide, an iridoid glycoside isolated from devil’s claw, is responsible for the herbs’s anti-inflamamtory effects. It was shown to inhibit the production of inflammatory cytokines including interleukins IL-1beta, IL-6, and tumor-necrosis factor (TNF-alpha) in mouse macrophage cells ⁽¹⁵⁾. A devil’s claw extract also demonstrated anti-inflammatory activity via inhibiting the induction of pro-inflammatory gene expression, possibly by blocking the activator protein (AP-1, a transcription factor) pathway ⁽⁹⁾.

  Harpagide may also prevent bone loss by regulating the stimulation of osteoblast differentiation and the suppression of osteoclast formation in  mice ⁽¹⁷⁾. In another study, it was shown to block lipopolysaccharide (LPS)-induced bone loss in a model of inflammatory osteoporosis. However, harpagide was not effective in preventing bone loss mediated by ovariectomy in postmenopausal osteoporosis ⁽¹⁸⁾.

  Investigations of the mechanisms underlying the pain-releiving activity of devil’s claw showed involvement of the heme oxygenase-1/carbon monoxide (plays a role in nociceptive processing) system in carrageenan-induced inflammatory pain ⁽²²⁾. Devil’s claw  exerts antioxidant effects by scavenging both superoxide and peroxyl in a dose dependent manner ⁽⁵⁾.

  Beta-sitosterol, a sterol found in devil’s claw, has anticancer properties but the mechanism of action is unknown ⁽²³⁾.

• Warnings
  • A case controlled study suggests increased risk of acute pancreatitis with use of devil’s claw ⁽¹⁰⁾.
• Adverse Reactions
  • Dyspepsia has been reported following consumption of a devil’s claw extract ⁽⁶⁾.
  • Ulcers and gastrointestinal bleeding have occurred with use of devil’s claw root ⁽¹¹⁾.
  • Intake of a product containing devil’s claw for osteoarthritis resulted in systemic hypertension in a 62-year-old healthy postmenopausal woman ⁽¹²⁾.
• Herb-Drug Interactions
  • Cytochrome P450 enzymes: Devil’s claw root can inhibit CYP1A2/2C8/2C9/2C19/2D6 and 3A4, and may interact with substances metabolized by these enzymes ⁽⁸⁾. But conflicting data suggest that the interactions are not clinically relevant ⁽¹³⁾.
  • P-Glycoprotein (P-gP): Devil’s claw modulates both the activity and expression of P-Gp, and may affect the transport of drugs mediated by this protein ⁽¹⁴⁾.
• References

  1. Newall CA, et al.Herbal Medicine: A Guide for Healthcare Professionals. London: Pharmaceutical Press; 1996.

  2. Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Boca Raton: CRC Press; 1994.

  3. Schulz V, et al. Rational Phytotherapy: A Physicians Guide to the Use of Herbs and Related Remedies, 3^rd ed. Berlin (Germany): Springer; 1998.

  4. Fiebich BL, et al. Inhibition of TNF-alpha synthesis in LPS-stimulated primary human monocytes by Harpagophytum extract SteiHap 69. Phytomedicine 2001;8:28-30.

  5. Langmead L, et al. Antioxidant effects of herbal therapies used by patients with inflammatory bowel disease: an in vitro study. Aliment Pharmacol Ther 2002;16:197-205.

  6. Wegener T, Lupke NP. Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil’s claw (Harpagophytum procumbens DC.). Phytother Res. 2003 Dec;17(10):1165-72.

  7. Gagnier JJ, van Tulder MW, Berman B, et al. Herbal medicine for low back pain. Spine 2007;32(1):82-92.

  8. Unger M, Frank A. Simultaneous determination of the inhibitory potency of herbal extracts on the activity of six major cytochrome P450 enzymes using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun Mass Spectrom. 2004;18(19):2273-81.

  9. Fiebich BL, Muñoz E, Rose T, Weiss G, McGregor GP. Molecular targets of the antiinflammatory Harpagophytum procumbens (devil’s claw): inhibition of TNFα and COX-2 gene expression by preventing activation of AP-1. Phytother Re. 2012 Jun;26(6):806-11.

  10. Douros A, Bronder E, Andersohn F, et al. Drug-induced acute pancreatitis: results from the hospital-based Berlin case-control surveillance study of 102 cases. Aliment Pharmacol Ther. 2013 Oct;38(7):825-34.

  11. Devil’s claw root: ulcers and gastrointestinal bleeding? Prescrire Int. 2013 Dec;22(144):296.

  12. Cuspidi C, Sala C, Tadic M, Grassi G, Mancia G. Systemic Hypertension Induced by Harpagophytum procumbens (devil’s claw): A Case Report. J Clin Hypertens (Greenwich). 2015 Nov;17(11):908-10.

  13. Modarai M, Suter A, Kortenkamp A, Heinrich M. The interaction potential of herbal medicinal products: a luminescence-based screening platform assessing effects on cytochrome P450 and its use with devil’s claw (Harpagophyti radix) preparations. J Pharm Pharmacol. 2011 Mar;63(3):429-38.

  14. Romiti N, Tramonti G, Corti A, Chieli E. Effects of Devil’s Claw (Harpagophytum procumbens) on the multidrug transporter ABCB1/P-glycoprotein. Phytomedicine. 2009 Dec;16(12):1095-100.

  15. Inaba K, Murata K, Naruto S, Matsuda H. Inhibitory effects of devil’s claw (secondary root of Harpagophytum procumbens) extract and harpagoside on cytokine production in mouse macrophages. J Nat Med. 2010 Apr;64(2):219-22.

  16. Lim DW, Kim JG, Han D, Kim YT. Analgesic effect of Harpagophytum procumbens on postoperative and neuropathic pain in rats. Molecules. 2014 Jan 16;19(1):1060-8.

  17. Chung HJ, Kyung Kim W, et al. Anti-osteoporotic activity of harpagide by regulation of bone formation in osteoblast cell culture and ovariectomy-induced bone loss mouse models. J Ethnopharmacol. 2016 Feb 17;179:66-75.

  18. Kim JY, Park SH, Baek JM, et al. Harpagoside Inhibits RANKL-Induced Osteoclastogenesis via Syk-Btk-PLCγ2-Ca(2+) Signaling Pathway and Prevents Inflammation-Mediated Bone Loss. J Nat Prod. 2015 Sep 25;78(9):2167-74.

  19. Torres-Fuentes C, Theeuwes WF, McMullen MK, et al. Devil’s Claw to suppress appetite—ghrelin receptor modulation potential of a Harpagophytum procumbens root extract.  PLoS One. 2014 Jul 28;9(7):e103118.

  20. Laudahn D, Walper A. Efficacy and tolerance of Harpagophytum extract LI 174 in patients with chronic non-radicular back pain. Phytother Res. 2001 Nov;15(7):621-4.

  21. Warnock M, McBean D, Suter A, Tan J, Whittaker P. Effectiveness and safety of Devil’s Claw tablets in patients with general rheumatic disorders. Phytother Res. 2007 Dec;21(12):1228-33.

  22. Parenti C, Aricò G, Chiechio S, Di Benedetto G, Parenti R, Scoto GM. Involvement of the Heme-Oxygenase Pathway in the Antiallodynic and Antihyperalgesic Activity of Harpagophytum procumbens in Rats. Molecules. 2015 Sep 15;20(9):16758-69.

  23. Lomenick B, Shi H, Huang J, Chen C. Identification and characterization of β-sitosterol target proteins. Bioorg Med Chem Lett. 2015 Nov 1;25(21):4976-9