Horsetail - Uses and Side Effects

Horsetail is used in traditional medicine as a diuretic and an antitubercular drug, and in the treatment of kidney and bladder disturbances. It's been used topically in cosmetics, and as an astringent to stop bleeding and stimulate wound healing.

Horsetail's mild diuretic action is probably the result of the equisetonin and flavonoid glycoside constituents. Horsetail also contains small amounts of pharmacologically active nicotine and inorganic silica components. Horsetail is available as dried extract in powdered form, dried or fresh stem of horsetail plant, infusion, liquid extract 1:1 in 25% alcohol), and tea, in products such as Springtime Horsetail and Wild Countryside.

Reported uses

Horsetail is used orally to treat diuresis, edema, and general disturbances of the kidney and bladder. It's used topically for supportive treatment of burns and wounds. Horsetail has also been used to treat brittle fingernails, rheumatic diseases, gout, frostbite, and profuse menstruation.

Administration

Diuresis: Dosage is 6 g of the dried stem by mouth every day with plenty of fluids, or 1 cup of tea taken several times between meals, or 1 to 4 ml ofliquid extract by mouth three times a day

Infusion: An infusion is prepared by placing 1.5 g of dried stem in 1 cup of water; dosage is 2 to 4 g by mouth every day

Tea: A tea is prepared by pouring boiling water over 2 to 3 g of the herb, boiling for 5 minutes, and then straining after 10 to 15 minutes; consumed several times a day between meals

Topical support for burns or wounds: A compress containing 10 g of stem/L of water may be applied to affected areas.

Hazards

Side effects of horsetail include electrolyte imbalance, skin irritation from topical use, thiamine deficiency from long-term use, and symptoms of nicotine poisoning and toxicity including nausea and vomiting, muscle weakness, abnormal pulse rate, fever, and ataxia. Use of horsetail with benzodiazepines, disulfiram, or metronidazole may cause a disulfiram-like reaction. Horsetail may increase digitalis toxicity as a result of potassium loss with diuretic effect. When it's used with potassium-wasting drugs (including corticosteroids, diuretics, and laxative stimulants), there's an increased risk of hypokalemia. Overuse of licorice with horsetail may increase potassium depletion and risk of cardiac toxicity. Excessive alcohol consumption while horsetail is being used may lead to thiamine deficiency.

Pregnant patients, breast-feeding patients, those with impaired heart or kidney function, those with liver problems, those who are taking a cardiac glycoside, and those who have a history or potential of thiamine deficiency (for example, alcoholic patients) should avoid using horsetail.

Safety Risk The liquid extract contains 25% alcohol and there fore shouldn't be used with disulfiram, metronidazole, and benzodiazepines.

Clinical considerations

Horsetail dosage varies with the formulation. Large amounts may cause a toxic reaction.

The dried, powdered extract is more concentrated than stem alone.

Monitor patient's serum potassium level.

Assess patient for signs and symptoms of hypokalemia, including weakness, muscle flaccidity, and abnormal ECG results.

Horsetail shouldn't be used for extended periods because of the potential for toxic reaction and thiamine depletion.

Instruct patients to stop taking horsetail immediately if signs or symptoms of nicotine toxicity (muscle weakness, abnormal pulse rate, fever, ataxia, and cold extremities) or potassium depletion (muscle cramping, irritability, or weakness) occur.

If patient is pregnant or breast-feeding, advise her not to use horsetail.

Advise patients taking a potassium wasting diuretic, a cardiac glycoside (Lanoxin), a corticosteroid, or licorice not to use horsetail.

Tell patient to notify pharmacist of any herbal or dietary supplement that he's taking when obtaining a new prescription.

Advise patient to consult his health care provider before using an herbal preparation because a conventional treatment with proven efficacy may be available.

Safety Risk Horsetail should be kept out of reach of children because poisonings have been reported in those that used the stems as blowguns or whistles.

Research summary

The FDA lists horsetail on its undetermined safety list. Horsetail is still found in some over-the-counter herbal preparations. It has been shown to contain small amounts of nicotine and other active compounds, and is a marginally effective diuretic.

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