Horsetail

Generic name: Equisetum Arvense L., Equisetum Myriochaetum
Brand names: Bottle Brush, Dutch Rushes, Horse Willow, Mexican Giant Horsetail, Paddock-pipes, Pewterwort, Scouring Rush, Shave Grass, Toadpipe

Usage of Horsetail

Brittle Nails

Clinical data

In 2 clinical trials evaluating a formulation of E. arvense (a plant extract rich in organic silica) and a sulfur donor in a hydroalcoholic solution (hydroxypropyl Chitosan [HPCH]), improvements in nail alterations (eg, splitting, fragility, longitudinal grooves) were observed. The organic silica properties of E. arvense serve to harden and strengthen the nail, while HPCH improves nail hydration, and the sulfur donor supports nail growth.(Sparavigna 2006)

Gout

The American College of Rheumatology, for its 2012 guidelines on the management of gout, voted that the use of various oral complementary agents, including horsetail, was inappropriate for the treatment of an acute attack of gout. The new guideline (2020) based on additional evidence regarding the management of gout no longer included a statement regarding the use of horsetail.(Fitzgerald 2020, Khanna 2012)

Neuroprotective effects

In vitro and in vivo data

The neuroprotective activity of 3 Equisetum species ethanolic extracts using zebrafish tests were determined in vivo. The results indicated that E. sylvaticum extract has a significant antioxidant activity; whereas, E. pratense extract had anxiolytic and antidepressant effects significantly higher than the other 2 extracts used. Promising results for the antioxidant in vitro tests as well as the neuroprotective activity of in vivo tests for various ethanolic extracts from Equisetum species were noted.(Batir-Marin 2021)

Osteoporosis

Animal data

In a study of rats, the addition of an ethanolic extract of E. arvense to an anabolic nutrient mixture containing Calcium carbonate, vitamin D, zinc sulfate, L-lysine, L-proline, L-arginine, and L-ascorbic acid was beneficial for bone formation; it was also more effective in preventing osteoporotic bone loss compared with raloxifene. Because of its high silica content, E. arvense may increase efficacy of the formulated nutrient mixture used for the treatment of osteoporosis and may aid in the prevention of osteoporosis; however, clinical trials are lacking.(Kotwal 2016)

Pancreatic carcinoma

In vitro data

In vitro testing of Equisetum arvense ethanolic extracts induced cell death in pancreatic carcinoma AsPC-1 cells.(Bhat 2020)

Urological effects

The horsetail plant exerts slight diuretic activity, possibly due to the high concentrations of flavonoids, phenolic compounds, and mineral salts found in the aerial parts of E. arvense. In addition, a review article concluded that Equisetum species have great potential in the management of kidney disorders.(Boeing 2021)

Historical reports of the use of horsetail in the treatment of urological disorders such as cystitis and urinary tract infections exist. Although horsetail shows some promise for the treatment of overactive bladder, there are no clinical data demonstrating this efficacy.(Chughtai 2013)

Clinical data

In a randomized, double-blind trial of 36 healthy male volunteers, diuretic effects comparable with those of Hydrochlorothiazide 25 mg and superior to placebo were observed with E. arvense 900 mg/day. No changes in electrolytes or liver, kidney, or hematological function tests were observed, and adverse reactions were mild and infrequent. E. arvense was deemed safe for oral acute use.(Carneiro 2014)

Wound Healing

Clinical data

In a clinical trial of postpartum mothers, an E. arvense 3% ointment improved wound healing and pain intensity following episiotomy, based on reductions in scores on the Redness, Edema, Ecchymosis, Discharge and Approximation of the Edges (REEDA) scale.(Asgharikhatooni 2015)

In terms of innovative dressing materials, chitosan-based hydrogels that have been modified with E. arvense L. extracts have demonstrated beneficial effects.(Głab 2021)

Horsetail side effects

Research reveals limited information regarding adverse reactions with the use of horsetail; however, there was an isolated report of strong headache in 1 clinical trial from the use of a dry extract from the aerial parts of E. arvense.(Carneiro 2014) In another isolated report, a possible link between habitual consumption of horsetail infusions and recurrent episodes of acute pancreatitis were documented after all other etiologies were ruled out.(García-Gavilán 2017) A case of hyponatremia attributed to decreased oral intake and syndrome of inappropriate secretion of anti­diuretic hormone (due to nausea) possibly exacer­bated by the diuretic effect of horsetail (E. arvense) has been reported.(Bates 2021)

Individuals allergic to nicotine should avoid horsetail because of its nicotine content; one case of dermatitis has been reported.(Sudan 1985)

Before taking Horsetail

Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.Revilla 2002

How to use Horsetail

E. palustre products are contraindicated for use in humans.

Brittle nails: A formulation containing E. arvense and a sulfur donor in an HPCH solution applied topically every night for 28 days in one trial, or every other day (preferably in the evening) for 14 days in another trial to strengthen fingernails.(Sparavigna 2006)

Diuretic: A dry extract of the aerial parts of E. arvense containing 0.026% total flavonoids was administered as 300 mg orally 3 times daily for 4 days (total daily dose of 900 mg, the maximum recommended dose for dry extracts) in a clinical trial of healthy volunteers.(Carneiro 2014)

Type 2 diabetes: A water extract of another species of horsetail (E. myriochaetum) as a single oral dose of 0.33 g/kg was used in a clinical study evaluating the hypoglycemic effects of horsetail.(Revilla 2002)

Wound healing: An E. arvense 3% ointment applied topically every 12 hours for 10 days was used following episiotomy in postpartum mothers.(Asgharikhatooni 2015)

Warnings

Horsetail has been listed as an herb of undefined safety by the FDA.(Fetrow 2000) Horsetail remedies prepared from E. arvense are generally considered safe when used properly. However, another species of horsetail, such as E. palustre, is poisonous to horses and contraindicated for use in humans.(UMMC 2017) Few in vivo toxicity studies have been conducted for most Equisetum species, so there is no consensus on an effective non-toxic dosage.(Boeing 2021)

Ingestion of large amounts of E. arvense fern may be toxic. There have been reports of children being poisoned by using the stems as blowguns or whistles.(Leung 1996) Crude horsetail contains the enzyme thiaminase, which destroys the B vitamin thiamine. Thiaminase poisoning may lead to permanent liver damage; preclinical studies have revealed various pharmacological actions of E. arvense, but no acute hepatotoxicity.(Carneiro 2014, Hallowell 1994) The Canadian Health Protection Branch prohibits thiaminase in dietary supplements, and supplement manufacturers must provide supportive documentation of its removal.(Lininger 1998) In a case report, a 52-year-old man who had consumed horsetail juice (500 mL/day for 2 weeks) and who had osteoarthritis, renal colic, and asymptomatic underlying chronic liver disease secondary to hepatitis B infection developed acute hepatitis; symptoms developed after consuming the juice for 1 week.(Klncalp 2012) In a clinical trial of healthy volunteers, oral use of E. arvense at 900 mg daily (in 3 divided doses) produced no signs of liver, kidney, hematological, or electrolyte toxicity.(Carneiro 2014)

In animals, ingestion of horsetail produces muscle weakness, ataxia, weight loss, abnormal pulse rate, cold extremities, and fever,(Klncalp 2012) symptoms similar to those occurring with nicotine intoxication. Hay composed of 20% or more of E. arvense produced these symptoms in 2 to 5 weeks.(Duke 1985) E. arvense may also induce seborrheic dermatitis in animals.(Kamphues 1990, Sudan 1985)

E. palustre contains toxic alkaloids(Bisset 2001, Lininger 1998). Cattle appear to recognize the odor of this species of horsetail and refuse to eat hay contaminated with E. palustre at a concentration of about 12%.(Spoerke 1980)

What other drugs will affect Horsetail

Efavirenz: Horsetail may diminish the therapeutic effect of efavirenz. Monitor therapy.(Cordova 2017)

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