Devil's claw has been used to treat pain symptoms from osteoarthritis, rheumatoid arthritis, gout, myalgia, fibrositis, lumbago, tendonitis, pleuritic chest pain, and gastrointestinal upset. The active constituent, harpagoside, seems to reduce nonspecific low back pain when used in a dose range from 50 to 100 mg. In fact, its use in this range has been compared to 12.5 mg of the discontinued drug, rofecoxib (Chrubasik et al. 2002, Gagnier et al. 2004, Chrubasik et al. 2005). Additionally, oral dosing of devil's claw either alone or in combination with NSAIDs may lessen pain associated with osteoarthritis (Chantre et al. 2000, Chrubasik et al.
2002, Wegener and Lupke 2003) and may even need lower doses of NSAIDs to achieve the same level of pain relief (Chantre et al. 2000). More evidence is needed to substantiate its use or disuse for rheumatoid arthritis-related pain although preliminary data suggest it may be ineffective (Grahame and Robinson 1981).
Besides containing harpagoside, Devil's claw contains iridoid glycoside constituents and procumbide that add to its effect, as well as phenylethanol derivatives acteoside (verbasco-side) and isoacteoside, and the oligosaccharide stachyose (Fiebich et al. 2001). The iridoid glycoside constituents seem to provide an antiinflammatory effect (Chantre et al. 2000). Current evidence implies that harpagoside inhibits both the cyclooxygenase and lipoxygenase inflammatory pathways (Chrubasik et al. 2000). Devil's claw seems to inhibit only COX-2, not COX-1, and also inhibits the inflammation-modulating enzyme nitric oxide synthetase (Jang et al. 2003). An increased synthesis and release of tumor necrosis factor (TNF)-a by compounds other than harpagoside aid in the antiinflammatory effect; however, research in humans shows no effect of devil's claw on the arachidonic acid pathway (Moussard et al. 1992).
The most commonly reported side effect of devil's claw is diarrhea, but the supplement is generally well tolerated (Chantre et al. 2000). Other generalized complaints include nausea, vomiting, and abdominal pain, headache, tinnitus, anorexia, and loss of taste. Some people have experienced dysmenorrhea and hemodynamic instability (Chrubasik et al. 2002).
Possible drug interactions may stem from devil's claw ability to inhibit cytochrome P-450 2C9 (CYP2C9), although the effect has not been reported in humans (Unger and Frank 2004). The pain physician should be advised that drugs metabolized by CYP2C9 such as NSAIDs; meloxicam (Mobic); piroxicam (Feldene); celecoxib (Celebrex); amitriptyline (Elavil); warfarin (Coumadin); glipizide (Glucotrol); losartan (Cozaar); and others may need to be reduced or even eliminated.
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