Devil’s Claw

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Scientific Name(s): Harpagophytum procumbens , subsp. procumbens DC. ex Meisn. Family: Pediliaceae (sesame).

Common Name(s): Devil’s claw , grapple plant , grapple vine , Radix Harpagophyti , wood spider , xwate .

Uses

Devil’s claw is a folk remedy used for an extensive range of diseases, including arthritis and rheumatism. Clinical trials are generally supportive of its use as an anti-inflammatory and analgesic in low back pain and osteoarthritis.  

Dosing

Devil’s claw has been studied for low back pain, muscle pain, and osteoarthritis using daily doses of crude tuber up to 9 g, 1 to 3 g of extract, or harpagoside 50 to 100 mg.

Contraindications

Because of the bitterness of the preparation and consequent increase in gastric secretion, devil’s claw is contraindicated in patients with gastric or duodenal ulcers.

Pregnancy/Lactation

Documented oxytoxic adverse effects. Avoid use.

Interactions

None well documented.

Adverse Reactions

Rare, generally consisting of headache, tinnitus, or anorexia.

Toxicology

Clinically important toxicity has not been observed in limited, short-term use.

Botany

Devil’s claw grows naturally in the Kalahari Desert and Namibian steppes of southwest Africa. The plant is a weedy perennial bearing small, claw-like protrusions on the fruit and a strong central taproot growing up to 2 m deep. The secondary roots are used in decoctions and teas. The plant’s leaves are large and grey-green in color, and it produces pink, red, or purple, trumpet-shaped flowers. 1 , 2 Devil’s claw is also known as Uncaria procumbens and Harpagophytum burchellii Decne.

History

Devil’s claw has been widely used among indigenous people of South Africa as a folk remedy for diseases ranging from liver and kidney disorders to allergies, headaches, and most commonly, rheumatism. Devil’s claw was reportedly introduced to Europe by a German soldier in the mid-1900s, and thereafter its popularity increased among British, Canadian, and European herbalists. Devil’s claw is marketed in Canada and Europe as a home remedy for the relief of arthritic diseases. 1 , 2 , 3

Chemistry

The major chemical component thought to be responsible for the anti-inflammatory activity of devil’s claw is harpagoside, a monoterpene glucoside. Other iridoid glycosides include procumbide, harpagide, 8-para-coumaroyl-harpagide, and verbascoside. Harpagoside is found primarily in the roots; secondary tubers contain twice as much glucoside as the primary roots. Flowers, stems, and ripe fruits are essentially devoid of the compound, while traces have been isolated from the leaves. Harpagoside can be progressively hydrolyzed to harpagid and harpagogenin. Commercial sources of devil’s claw extract contain 1.4% to 2% of harpagoside.

Other constituents include carbohydrates, flavonoids (kaempferol, luteolin), aromatic acids, phytosterols, and triterpenes. High-performance liquid chromatography methods for identification have been reported. 2 , 4 , 5

Uses and Pharmacology

Anti-inflammatory/analgesic effects

In vitro studies are largely supportive of anti-inflammatory action. Mechanisms elucidated include inhibition of COX-2 enzymes and proinflammatory enzymes, antioxidant activity, reductions in expression of prostaglandin PGE ₂ , and inhibition of cysteinyl-leukotrienes. 3 , 4 , 6 , 7 , 8 , 9

Animal data

Most animal studies support the anti-inflammatory and analgesic effects of devil’s claw extracts. Studies have included oral, intraperitoneal, and intraduodenal routes of administration, with oral use having the most negative findings. Inhibition of carrageenin-induced paw edema by devil’s claw was comparable with that of phenylbutazone, indomethacin, and acetyl salicylic acid. A dose-dependent effect has also been described. 3 , 4 , 10 , 11 , 12 , 13 , 14

Clinical data

Reviews of clinical trials have focused primarily on arthritic conditions (hip and knee) and low back pain. A meta-analysis of available data has not been conducted, possibly because of diverse methodologies. 3 , 4 , 15 , 16

Few quality double-blind, placebo-controlled, or comparator randomized trials have been conducted in osteoarthritis; however, there is general support for evidence of effect in pain reduction. Other clinical studies (open-label) are also supportive. Well-designed, adequately powered studies are required before definitive statements regarding optimal dose, efficacy, and duration of therapy can be made. 15 , 16 The use of devil’s claw in treating low back pain has been reviewed by a Cochrane group who found evidence to support a short-term reduction in pain greater than that of placebo, based on 2 quality clinical trials. 15 Positive results from other less well-designed trials have been published. 3 , 4

Other uses
Cardiac effects

Older animal studies demonstrated cardiac effects of extracts of H. procumbens , including dose-dependent reduction in blood pressure, decreased heart rate, and anti-arrhythmic activity, with mixed results or inotropic and chronotropic effects for different iridoids. 17 , 18 , 19 Clinical studies are lacking.

Central nervous system

A study in rats showed anticonvulsant effects of an extract of H. procumbens , possibly via CNS depression and gamma aminobutyric acid neurotransmission. 20 Anticholinesterase activity has also been described. 21

Dosage

Devil’s claw has been studied for low back pain, muscle pain, and osteoarthritis using daily doses of crude tuber up to 9 g daily, 1 to 3 g of extract, and harpagoside 50 to 100 mg. 3 , 22 , 23 Commercial preparations are inconsistent in the composition of iridoid glycosides, with some products likely to be more effective than others. Harpagoside is considered the key ingredient for anti-inflammatory effect. 23

Devil’s claw is not recommended for use in children due to lack of safety or clinical trial data. 3 It is also not recommended for long-term use (more than 3 to 4 months) because of a lack of data. 3 , 24

Pregnancy/Lactation

Documented oxytoxic adverse effects. Avoid use. 2 , 3 H. procumbens extract produced rhythmic contractions in isolated rat uterine tissue. 25

Interactions

A poorly documented case report of an interaction with warfarin manifesting as purpura exists. 3 , 26 , 27However, devil’s claw does not affect blood eicosanoid production. 28 Use with antiarrhythmic, chronotropic, or inotropic medicines is contraindicated because of decreased heart rate observed in rats and mild positive inotropic effects in rabbits in older studies. 3 , 18 , 19 Devil’s claw may also potentiate antidiabetic therapy. 2 , 3 , 4

Screening studies report that H. procumbens is unable to inhibit cytochrome P450 enzymes and is unlikely to have any clinically relevant effect on the cytochrome system. 4 , 29 It is possible that devil’s claw may affect multidrug P-glycoprotein drug transporter. 30

Adverse Reactions

Rare, GI-related adverse effects have been reported in clinical trials, including mild GI upset, anorexia, and loss of taste. Headache and tinnitus have been reported. 31 , 32 Cardiovascular adverse events are theoretically possible based on older studies in rodents; however, case reports are lacking. 32

Anecdotal reports suggest devil’s claw may increase stomach pH due to its bitter taste, and is thus contraindicated in people with gastric or duodenal ulcers. 3 , 33 Cautious use by patients with gallstones is likewise advised. 2 , 3 For diabetic patients, consider the unsubstantiated reports of possible hypoglycemic effects of devil’s claw. 3

Toxicology

Harpagoside has been found to be of low toxicity, with a median lethal dose of more than 13.5 g/kg in mice. Although no long-term toxicity studies have been reported, rats given oral doses of harpagoside 7.5 g/kg/day showed no clinical, hematologic, or gross pathologic changes. 3 , 33

Bibliography

1. Harpagophytum procumbens . USDA, NRCS. 2011. The PLANTS Database ( http://plants.usda.gov , 6 December 2011). National Plant Data Team, Greensboro, NC 27401-4901 USA. Accessed March 8, 2012.
2. Radix Harpagophyti . In: WHO Monographs on Selected Medicinal Plants . Vol. 3. Geneva, Switzerland: World Health Organization; 2007. http://apps.who.int/medicinedocs/en/m/abstract/Js14213e/ .
3. Brendler T, Gruenwald J, Ulbricht C, Basch E; Natural Standard Research Collaboration. Devil’s Claw ( Harpagophytum procumbens DC): an evidence-based systematic review by the Natural Standard Research Collaboration. J Herb Pharmacother . 2006;6(1):89-126.
4. Grant L, McBean DE, Fyfe L, Warnock AM. A review of the biological and potential therapeutic actions of Harpagophytum procumbens . Phytother Res . 2007;21(3):199-209.
5. Clarkson C, Staerk D, Hansen SH, Smith PJ, Jaroszewski JW. Identification of major and minor constituents of Harpagophytum procumbens (Devil’s claw) using HPLC-SPE-NMR and HPLC-ESIMS/APCIMS. J Nat Prod . 2006;69(9):1280-1288.
6. Ouitas NA, Heard CM. A novel ex vivo skin model for the assessment of the potential transcutaneous anti-inflammatory effect of topically applied Harpagophytum procumbens extract. Int J Pharm . 2009;376(1-2):63-68.
7. 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 Res . 2011. doi: 10.1002/ptr.3636.
8. Anauate MC, Torres LM, de Mello SB. Effect of isolated fractions of Harpagophytum procumbens D.C. (devil’s claw) on COX-1, COX-2 activity and nitric oxide production on whole-blood assay. Phytother Res . 2010;24(9):1365-1369.
9. Abdelouahab N, Heard C. Effect of the major glycosides of Harpagophytum procumbens (Devil’s Claw) on epidermal cyclooxygenase-2 (COX-2) in vitro. J Nat Prod . 2008;71(5):746-749.
10. Wachsmuth L, Lindhorst E, Wrubel S, et al. Micro-morphometrical assessment of the effect of Harpagophytum procumbens extract on articular cartilage in rabbits with experimental osteoarthritis using magnetic resonance imaging. Phytother Res . 2011;25(8):1133-1140.
11. Uchida S, Hirai K, Hatanaka J, Hanato J, Umegaki K, Yamada S. Antinociceptive effects of St. John’s wort, Harpagophytum procumbens extract and Grape seed proanthocyanidins extract in mice. Biol Pharm Bull . 2008;31(2):240-245.
12. Mahomed IM, Ojewole JA. Analgesic, antiinflammatory and antidiabetic properties of Harpagophytum procumbens DC ( Pedaliaceae ) secondary root aqueous extract. Phytother Res . 2004;18(12):982-989.
13. 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;64(2):219-222.
14. Catelan SC, Belentani RM, Marques LC, et al. The role of adrenal corticosteroids in the anti-inflammatory effect of the whole extract of Harpagophytum procumbens in rats. Phytomedicine . 2006;13(6):446-451.
15. Gagnier JJ, van Tulder M, Berman B, Bombardier C. Herbal medicine for low back pain. Cochrane Database Syst Rev . 2006;(2):CD004504.
16. Brien S, Lewith GT, McGregor G. Devil’s Claw ( Harpagophytum procumbens ) as a treatment for osteoarthritis: a review of efficacy and safety. J Altern Complement Med . 2006;12(10):981-993.
17. Occhiuto F, Circosta C, Ragusa S, Ficarra P, Costa De Pasquale R. A drug used in traditional medicine: Harpagophytum procumbens DC. IV. Effects on some isolated muscle preparations. J Ethnopharmacol . 1985;13(2):201-208.
18. Circosta C, Occhiuto F, Ragusa S, et al. A drug used in traditional medicine: Harpagophytum procumbens DC. II. Cardiovascular activity. J Ethnopharmacol . 1984;11(3):259-274.
19. Soulimani R, Younos C, Mortier F, Derrieu C. The role of stomachal digestion on the pharmacological activity of plant extracts, using as an example extracts of Harpagophytum procumbens . Can J Physiol Pharmacol . 1994;72(12):1532-1536.
20. Mahomed IM, Ojewole JA. Anticonvulsant activity of Harpagophytum procumbens DC [ Pedaliaceae ] secondary root aqueous extract in mice. Brain Res Bull . 2006;69(1):57-62.
21. Georgiev MI, Alipieva K, Orhan IE. Cholinesterases inhibitory and antioxidant activities of Harpagophytum procumbens from in vitro systems. Phytother Res . 2012;26(2)313-316.
22. Chrubasik S. Addendum to the ESCOP monograph on Harpagophytum procumbens . Phytomedicine . 2004;11(7-8):691-696.
23. Ouitas NA, Heard C. Estimation of the relative antiinflammatory efficacies of six commercial preparations of Harpagophytum procumbens (Devil’s Claw). Phytother Res . 2010;24(3):333-338.
24. Thanner J, Kohlmann T, Künzel O, Chrubasik S. Retrospective evaluation of biopsychosocial determinants and treatment response in patients receiving devil’s claw extract (doloteffin). Phytother Res . 2009;23(5):742-744.
25. Mahomed IM, Ojewole JA. Uterotonic effect of Harpagophytum procumbens DC ( Pedaliaceae ) secondary root aqueous extract on rat isolated uterine horns. J Smooth Muscle Res . 2009;45(5):231-239.
26. Fugh-Berman A. Herb-drug interactions. Lancet . 2000;355(9198):134-138.
27. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm . 2000;57(13):1221-1227.
28. Izzo AA, Di Carlo G, Borrelli F, Ernst E. Cardiovascular pharmacotherapy and herbal medicines: the risk of drug interaction. Int J Cardiol . 2005;98(1):1-14.
29. 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;63(3):429-438.
30. Romiti N, Tramonti G, Corti A, Chieli E. Effects of Devil’s Claw ( Harpagophytum procumbens ) on the multidrug transporter ABCB1/P-glycoprotein. Phytomedicine . 2009;16(12):1095-1100.
31. 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;21(12):1228-1233.
32. Vlac hojannis J, Roufogalis BD, Chrubasik S. Systematic review on the safety of Harpagophytum preparations for osteoarthritic and low back pain. Phytother Res . 2008;22(2):149-152.
33. Duke JA. Handbook of Medicinal Herbs . Boca Raton, FL: CRC Press; 2002.

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