Stinging nettle is aperennial herb, found growing wild throughout the temperate zones of both hemispheres worldwide (Bombardelli and Morazzoni, 1997; Leung and Foster, 1996).The material of commerce comes mostlyfromwild plants collected in Albania, Bulgaria, Hungary, Germany, the former U.S.S.R., and the former Yugoslavia, though it is also cultivated somewhat(Bombardelli and Morazzoni, 1997; Wichtl and Bisset, 1994). The genus name Urtica comes from the Latin verb urere, meaning "to burn," because of its urticate (stinging) hairs. The species name dioica means "two houses" because the plant usually has either male or female flowers (Bombardelli and Morazzoni, 1997).
Herb and Leaf:
Stinging nettle herb has been used since ancient times. Greek physicians Dioscorides (first century C.E.) and Galen (ca. 130200 C.E.) reported nettle leaf had diuretic and laxative action and was useful for asthma, pleurisy, and for the treatment of spleen-related illness. Roman naturalist Pliny the Elder (ca. 2379 C.E.)reported hemostatic properties (Bombardelli and Morazzoni, 1997).
In traditional African medicine the herb is used as a snuff powder for nosebleeds, excessive menstruation, and to treat internal bleeding. It is applied on burns (List and Hrhammer, 1979). In India, the Ayurvedic Pharmacopoeia lists stinging nettle herb foruterine hemorrhage, cutaneous eruptions, infantile and psychogenic eczema, and nosebleed, at dosage 24 g herb or 34 ml fluidextract,always in combination with other herbs(Karnick, 1994). It is also taken in syrup or tincture form to treat urticaria (nettle rash) (Nadkarni, 1976). Stinging nettle is also widely used in North American aboriginal medicines. People of the Hesquiat, Sanpoil, Shuswap, and Tainarna nations use it as an antirheumatic drug (Moerman, 1998; Palmer, 1975; Smith, 1973; Turner and Efrat, 1982; Ray, 1933). It is also used as a gynecological aid by women of the Cowlitz, Cree, Kwakiutl, Lummi, Quinault, and Squaxin nations. It is taken as an aqueous infusion during childbirth to relax the muscles. The plant juice is taken by pregnant women who are overdue and the tips of the plant are chewed by women during labor (Gunther, 1973; Leighton, 1985; Moerman, 1998; Turner and Bell, 1973; Turner and Efrat, 1982).
In Germany,stinging nettle herb is licensed as a standard medicinal tea for diuretic action. It is also used as a component of prepared medicines intended for supportive treatment of rheumatic ailments and irrigation therapy in inflammatory conditions of the lower urinary tract (Wichtl and Bisset, 1994).Stinging nettle herb is used in German homeopathy in treatments for urticaria, herpes, eczema, hypersensitive reactions in the skin and joints, and burns (List and Hrhammer, 1979). In the United States, stinging nettle herb is used as a component in a wide range of dietary supplements. It is also used during and following birth and during lactation in traditional women's tonic formulas. It is prescribed by naturopathic physicians and licensed acupuncturists as a component in formulas used to treat hayfever and other allergies.
Modern clinical studies have investigated the use of stinging nettle herb to treat allergic rhinitis (Mittman, 1990), rheumatic complaints (Ramm and Hansen, 1995), acute arthritis (Chrubasik et al., 1997), and as a diuretic (Kirchhoff, 1983).
In a double-blind randomized study, 98 individuals with allergic rhinitis compared the effects of a freeze-dried stinging nettle herb powder (Eclectic Institute, U.S.A.) with placebo. Sixty-nine individuals completed the study. Assessment was based on daily symptom diaries and global response recorded at the follow-up visit after one week of therapy. The extract was rated higher than placebo in the global assessments. In the diary data, however, stinging nettle extract was rated only slightly better. The study reported that the extract produced positive, though limited results in the treatment of allergic rhinitis (Mittman, 1990).
In a multicenter study, 152 patients with degenerative, rheumatic diseases were given 1.54 g nettle herb dry extract (6.48.0:1) daily. Subjective improvement of symptoms was observed in 70% of the patients after three weeks (Ramm and Hansen, 1995). In another open randomized study, 40 patients with acute arthritis compared the effects of stewed stinging nettle herb combined with a sub-therapeutic dose of the anti-inflammatory drug Diclofenac against a standard dose of Diclofenac. Half of the patients took 50 g nettle and 50 mg Diclofenac and the other half took 200 mg Diclofenac. Thirty-seven patients completed the study. Assessment was based on the decrease in the elevated acute phase protein CRP (a protein elevated by inflammatory events and other pathological processes) and the clinical signs of acute arthritis: physical impairment, subjective pain, and pressure pain (patient assessment) and stiffness (physician assessment). All assessments were done on a verbal rating scale from 0 to 4. In both groups median scores improved by about 70% relative to the initial value. Only minor adverse effects occurred during treatment. The authors concluded that stinging nettle herb may enhance the NSAID antirheumatic effectiveness and that further investigations are needed in order to determine whether acute attacks of arthritis may respond to stewed stinging nettle herb on its own (Chrubasik et al, 1997).
In an open 14-day clinical study, 32 patients diagnosed with myocardial or chronic venous insufficiency were treated with 15 ml of nettle herb juice three times daily. A significant increase in the daily volume of urine was observed throughout the treatment, the volume in day two being 9.2% higher (p<0.0005) than the baseline amount in patients with myocardial insufficiency and 23.9% higher (p<0.05) in those with chronic venous insufficiency. Minor decreases in body weights (approximately 1%) and systolic blood pressure were also observed. Serum parameters were unaffected and the treatment was well tolerated apart from a tendency towards diarrhea. The treatment produced a distinct diuretic effect (Kirchhoff, 1983).
Pharmacopeial gradestinging nettle herb (leaf, flower, and stem) must be collected during the flowering period and contain not less than 18% water-soluble extractives, not more than 2% stem above 3 mm in diameter, and other quantitative standards. Botanical identity must be confirmed by thin-layer chromatography (TLC) as well as macrocopic and microscopic authentication (BHP, 1996). The German Pharmacopoeia and German Pharmaceutical Codex require similar standards though they do not have a water-soluble extractive requirement and the Codex requires not more than 10% stem fragments (DAB 10, 1994; DAC, 1986; Wichtl and Bisset, 1994). The ESCOP monograph requires that the material comply with the standards of the German Pharmacopoeia or the Swiss Pharmacopoeia (ESCOP, 1997).
Stinging nettle root is used in Germany as a component of approved medicines for treatment of benign prostatic hyperplasia (BPH). In the United States, it is used similarly though as a dietary supplement its indications for use are limited to non-therapeutic "structure and function" claims.Naturopathic physicians prescribe it for BPH.
Modern clinical studies have investigated the use of nettle root in the treatment of BPH (Belaiche and Lievoux, 1991; Bombardelli and Morazzoni, 1997; ESCOP, 1997; Krzeski et al., 1993; Leung and Foster, 1996; Schneider et al., 1995; Skeland and Albrecht, 1997; Vontobel et al., 1985).
In a randomized, reference-controlled, multicenter, double-blind clinical trial 543 patients with Aiken's stage I to II BPH compared therapeutic equivalence between finasteride (Proscar®, Merck), and a combination nettle root-saw palmetto fruit extract (PRO® 160/120, Prostagutt® forte). For 48 weeks, patients were given 2 capsules of PRO® 160/120 or 1 capsule of finasteride per day. The primary variable was the change of the maximum urinary flow after 24 weeks of therapy. Urodynamic parameters such as average urinary flow, micturition volume, and micturition time were monitored as secondary variables. An increase in urinary flow rate was observed in both treatment groups (1.9 ml/s with PRO160/120; 2.4 ml/s with finasteride). The average urinary flow increased, whereas the micturition time decreased in both groups to a similar extent. The International Prostate Symptom Score (IPSS) decreased from 11.3 to 8.2 after 24 weeks and to 6.5 at week 48 for the PRO160/120 group, and from 11.8 to 8.0 and to 6.2 at week 48 for the finasteride group. Fewer adverse reactions were reported for the nettle-saw palmetto treatment group, such as diminished ejaculation volume, erectile dysfunction, and headache (Skeland and Albrecht, 1997).
An open, prospective, multicenter observational study involving 419 specialist urological practices tested the efficacy and tolerability of a combination preparation made of stinging nettle root extract (WS 1031; Schwabe, Germany) and saw palmetto fruit (Serenoa repens) extract (WS 1473; Prostagutt®, Schwabe, Germany) with 2,080 patients suffering from BPH, stage I to II according to Aiken. A before-and-after comparison revealed an improvement in the pathological findings and in the obstructive and irritative symptoms. Efficacy and tolerability of the preparation were assessed by the physicians as generally "good" or "very good." Most patients in the study reported an improvement in their prostatic symptoms and general quality of life (Schneider et al., 1995).
In a double-blind study, 134 patients between the ages of 53 and 84 with symptoms of BPH were drawn from two medical centers in Warsaw. The patients were randomly assigned to receive 2 capsules of the standard dose of a stinging nettle root-pygeum bark (Prunus africanum) preparation (300 mg nettle with 25 mg pygeum) or 2 capsules containing half the standard dose, twice daily for eight weeks. After 28 days of treatment, urine flow, residual urine, and nocturia were significantly reduced in both treatment groups. After 56 days, further significant decreases were found in residual urine in the half-dose group, and in nocturia in both groups. Five patients reported adverse effects from the treatment, though treatment was not discontinued due to side effects. The authors concluded that half-doses of the nettle-pygeum combination extract are as safe and effective as the recommended full dose (Krzeski et al., 1993).
In a placebo controlled, double-blind study the effect on symptomatology and objective findings of stinging nettle root extract vs. placebo were investigated in 50 patients with prostatic hyperplasia. Twenty-five BPH I-II patients were given 300 mg stinging nettle root dry extract (5:1) twice daily for nine weeks, and 25 received placebo. Average age was 67 years. A significant (p<0.05) improvement of micturition volume (44% increase) and maximum urinary flow was observed, and a highly significant (p=0.0005) decrease in serum levels of sex hormone binding globulin (SHBH) (Vontobel et al., 1985).
In another study, 67 men over 60 years of age with prostatic adenoma evaluated the effects of a stinging nettle root alcoholic tincture (1:5, 40% ethanol) with a daily dose of 5 ml. After six months of treatment, symptoms of nocturia were alleviated (nocturnal micturition frequency), especially in less severe cases (Belaiche and Lievoux, 1991).
Pharmacopeial grade stinging nettle root must pass botanical identity tests as determined by TLC as well as macroscopic and microscopic authentication. Quantitative standards include not less than 15% water-soluble extractive (BHP, 1996; DAB, 1997; Wichtl and Bisset, 1994). The ESCOP monograph requires that the material comply with the standards of the German Pharmacopoeia (ESCOP, 1997).
The approved modern therapeutic applications forstinging nettle herb, leaf and root are supportable based on their history of clinical use in well established systems of traditional medicine, on well documented phytochemical investigations,on pharmacological studies in animals,and on human clinical studies.
Stinging nettle root consists of the underground parts of Urtica dioica L., U.urens L., and their hybrids [Fam. Urticaceae] and preparations from nettle root in effective dosage. The preparation contains b-sitosterol in free forms and as glycosides, as well as scopoletin.
Stinging nettle root contains both acid and neutral polysaccharides (2 glucans, 2 glucogalacturonans, and 1 arabinogalactan); sterols (0.21% 3-b-sitosterol, 0.050.2% sitosterol-3-b-D-glucoside); 0.10.2% lectin U. dioica agglutinin or UDA composed of six isolectins; coumarin (approximately 0.0020.01% scopoletin); phenolic acids, phenylpropanoid aldehydes, and alcohols; lignans (neo-olivil and derivatives); fatty acids; tannins; and monoterpenes and triterpenes (Bruneton, 1995; ESCOP, 1997; Leung and Foster, 1996; List and Hrhammer, 1979; Newall et al., 1996; Wichtl and Bisset, 1994).
The Commission E reported increased urinary volume, increased maximum urinary flow, and reduced residual urine activities. Note: This preparation relieves the symptoms of an enlarged prostate without reducing the enlargement. Please consult a physician at regular intervals.
The British Herbal Pharmacopoeia reported prostatic action (BHP, 1996). Preliminary clinical observations of men after long-term treatment with an alcoholic extract of nettle root reported improvement of bladder outlet obstruction symptoms and decrease in post-voiding residual urine (Bruneton, 1995). A study of BPH patients treated with a nettle root alcoholic fluidextract reported a 66% decrease in residual urine; another study reported a reduction of nocturnal micturition frequency in patients over 60 years of age after six months of treatment with a nettle root alcoholic tincture at 5 ml daily (ESCOP, 1997; Leung and Foster, 1996). The active substances responsible for these actions are unknown, which makes quality control and chemical or biological standardization of extracts difficult (Bruneton, 1995; Wichtl and Bisset, 1994).
The Commission E approved the internal use of nettle root for difficulty in urination in benign prostatic hyperplasia stages 1 and 2.
ESCOP indicates its use for symptomatic treatment of micturition disorders [nocturia (excessive nighttime urination), pollakisuria (frequent urination), dysuria (painful urination), or urine retention] in BPH stages 1 and 2 (ESCOP, 1997). The French Herbal Remedies Notice to Applicants for Marketing Authorization allows two uses of nettle root: as an adjunctive treatment for the bladder outlet obstruction symptoms of prostatic origin, and to enhance the renal elimination of water (Bruneton, 1995). It is used as a diuretic for conditions of dropsy and also for early stages of prostatitis. In African medicine it is used to treat diarrhea and as an anthelmintic to expel intestinal worms (List and Hrhammer, 1979).
Occasionally, mild gastrointestinal upsets.
No restrictions known (McGuffin et al. 1997).
Unless otherwise prescribed: 46 g per day of cut root for infusions as well as other galenical preparations for oral use.
Infusion: Steep 1.5 g in 150 ml boiled water for 10 to 20 minutes, three to four times daily.
Decoction: 1.5 g in cold water, heat to boil and keep boiling for about 1 minute, then steep covered for 10 minutes, three to four times daily.
Fluidextract 1:1 (g/ml): 1.5 ml, three to four times daily.
Tincture 1:5 (g/ml): 5.07.5 ml, three to four times daily.
Native dry extract 5.46.6:1 (w/w): 0.220.33 g, three to four times daily.
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- This material was adapted from The Complete German Commission E MonographsTherapeutic Guide to Herbal Medicines. M. Blumenthal, W.R. Busse, A. Goldberg, J. Gruenwald, T. Hall, C.W. Riggins, R.S. Rister (eds.) S. Klein and R.S. Rister (trans.). 1998. Austin: American Botanical Council; Boston: Integrative Medicine Communications.
- 1) The Overview section is new information.
- 2) Description, Chemistry and Pharmacology, Uses, Contraindications, Side Effects, Interactions with Other Drugs, and Dosage sections have been drawn from the original work. Additional information has been added in some or all of these sections, as noted with references.
- 3) The dosage for equivalent preparations (tea infusion, fluidextract, and tincture) have been provided based on the following example:
- Unless otherwise prescribed: 2 g per day of [powdered, crushed, cut or whole] [plant part]
- Infusion: 2 g in 150 ml of water
- Fluidextract 1:1 (g/ml): 2 ml
- Tincture 1:5 (g/ml): 10 ml
- 4) The References and Additional Resources sections are new sections. Additional Resources are not cited in the monograph but are included for research purposes.
- This monograph, published by the Commission E in 1994, was modified based on new scientific research. It contains more extensive pharmacological and therapeutic information taken directly from the Commission E.