Synonyms/Common Names/Related Substances:

• Aescin, aescine, Aesculaforce®, aescule, aesculetin, buckeye, bongay, chestnut, conkers, Conquerors, coumarins, eschilo, escin, escina, escine, esculin, fatty acids, fish poison, flavonoids, graine de marronier d'Inde (French), fraxetin glucoside, fraxin, H. vulgare Gaertnhestekastanje, HCSE, Hippocastabi foliu, Hippocastanaceae (family), Hippocastani semen, horse chestnut seed extract, horsechestnut, linolenic acid, Marron Europeen, Marronier, NV-101, palmitic acid, quinines, Rokastaniensamen, rosskastanie, scopoletin glucoside, scopolin, Spanish chestnut, tannins, steric acid, sterols, Venastat®, Venoplant®.
• Combination product examples: Venostasin® (a German preparation containing 100mg of escin).

Clinical Bottom Line/Effectiveness

Brief Background:

• Horse chestnut seed extract (HCSE) is widely used in Europe for chronic venous insufficiency (CVI), a syndrome characterized by lower extremity edema, varicosities (1), pain, pruritus, atrophic skin changes, and ulcerations (2;​3). CVI is the only indication for which there is strong supportive scientific evidence (4;​5;​6), although horse chestnut has traditionally been recommended for a variety of medical conditions.
• Review of the literature reveals 14 randomized controlled trials, of which seven are well-designed (albeit limited by small size and short duration). These studies support the superiority of HCSE over placebo and suggest equivalence to compression stockings. Recent research indicates that HCSE combined with conventional therapy for CVI may be more cost effective (7).
• Side effects of HCSE have been similar to placebo in clinical trials. However, due to an increased risk of hypoglycemia, caution is advised in children and people with diabetes.
• Horse chestnut flower, branch bark, and leaves have not been shown to be effective for any indication, and it is strongly advised that they be avoided due to known toxicity (8).

Dosing/Toxicology

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Precautions/Contraindications

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Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

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Mechanism of Action

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History

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Evidence Table

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Evidence Discussion

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Products Studied

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Author Information

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References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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