Wormwood (Artemisia absinthium)
Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
3,6-Dihydrochamazulene, 3-rhamnoglucoside, 5,6-dihydrochamazulene, absinthe, absinthic acid, absinthin, absinthinin, absinthium, absinthol, acetylenes, ai ye, alpha-thujone, Ambrosia elatior, Ambrosia tenuifolia, anabsinthin, angry wormwood, annual wormwood, arabsin, argy wormwood, artabsin, artabsinolides, artelinic acid, artemether, artemetin, Artemisia absinthium, Artemisia afra, Artemisia annua, Artemisia argyi, Artemisia camphorate, Artemisia japonica, Artemesia maritime, Artemisia mendozana, Artemesia pontica, Artemisia princeps, Artemisia roxburghiana, Artemisia tangutica, Artemisia verlotorum, artemisinin, artemolin, artemotil, artenimol, artesunate, Asteraceae (family), azulenes, beta-pinene, beta-thujone, bisabolene, C13 trans-spiroketal enol ether, C14 trans-spiroketal enol ether, cadinene, camphene, camphor, chamazulene, Chinese wormwood, cineole, diayangambin, dihydroartemisinin (DHA), epiyangambin, fenchone, flavonoids, green fairy, Japanese wormwood, isoabsinthin, isovalerianic acid, lignans, liqueur absinthe, malic acid, matricin, monoterpene ketones, mugwort leaf, nitrate of potash, Parthenium hysterophorus, p-coumaric, phellandrene, phenolic acids, p-hydroxyphenylacetic, pinene, pinocamphone, protocatechuic, pulegone, qinghao (Chinese), qinghaosu (Chinese), quercetin 3-glucoside, quercetin 3-rhamnoglucoside, resin, Roxburgh wormwood, sabinene, sabinylacetate, sesquiterpene lactone peroxide, sesquiterpene lactones, sodium artesunate, spinacetin 3-glucoside, spinacetin 3-rhamnoglucoside, starch, succinic acid, sweet wormwood, syringic, Tangut wormwood, tannin, tenacetone, thujone, thujyl alcohol, trans-dehydromatricaria ester, trans-sabinylacetate, vanillic acid, vintage absinthes, volatile oils, Wermutkraut (German).
Combination product examples: SedaCrohn® (wormwood, rose, cardamom seeds, and mastic resin), Riamet® (artemether and lumefantrine), and Coartem® (artemether and lumefantrine).
Note: This monograph focuses on common wormwood (Artemisia absinthium) and does not specifically include clinical trials investigating the effects of isolated constituents or derivatives of wormwood, such as absinthinin, artemisinin, or artemether.
Wormwood (Artemisia absinthium) is an active ingredient of absinthe, a liqueur, and, in the 18th and early 19th Centuries, it acquired a reputation for triggering psychotic events, called absinthism. Absinthe was banned throughout Western Europe. Modern analyses suggest that the hallucinogenic properties of absinthe are a myth and that the early studies confused the effects of drinking an excessive amount of absinthe from drinking absinthe. Absinthe has consequently returned to the market.
Wormwood and several of its derivatives, including absinthinin, artemether, artesunate, and artemisinin, have been studied for their effects on various conditions. Artemisinin has been studied for treating malaria, including highly drug-resistant strains. Currently, preferred treatments for malaria are combination therapies that include artemisinin derivatives (artemisinin-combination therapies, or ACTs). Use of artemisinin alone is strongly discouraged by the World Health Organization (WHO), due to the potential for malarial parasites to develop resistance to the drug.
At this time, there is insufficient available evidence on the use of Artemisia absinthium for any condition. More high-quality research is needed before firm conclusions can be made.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
In clinical research, wormwood has been found to improve treatment and mood in patients with Crohn's disease. More high-quality studies are needed in this area.
Artemisinin has been identified as an active ingredient of wormwood and is undergoing further analysis, especially for its properties in treating malaria, including highly drug-resistant strains. Currently, preferred treatments for malaria include combination therapies that include artemisinin derivatives (artemisinin-combination therapies, or ACTs).
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.
Anorexia nervosa, antihelminthic, anti-inflammatory, antiseptic, antispasmodic, antitumor, atherosclerosis (hardening of the arteries, prevention), back pain, bloating, cancer, carminative (gas reliever), cholagogue (promotes bile flow), convulsions, depression, diuretic, dropsy (water retention), emmenagogue (promotes menstrual flow), fibromyalgia, flavoring, hemorrhoids, herpes, hypnotic, improvement of mental state, insect and spider bites, insecticidal, jaundice, labor pains, mood, neonatal jaundice, neurasthenia (nervous breakdown), pain relief, parasitic worm infections, preservative, schistosomiasis (parasite infection), skin wounds, stimulant, stomach ailments, tonic.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
Wormwood has been taken by mouth as juice of wormwood leaves, as an herbal blend, as tea made of dried wormwood, as a tincture, or in pill form. Juice of wormwood leaves has been applied to skin wounds.
For Crohn's disease, 750 milligrams of an herbal blend of wormwood has been taken two times daily for 10 weeks.
For malaria, tea traditionally prepared from nine grams of Artemisia annua leaves per one liter of water has been taken by mouth.
Children (under 18 years old)
There is no proven safe or effective dose of wormwood in children.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. 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. Consult a healthcare provider immediately if you experience side effects.
Avoid with known allergy or hypersensitivity to Artemisia, its constituents, or members of the Asteraceae family.
Side Effects and Warnings
Abdominal cramps, drooling, and vomiting have been reported with use of wormwood by mouth. Wormwood may also cause dizziness, effects on vision, gastrointestinal symptoms, or insomnia and may counteract alcohol-induced reduced anxiety.
Use cautiously, as adverse effects may occur following excessive consumption of Artemisia absinthium or after drinking the essential oil of wormwood.
Use cautiously in patients with heart conditions, as abnormally slow heartbeat has been reported in a comatose patient with severe absinthe intoxication.
Use cautiously in patients with gastrointestinal disorders, musculoskeletal disorders, or neurological conditions.
Use cautiously in individuals with kidney dysfunction, as, according to a case report, a man who drank about 10 milliliters of oil of Artemisia absinthium developed kidney failure, which resolved within a few days after he stopped ingesting the oil.
Avoid in pregnant or breastfeeding women, due to a lack of available scientific evidence and safety information.
Avoid in individuals with known allergy or hypersensitivity, including atopic asthma and contact dermatitis, to Artemisia, its constituents, or members of the Asteraceae family.
Note: Confusing the liquor absinthe and the oil of absinthe led one person to drink the oil; initial confusion followed by incomprehensibility, seizures, and violent behavior ensued. Haloperidol quickly improved his mental condition.
Pregnancy and Breastfeeding
Avoid in pregnant or breastfeeding women, due to a lack of available scientific evidence and safety information.
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.
Interactions with Drugs
Wormwood may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may change in the blood and may cause increased or decreased effects or potentially serious adverse reactions. Patients taking any medication should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
Wormwood may interact with agents that affect the immune system, agents that affect the blood, agents that damage the kidney, agents that prevent formation of new blood vessels, alcohol, agents that affect heart rhythm, anticancer agents, anti-inflammatory agents, antimalarial agents, antimicrobials, butyric acid, cannabinoids, drugs that affect GABA, gastrointestinal agents, hormonal agents, neurologic agents, serotonin receptor antagonists, or skeletal muscle relaxants.
Interactions with Herbs and Dietary Supplements
Wormwood may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of other herbs or supplements may become too high or too low in the blood. It may also alter the effects that other herbs or supplements possibly have on the cytochrome P450 system.
Wormwood may interact with anticancer herbs and supplements, anti-inflammatory herbs and supplements, antimalarial herbs and supplements, antimicrobials, antioxidants, cannabinoids, gastrointestinal herbs and supplements, herbs and supplements that affect GABA, herbs and supplements that affect heart rhythm, herbs and supplements that affect the blood, herbs and supplements that damage the kidney, herbs and supplements that affect the immune system, herbs and supplements that prevent formation of new blood vessels, hormonal herbs and supplements, neurologic herbs and supplements, serotonin receptor antagonists, skeletal muscle relaxants, or vitamin E.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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.
Chung MJ, Kang AY, Park SO, et al. The effect of essential oils of dietary wormwood (Artemisia princeps), with and without added vitamin E, on oxidative stress and some genes involved in cholesterol metabolism. Food Chem Toxicol 2007;45(8):1400-1409. View Abstract
Dettling A, Grass H, Schuff A, et al. Absinthe: attention performance and mood under the influence of thujone. J Stud Alcohol 2004;65(5):573-581. View Abstract
Efferth T. Willmar Schwabe Award 2006: antiplasmodial and antitumor activity of artemisinin--from bench to bedside. Planta Med 2007;73(4):299-309. View Abstract
Krebs S, Omer TN, Omer B. Wormwood (Artemisia absinthium) suppresses tumour necrosis factor alpha and accelerates healing in patients with Crohn's disease - A controlled clinical trial. Phytomedicine 2010;17(5):305-9. View Abstract
Krishna S, Bustamante L, Haynes RK, et al. Artemisinins: their growing importance in medicine. Trends Pharmacol Sci 2008;29(10):520-527. View Abstract
Lachenmeier DW. [Absinthe - history of dependence to thujone or to alcohol?]. Fortschr Neurol Psychiatr 2007;75(5):306-308. View Abstract
Lachenmeier DW. [Thujone-attributable effects of absinthe are only an urban legend--toxicology uncovers alcohol as real cause of absinthism]. Med Monatsschr Pharm 2008;31(3):101-106. View Abstract
Lundh K, Hindsen M, Gruvberger B, et al. Contact allergy to herbal teas derived from Asteraceae plants. Contact Dermatitis 2006;54(4):196-201. View Abstract
Meschler JP, Howlett AC. Thujone exhibits low affinity for cannabinoid receptors but fails to evoke cannabimimetic responses. Pharmacol Biochem Behav 1999;62(3):473-480. View Abstract
Mueller MS, Runyambo N, Wagner I, et al. Randomized controlled trial of a traditional preparation of Artemisia annua L. (Annual Wormwood) in the treatment of malaria. Trans R Soc Trop Med Hyg 2004;98(5):318-321. View Abstract
Olsen OT, Frolund L, Heinig J, et al. A double-blind, randomized study investigating the efficacy and specificity of immunotherapy with Artemisia vulgaris or Phleum pratense/betula verrucosa. Allergol Immunopatho (Madr) 1995;23(2):73-78. View Abstract
Omer B, Krebs S, Omer H, et al. Steroid-sparing effect of wormwood (Artemisia absinthium) in Crohn's disease: a double-blind placebo-controlled study. Phytomedicine 2007;14(2-3):87-95. View Abstract
Rath K, Taxis K, Walz G, et al. Pharmacokinetic study of artemisinin after oral intake of a traditional preparation of Artemisia annua L. (annual wormwood). Am J Trop Med Hyg 2004;70(2):128-132. View Abstract
Sundar SN, Marconett CN, Doan VB, et al. Artemisinin selectively decreases functional levels of estrogen receptor-alpha and ablates estrogen-induced proliferation in human breast cancer cells. Carcinogenesis 2008;29(12):2252-2258. View Abstract
Weisbord SD, Soule JB, and Kimmel PL. Poison on line--acute renal failure caused by oil of wormwood purchased through the Internet. N Engl J Med 1997;337(12):825-827 View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017