Herbal Monograph
Devil's claw
Harpagophytum procumbens (Burch.) DC. ex Meisn.
Pedaliaceae
Premier anti-inflammatory bitter for osteoarthritis, low back pain, and loss ...
Overview
Plant Description
Perennial herb with a succulent primary taproot ('mother tuber') that can extend up to 2 m deep. From the primary tuber, fleshy lateral roots develop secondary storage tubers ('babies') that can reach up to 25 cm long and 6 cm thick; these secondary tubers are the medicinal part. Annual, prostrate (procumbent) creeping stems arise each season and can extend up to 1.5-2 m along the ground surface. Leaves are opposite, simple, petiolate, up to 6.5 cm long and 4 cm wide, with deeply to shallowly lobed margins, greyish-green in color and slightly fleshy. Flowers are tubular, 5-6 cm long, solitary in leaf axils, light purple to pink (occasionally white) on the exterior with a yellow interior to the tube. Fruit is a large, woody capsule up to 15 cm in diameter bearing four rows of curved, branching arms tipped with sharp, recurved hooks (the 'devil's claws' for which the plant is named). These hooked fruits attach to the hooves and feet of large animals for seed dispersal and can cause significant injury. Seeds are numerous, black, and flattened.
Habitat
Native to the deep Kalahari sand of southern Africa. Grows in red, sandy soils of open savanna, grassland margins, and degraded or overgrazed land at elevations of 500-1000 m. Adapted to harsh, semi-arid conditions with hot summers, cold winters, and irregular rainfall (200-500 mm annually). The deep taproot and secondary storage tubers are adaptations to prolonged drought, storing the trisaccharide stachyose as a photosynthetic reserve. The plant goes dormant during the dry winter months, with above-ground parts dying back entirely.
Distribution
Endemic to southern Africa. Found primarily in the eastern and southeastern parts of Namibia, southern Botswana, the Kalahari region of the Northern Cape Province of South Africa, and parts of the North West Province, Limpopo Province, and southern Zimbabwe. Namibia is the major exporting country, followed by Botswana and South Africa. Not successfully cultivated commercially at scale; virtually all material in trade is wild-harvested.
Parts Used
Secondary storage tuber (Harpagophyti radix — dried, sliced secondary roots/tubers)
Preferred: Dried, sliced tubers for decoction or aqueous extract; standardized dry extract (tablets/capsules) for clinical use; tincture for bitter tonic applications
The European Pharmacopoeia, EMA, Commission E, and WHO monographs all specify the dried secondary storage tubers (also called 'secondary roots' or 'tuberous secondary roots') as the official drug. The secondary tubers are richer in iridoid glycosides (particularly harpagoside) than the primary tuber. The primary tuber is not used medicinally and must be left intact during harvesting for plant survival. The official drug consists of the cut and dried tuberous secondary roots, with a minimum harpagoside content of 1.2% (Ph. Eur.). The drug has a characteristic bitter taste due to the iridoid glycoside content.
Key Constituents
Iridoid glycosides
The iridoid glycoside fraction — particularly harpagoside — is the principal driver of devil's claw's anti-inflammatory and analgesic activity. Harpagoside inhibits the NF-kB and AP-1 signaling pathways, suppressing COX-2, iNOS, and pro-inflammatory cytokine expression. Clinical standardization of extracts is based on harpagoside content, with 50-100 mg harpagoside per day as the therapeutic target for musculoskeletal indications. However, there is growing evidence that the whole extract, including minor iridoids and other constituents, may contribute synergistically to the overall anti-inflammatory effect, and that isolated harpagoside does not fully account for the activity of crude drug preparations.
Phenylethanoid glycosides (phenylpropanoids)
The phenylethanoid glycoside fraction, primarily verbascoside, contributes antioxidant and additional anti-inflammatory activity. Verbascoside is a potent free radical scavenger and inhibitor of lipid peroxidation. These compounds may act synergistically with the iridoid glycosides to produce the overall anti-inflammatory effect observed with whole devil's claw extracts.
Sugars and oligosaccharides
The high stachyose content is relevant to the pharmaceutical quality and processing of devil's claw material. Stachyose itself is not directly responsible for the anti-inflammatory activity but contributes to the solubility profile of aqueous extracts. Its prebiotic properties may have secondary gastrointestinal effects. The high sugar content also affects stability and storage requirements.
Triterpenes and phytosterols
Triterpenes and phytosterols contribute ancillary anti-inflammatory activity but are not considered primary active constituents. Their concentrations are too low to drive the therapeutic effect independently.
Flavonoids
The flavonoid fraction is minor in devil's claw compared to many other medicinal plants. Flavonoids contribute to the antioxidant capacity of the extract but are not considered major drivers of the primary therapeutic effects.
Other constituents
Minor constituents providing ancillary antioxidant and antimicrobial effects. Harpagoquinone is a chemotaxonomic marker for the genus. Phenolic acids contribute to the overall polyphenol content and antioxidant capacity.
Herbal Actions
Reduces inflammation
The principal and best-documented action of devil's claw. Demonstrated in multiple in vitro and in vivo models: inhibition of LPS-stimulated COX-2 and iNOS expression via NF-kB pathway suppression; reduction of pro-inflammatory cytokines (TNF-alpha, IL-6, IL-1beta) from human monocytes; inhibition of AP-1-mediated inflammatory gene transcription. Harpagoside is the primary driver but the whole extract appears more potent than isolated harpagoside, suggesting synergistic contributions from other constituents. Commission E approved for supportive therapy of degenerative disorders of the locomotor system. EMA recognizes well-established use for relief of minor articular pain.
[1, 2, 15, 16]Relieves pain
Analgesic activity demonstrated in clinical trials for osteoarthritis and low back pain. The mechanism is primarily related to inhibition of inflammatory mediators (COX-2, prostaglandins) rather than a direct central analgesic effect. Clinical trials using standardized extracts providing 50-100 mg harpagoside per day have shown significant pain reduction in osteoarthritis and chronic low back pain. One pilot study found non-inferiority to 12.5 mg rofecoxib (Vioxx) per day for low back pain.
[2, 10, 11]Devil's claw is a pronounced bitter (due to the iridoid glycoside content) and stimulates appetite and digestive secretions including gastric acid, bile, and pancreatic enzymes. Commission E approved specifically for loss of appetite (Appetitlosigkeit) and dyspeptic complaints. This is one of the two principal approved indications (alongside musculoskeletal support). The bitter action underlies the traditional African use as a digestive remedy and the contraindication in gastric/duodenal ulcers (stimulation of gastric acid in an already-ulcerated stomach).
[1, 3, 5]Used for symptomatic relief in both degenerative (osteoarthritis) and inflammatory (rheumatoid) arthritic conditions. ESCOP and BHP list antirheumatic as a key action. Evidence for osteoarthritis is stronger than for rheumatoid arthritis. The combination of anti-inflammatory, analgesic, and putative chondroprotective effects contributes to the antirheumatic profile. Requires prolonged use (at least 2-3 months) to achieve full benefit.
[4, 8, 10]Traditional use in southern African medicine as a febrifuge (fever reducer). Pharmacological rationale based on inhibition of prostaglandin synthesis via COX pathway suppression. Clinical evidence for antipyretic action is limited to traditional reports and is not a primary therapeutic application in Western herbalism.
[3, 17]Therapeutic Indications
Musculoskeletal System
Osteoarthritis (degenerative joint disease)
Commission E approved for 'supportive therapy of degenerative disorders of the locomotor system.' EMA well-established use monograph for 'relief of minor articular pain.' Gagnier et al. (2004) systematic review found moderate evidence for Harpagophytum powder at 60 mg harpagoside/day in osteoarthritis of spine, hip, and knee. Farpour et al. (2021) RCT in knee OA found significant pain reduction with Harpagophytum extract. Evidence is strongest for hip and knee OA. Treatment duration of at least 2-3 months recommended for full benefit.
[1, 2, 10, 14]Chronic non-specific low back pain
Strong evidence from multiple RCTs and systematic reviews. Gagnier et al. (2004): strong evidence for aqueous extract at 50 mg harpagoside/day for acute exacerbations of chronic NSLBP. Chrubasik et al. (2003) pilot RCT found Doloteffin (60 mg harpagoside/day) non-inferior to rofecoxib 12.5 mg/day, with fewer severe adverse events. Cochrane review of herbal medicine for low back pain (Gagnier et al., 2006) concluded devil's claw has an impact on pain greater than placebo. Commission E indication for 'degenerative disorders of the locomotor system' encompasses this use.
[1, 10, 11, 12]Tendinitis and soft tissue rheumatism
Traditional use for tendinitis and non-articular musculoskeletal pain. Pharmacological rationale based on anti-inflammatory and analgesic actions. Clinical evidence is largely extrapolated from osteoarthritis and low back pain trials. Hoffmann recommends devil's claw for 'tendonitis' specifically.
[5, 6]Myalgia and fibromyalgia
Limited clinical evidence. One open-label study suggested benefit in fibromyalgia symptoms, but methodological quality was low. Anti-inflammatory and analgesic mechanisms provide rationale. Not a primary indication in any authoritative monograph.
[2]gastrointestinal
Loss of appetite (anorexia)
Commission E approved indication: 'loss of appetite' (Appetitlosigkeit). The pronounced bitter taste of devil's claw stimulates gustatory and gastric reflexes, promoting appetite and digestive secretion. This is one of the two principal Commission E-approved indications. WHO monograph also lists appetite stimulation. Used as a bitter tonic in a manner analogous to gentian root.
[1, 3]Dyspeptic complaints
Commission E approved for 'dyspeptic complaints.' ESCOP monograph includes 'symptomatic treatment of dyspepsia.' The bitter iridoid glycosides stimulate gastric acid, bile, and pancreatic enzyme secretion, improving digestive function. Lower doses are used for digestive indications compared to musculoskeletal use (typically 1.5 g dried tuber or equivalent, three times daily).
[1, 3, 4]Cardiovascular System
Hypertension (adjunctive)
Isolated case reports suggest potential cardiovascular effects. One case report documented hypertension associated with devil's claw use. Paradoxically, some traditional sources suggest mild hypotensive activity. The evidence is contradictory and insufficient to support or contraindicate use for cardiovascular conditions. Not listed as an indication in any authoritative monograph. Patients on cardiovascular medications should be monitored.
[13]Energetics
Temperature
cool
Moisture
dry
Taste
Tissue States
hot/excitation, damp/stagnation
Devil's claw is cooling and drying in Western energetic assessment, reflecting its pronounced bitter taste and anti-inflammatory action. The strong bitterness (from iridoid glycosides) stimulates digestive secretions and promotes metabolic 'clearing' — consistent with the traditional use for loss of appetite and dyspepsia. The cooling quality aligns with its use in hot, inflammatory joint conditions (osteoarthritis, rheumatic inflammation). The drying tendency relates to its stimulation of digestive secretions and its action on damp, boggy inflammatory states. This energetic profile means devil's claw is best indicated for hot, inflammatory musculoskeletal conditions with tissue swelling and stagnation, and for sluggish, cold digestive patterns with loss of appetite. It is less indicated for cold, deficient constitutions or for dry, atrophic conditions.
Traditional Uses
Khoisan and San traditional medicine (southern Africa)
- Bitter tonic for loss of appetite and indigestion
- Febrifuge (fever reducer)
- Treatment of rheumatic conditions and pain
- Aid during childbirth (oxytocic)
- Treatment of menstrual problems
- Purgative / blood purifier
- Treatment of sores, ulcers, and boils (topical)
- Treatment of syphilis and other 'blood diseases'
- General health tonic
- Treatment of sprains and soft tissue injuries
"The Khoisan peoples of the Kalahari region have used devil's claw for centuries as a general health tonic and for the treatment of pain, fever, digestive complaints, and skin conditions. A German trader and colonial farmer named G.H. Mehnert learned of the plant's medicinal properties from the San and Nama peoples in Namibia in the early 1900s, introducing it to European phytotherapy. Mncwangi et al. (2012): 'Historically, the native Khoisan people have harvested and utilised devil's claw for childbirth, loss of appetite, and as a purgative, as well as for treatment of various diseases and ailments such as menstrual problems, indigestion, bitter tonic, inflammation, and syphilis.'"
German phytotherapy (Commission E / ESCOP)
- Loss of appetite (bitter tonic)
- Dyspeptic complaints
- Supportive therapy of degenerative disorders of the locomotor system
"Commission E approved internal use for 'loss of appetite' and 'dyspeptic complaints' and as 'supportive therapy of degenerative disorders of the locomotor system.' ESCOP expanded indications to include 'painful arthrosis' and 'symptomatic treatment of painful osteoarthritis, tendonitis, and loss of appetite.' The entry of devil's claw into European phytotherapy was initiated by G.H. Mehnert's early 20th-century reports, with systematic pharmacological research beginning in the 1950s-1960s by O.H. Volk and subsequently Zorn and colleagues."
British herbal tradition (BHP / BHC)
- Rheumatism and arthritis
- Liver and gallbladder disorders
- Loss of appetite
- Dyspepsia
"The British Herbal Pharmacopoeia lists devil's claw with actions including anti-inflammatory, antirheumatic, analgesic, and sedative. Indicated for rheumatism, arthritis, gout, myalgia, fibrositis, lumbago, and loss of appetite."
[8]
Western clinical herbalism (Hoffmann, Mills & Bone)
- Osteoarthritis and degenerative joint disease
- Rheumatoid arthritis (adjunctive)
- Chronic low back pain
- Tendinitis
- Gout (adjunctive)
- Dyspepsia and loss of appetite
"Hoffmann (2003): 'Devil's claw is used in the treatment of arthritis, and has significant anti-inflammatory activity. Other actions of Harpagophytum that aid in its anti-arthritic application are its analgesic and vasodilatory effects. It can be used in tendonitis and to treat degenerative diseases of the musculoskeletal system.' Mills & Bone (2013) emphasize that devil's claw needs relatively large doses for musculoskeletal benefit and recommend use over a minimum of 2-3 months."
Modern Research
Osteoarthritis and low back pain (systematic review)
Systematic review of randomized and controlled trials evaluating Harpagophytum procumbens for osteoarthritis and low back pain.
Findings: Gagnier et al. (2004) identified twelve trials: six investigating osteoarthritis, four low back pain, and two mixed-pain conditions. The review found: (1) strong evidence for aqueous extract at 50 mg harpagoside/day for acute exacerbations of chronic non-specific low back pain; (2) moderate evidence for Harpagophytum powder at 60 mg harpagoside/day in osteoarthritis of spine, hip, and knee; (3) moderate evidence for aqueous extract at 60 mg harpagoside being non-inferior to rofecoxib 12.5 mg/day for chronic NSLBP; (4) limited evidence for ethanolic extract containing less than 30 mg harpagoside/day in knee and hip OA.
Limitations: Many of the published trials lacked important methodological quality criteria. Heterogeneity in preparations, dosages, and outcome measures prevented meta-analysis. Most trials were of short duration (4-16 weeks). Some trials were industry-sponsored.
[10]
Comparison with rofecoxib for low back pain
Randomized double-blind pilot study comparing Doloteffin (Harpagophytum extract) with Vioxx (rofecoxib) for non-specific low back pain.
Findings: Chrubasik et al. (2003) randomized 88 patients with acutely exacerbated chronic low back pain to Doloteffin (60 mg harpagoside/day) or rofecoxib (12.5 mg/day) for 6 weeks. Results showed no statistically significant difference between groups in pain reduction. Seven drop-outs occurred due to adverse events (Harpagophytum = 1; rofecoxib = 6). Adverse events (primarily gastrointestinal) occurred in 14 participants per group but were more severe in the rofecoxib group.
Limitations: Pilot study with small sample size (N=88). Not powered for definitive equivalence or non-inferiority conclusions. Six-week duration. Rofecoxib was subsequently withdrawn from the market (2004) for cardiovascular safety reasons, limiting the ongoing relevance of this specific comparator.
[11]
Anti-inflammatory mechanism (NF-kB and AP-1 pathways)
Investigation of molecular targets of Harpagophytum procumbens extract in inflammatory signaling pathways.
Findings: Fiebich et al. (2012) demonstrated that Harpagophytum extract inhibits LPS-stimulated TNF-alpha and COX-2 gene expression by preventing activation of the AP-1 transcription factor in human monocytes. Huang et al. (2006) showed that harpagoside suppresses LPS-induced iNOS and COX-2 expression through inhibition of NF-kB activation in RAW 264.7 macrophages. Together, these studies establish dual pathway inhibition (NF-kB and AP-1) as the molecular basis for devil's claw's anti-inflammatory action, with downstream suppression of PGE2, TNF-alpha, IL-6, IL-1beta, and nitric oxide production.
Limitations: In vitro studies using LPS-stimulated cell lines. Concentrations used may not directly correspond to achievable tissue concentrations after oral dosing in humans. The contribution of individual constituents versus the whole extract remains incompletely resolved.
Safety systematic review
Systematic review of the safety profile of Harpagophytum preparations in clinical trials.
Findings: Vlachojannis et al. (2008) reviewed safety data from 28 clinical trials dating back to 1985. Minor adverse events occurred in approximately 3% of patients, mainly gastrointestinal (diarrhea, nausea, abdominal pain). In none of the double-blind studies was the incidence of adverse events during Harpagophytum treatment higher than during placebo treatment. The review confirmed contraindication in patients with gastric or duodenal ulcers due to stimulation of gastric acid secretion. Cardiovascular effects were deemed unlikely at standard doses based on available data.
Limitations: Long-term safety data (beyond 16 weeks) is limited. Reproductive toxicity, genotoxicity, mutagenicity, and carcinogenicity studies were noted as urgently needed. Most trials used proprietary standardized extracts, and safety data may not be directly generalizable to all preparations.
[13]
Knee osteoarthritis RCT
Randomized active-controlled trial evaluating Harpagophytum extract (Teltonal) efficacy in knee osteoarthritis.
Findings: Farpour et al. (2021) randomized patients with knee osteoarthritis to Harpagophytum extract or diacerein (an IL-1 inhibitor) for 4 months. Both groups showed significant improvement in WOMAC pain, stiffness, and function scores. The Harpagophytum group was non-inferior to diacerein, with a better gastrointestinal side-effect profile. This trial provides additional evidence for devil's claw's efficacy in knee OA specifically.
Limitations: Active-controlled design (no placebo arm). Single-center study. Four-month duration, which, while longer than many earlier trials, may not capture long-term effects.
[14]
Preparations & Dosage
Decoction
Strength: 1.5 g dried tuber per cup (musculoskeletal); 0.5 g per cup (digestive)
Add 4.5 g (approximately 1 tablespoon) of dried, sliced devil's claw tuber to 500 mL of cold water. Bring slowly to a boil, then simmer gently for 15-20 minutes. Strain. The resulting decoction is very bitter.
1.5 g dried tuber per 150-200 mL water, three times daily (total 4.5 g/day) for musculoskeletal indications; 0.5 g per cup, three times daily (total 1.5 g/day) for loss of appetite and dyspepsia
Three times daily, 30 minutes before meals (for bitter tonic/digestive indications) or between meals (for musculoskeletal indications)
Musculoskeletal: minimum 2-3 months for full benefit, may be continued long-term with periodic reassessment. Digestive: 2-4 weeks, then reassess.
Not recommended for children under 18 years due to insufficient safety data
Decoction is the traditional African preparation method and the basis for many early clinical studies. Aqueous extraction preserves the iridoid glycosides and sugars. The decoction is extremely bitter — this is therapeutically intentional for digestive indications but patients may find it difficult to consume. Commission E and ESCOP dosage recommendations are based on this preparation method.
Tincture
Strength: 1:5 in 25% ethanol (dried tuber); 1:10 in 25% ethanol
Macerate dried devil's claw tuber in 25% ethanol at a ratio of 1:5 for 2-4 weeks. Press and filter. Alternatively, use 1:10 ratio in 25% ethanol.
1:5 tincture (25% ethanol): 0.5-1 mL, three times daily. 1:10 tincture (25% ethanol): 1-3 mL, three times daily. Lower doses for digestive indications; higher doses for musculoskeletal use.
Three times daily
Musculoskeletal: 2-3 months minimum. Digestive: 2-4 weeks.
Not recommended for children under 18 years
Tincture is a common preparation in Western herbalism. Lower ethanol percentages (25%) are preferred to maintain extraction of the water-soluble iridoid glycosides. Higher alcohol concentrations may reduce extraction efficiency for harpagoside and harpagide. The tincture form delivers a strong bitter stimulus that is therapeutically advantageous for digestive indications.
capsule/tablet (standardized dry extract)
Strength: Standardized to minimum 1.5% harpagoside (dry extract); target daily dose: 50-100 mg harpagoside
Commercially prepared standardized dry extracts in tablet or capsule form. Extracts are typically standardized to contain a minimum of 1.5-2% harpagoside. Take with water, with or between meals.
Dry extract equivalent to 50-100 mg harpagoside per day for musculoskeletal indications (this typically corresponds to 600-1200 mg of standardized extract per day, depending on extraction ratio and standardization). Equivalent to 1.5-3 g crude drug three times daily.
Divided into 2-3 doses daily
Minimum 2-3 months for musculoskeletal benefit; may be continued long-term
Not recommended for children under 18 years
Standardized extracts are the most clinically studied preparation form. The majority of positive clinical trial data is based on proprietary aqueous or hydroalcoholic extracts standardized to harpagoside content, particularly WS 1531 (now Doloteffin, Ardeypharm) and LI 174 (Rivoltan, Bionorica). Evidence is strongest at the higher dose level (equivalent to 60-100 mg harpagoside/day). Extracts providing less than 30 mg harpagoside/day showed limited clinical evidence.
powdered drug
Strength: Crude powdered drug; harpagoside content should be verified (Ph. Eur. minimum 1.2%)
Dried devil's claw tuber ground to a fine powder. Can be taken in capsules or mixed into food/liquid.
1.5-3 g of powdered dried tuber, three times daily (total 4.5-9 g/day) for musculoskeletal indications. 0.5 g three times daily for appetite/digestive use.
Three times daily
Minimum 2-3 months for musculoskeletal indications
Not recommended for children under 18 years
Powdered crude drug delivers the complete phytochemical profile including all iridoid glycosides, phenylethanoids, and sugars. Higher daily doses are needed compared to standardized extracts because the crude drug has lower harpagoside concentration per gram. The extremely bitter taste makes capsule administration preferable to bulk powder in liquid.
Safety & Interactions
Class 2b
Not to be used during lactation (AHPA Botanical Safety Handbook)
Contraindications
AHPA Class 2d: 'Not to be used by persons with gastric or duodenal ulcers.' Devil's claw is a potent bitter that stimulates gastric acid secretion. In patients with active gastric or duodenal ulceration, this increased acid production can exacerbate mucosal damage and delay healing. Commission E lists 'gastric and duodenal ulcers' as a specific contraindication. ESCOP and WHO monographs concur.
AHPA Class 2b: 'Not to be used during pregnancy.' Traditional use as an oxytocic (to stimulate uterine contractions during childbirth) in Khoisan medicine supports this contraindication. Animal studies have shown potential uterine stimulant effects. No human safety data in pregnancy. Commission E, ESCOP, WHO, and EMA monographs all contraindicate use during pregnancy. The WHO monograph specifically states: 'Harpagophytum should not be used during pregnancy due to its traditional oxytocic effects.'
Commission E lists gallstones as a contraindication due to the cholagogue (bile-stimulating) action of bitter iridoid glycosides. Stimulation of bile flow in patients with gallstones could potentially provoke biliary colic. ESCOP considers this a precaution rather than an absolute contraindication.
Drug Interactions
| Drug / Class | Severity | Mechanism |
|---|---|---|
| Warfarin and other anticoagulants (Anticoagulants / antithrombotics) | moderate | One case report documented purpura in a patient on warfarin who was also taking devil's claw. Possible mechanism includes CYP enzyme inhibition affecting warfarin metabolism. In vitro studies suggest harpagoside may inhibit CYP2C9 and CYP3A4 at high concentrations. |
| Antihypertensive medications (Antihypertensives) | theoretical | Contradictory reports: traditional sources suggest mild hypotensive activity, while a case report documented hypertension. The net cardiovascular effect at standard doses is uncertain. |
| Proton pump inhibitors and H2 antagonists (Acid-suppressive medications) | theoretical | Pharmacological antagonism: devil's claw stimulates gastric acid secretion (bitter action) while PPIs and H2 blockers suppress it. Concurrent use may reduce the efficacy of acid-suppressive therapy. |
| Hypoglycemic agents (insulin, sulfonylureas, metformin) (Antidiabetic medications) | theoretical | Limited animal data suggests possible hypoglycemic effects. Mechanism not established. |
Pregnancy & Lactation
Pregnancy
unsafe
Lactation
insufficient data
Pregnancy: Contraindicated (AHPA Class 2b). Traditional use as an oxytocic in Khoisan medicine for stimulating uterine contractions during childbirth provides a clear rationale for avoidance during pregnancy. Animal data suggests potential uterine stimulant effects. No human safety data in pregnancy. All major monograph sources (Commission E, ESCOP, WHO, EMA) contraindicate use during pregnancy. Lactation: Insufficient data. No studies on transfer of harpagoside or other constituents into breast milk. No traditional use data specific to lactating women. Avoidance during lactation is recommended as a precautionary measure due to the absence of safety data.
Adverse Effects
References
Monograph Sources
- [1] Blumenthal, M., Busse, W.R., Goldberg, A., et al.. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council / Integrative Medicine Communications (1998) . ISBN: 978-0965555500
- [2] Committee on Herbal Medicinal Products (HMPC). European Union herbal monograph on Harpagophytum procumbens DC. and/or Harpagophytum zeyheri Decne., radix. European Medicines Agency (2016)
- [3] World Health Organization. WHO Monographs on Selected Medicinal Plants — Volume 3: Radix Harpagophyti. World Health Organization (2007) . ISBN: 978-9241547024
- [4] ESCOP (European Scientific Cooperative on Phytotherapy). ESCOP Monographs: The Scientific Foundation for Herbal Medicinal Products — Harpagophyti radix. ESCOP / Thieme (2003) . ISBN: 978-1901964073
- [5] Hoffmann, D.. Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts Press (2003) . ISBN: 978-0892817498
- [6] Mills, S., Bone, K.. Principles and Practice of Phytotherapy: Modern Herbal Medicine (2nd edition). Churchill Livingstone / Elsevier (2013) . ISBN: 978-0443069925
- [7] Gardner, Z., McGuffin, M. (eds.). American Herbal Products Association's Botanical Safety Handbook (2nd edition). CRC Press (2013) . ISBN: 978-1466516946
- [8] British Herbal Medicine Association. British Herbal Pharmacopoeia. BHMA (1983)
- [9] Brinker, F.. Herbal Contraindications and Drug Interactions (4th edition). Eclectic Medical Publications (2010) . ISBN: 978-1888483147
Clinical Studies
- [10] Gagnier, J.J., Chrubasik, S., Manheimer, E.. Harpgophytum procumbens for osteoarthritis and low back pain: A systematic review. BMC Complementary and Alternative Medicine (2004) ; 4 : 13 . DOI: 10.1186/1472-6882-4-13 . PMID: 15369596
- [11] Chrubasik, S., Model, A., Black, A., Pollak, S.. A randomized double-blind pilot study comparing Doloteffin and Vioxx in the treatment of low back pain. Rheumatology (2003) ; 42 : 141-148 . DOI: 10.1093/rheumatology/keg053 . PMID: 12509627
- [12] Gagnier, J.J., van Tulder, M.W., Berman, B., Bombardier, C.. Herbal medicine for low back pain: a Cochrane review. Spine (2007) ; 32 : 82-92 . DOI: 10.1097/01.brs.0000249525.70011.fe . PMID: 17202897
- [13] Vlachojannis, J., Roufogalis, B.D., Chrubasik, S.. Systematic review on the safety of Harpagophytum preparations for osteoarthritic and low back pain. Phytotherapy Research (2008) ; 22 : 149-152 . DOI: 10.1002/ptr.2314 . PMID: 18236448
- [14] Farpour, H.R., Rajabi, N., Ebrahimi, B.. The Efficacy of Harpagophytum procumbens (Teltonal) in Patients with Knee Osteoarthritis: A Randomized Active-Controlled Clinical Trial. Evidence-Based Complementary and Alternative Medicine (2021) ; 2021 : 5596892 . DOI: 10.1155/2021/5596892 . PMID: 34621313
- [15] Fiebich, B.L., Munoz, E., Rose, T., et al.. Molecular targets of the antiinflammatory Harpagophytum procumbens (devil's claw): inhibition of TNFalpha and COX-2 gene expression by preventing activation of AP-1. Phytotherapy Research (2012) ; 26 : 806-811 . DOI: 10.1002/ptr.3636 . PMID: 22072539
- [16] Huang, T.H., Tran, V.H., Duke, R.K., et al.. Harpagoside suppresses lipopolysaccharide-induced iNOS and COX-2 expression through inhibition of NF-kappa B activation. Journal of Ethnopharmacology (2006) ; 104 : 149-155 . DOI: 10.1016/j.jep.2005.08.070 . PMID: 16203115
Traditional Texts
- [17] Mncwangi, N., Chen, W., Vermaak, I., Viljoen, A.M., Gericke, N.. Devil's Claw — A review of the ethnobotany, phytochemistry and biological activity of Harpagophytum procumbens. Journal of Ethnopharmacology (2012) ; 143 : 755-771 . DOI: 10.1016/j.jep.2012.08.013 . PMID: 22940241
Pharmacopeias & Reviews
- [18] European Pharmacopoeia Commission. European Pharmacopoeia — Harpagophyti radix (Devil's Claw Root). Council of Europe / EDQM (2023)
Last updated: 2026-03-02 | Status: review
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