Herbal Monograph
Uva ursi
Arctostaphylos uva-ursi (L.) Spreng.
Ericaceae
Premier urinary antiseptic herb for uncomplicated cystitis — requires alkalin...
Overview
Plant Description
Low-growing, prostrate, evergreen shrub, 10-30 cm tall, forming dense mats up to 1 m or more in diameter via trailing, rooting stems. Bark on older stems is reddish-brown, smooth, and papery, becoming shreddy with age. Leaves alternate, simple, coriaceous (leathery), obovate to spatulate, 1-3 cm long, 0.5-1.5 cm wide, with entire margins, dark glossy green above, paler below with a prominent reticulate venation pattern visible on the undersurface (a key identification feature distinguishing it from Vaccinium vitis-idaea). Leaves persist for 2-3 years. Flowers in small terminal racemes of 3-15, urn-shaped (urceolate), 5-6 mm long, white to pink, appearing in late spring. Fruits are globose drupes, 6-10 mm diameter, bright red when ripe, mealy and bland in texture, each containing 1-5 hard nutlets. The name 'uva-ursi' (Latin: bear's grape) and 'Arctostaphylos' (Greek: arktos = bear, staphyle = grape) both reference the berries being eaten by bears.
Habitat
Prefers well-drained, acidic to neutral, sandy or rocky soils in full sun to light shade. Drought-tolerant once established. Found in dry, open coniferous forests, heathlands, rocky slopes, sand dunes, and alpine meadows. Grows from sea level to approximately 3,000 m elevation. Tolerates poor, nutrient-depleted soils and exposed, windy sites. Pioneer species on disturbed ground after fire.
Distribution
Circumpolar distribution across the Northern Hemisphere. Native throughout northern and central Europe, northern Asia, and North America. In Europe, found from Scandinavia and the British Isles south to the mountains of Spain, Italy, and the Balkans. In North America, distributed from Alaska and Canada south to Virginia, New Mexico, and California. Major commercial harvesting occurs in Spain, Italy, the Balkans (Bosnia, Albania), and parts of Scandinavia. Wild-harvested rather than cultivated for most commercial supply.
Parts Used
Leaf (Uvae ursi folium)
Preferred: Dried leaf for cold maceration (preferred to minimize tannin extraction), infusion, or powdered extract in tablets/capsules; tincture
The dried leaf is the sole medicinal part recognized by all major pharmacopeial and regulatory monographs (Commission E, WHO, EMA, BHP, European Pharmacopoeia). The leaf is the primary site of arbutin biosynthesis and accumulation, with concentrations of 5-17% arbutin in dried leaf material. The European Pharmacopoeia monograph (Uvae ursi folium) specifies the whole or cut, dried leaf of Arctostaphylos uva-ursi (L.) Spreng., containing not less than 7.0% of anhydrous arbutin calculated on the dried drug. The high tannin content (6-20% gallotannins) gives the leaf its characteristic astringent taste and contributes to the urinary tract astringent action.
Key Constituents
Hydroquinone glycosides (phenol glycosides)
The hydroquinone glycoside fraction — primarily arbutin — is the key active constituent responsible for uva ursi's urinary antiseptic activity. The antimicrobial mechanism requires: (1) systemic absorption and hepatic conjugation, (2) renal excretion of conjugated metabolites, and (3) alkaline urine pH (> 7) to liberate free hydroquinone at the site of infection. This pH-dependent activation is clinically critical — efficacy is significantly reduced in acidic urine. Commission E, WHO, and EMA monographs all identify arbutin as the principal active marker. The EMA calculates dosage as hydroquinone derivatives expressed as anhydrous arbutin.
Tannins (hydrolysable tannins)
The high tannin content contributes the astringent action on urinary tract mucous membranes, reducing inflammation and excessive mucous discharge. Tannins precipitate surface proteins on inflamed mucosal tissues, forming a protective layer that reduces irritation and inhibits bacterial adhesion. However, the high tannin content is also the primary source of gastrointestinal side effects (nausea, stomach upset) and is the reason cold maceration is preferred over hot infusion — cold water extracts arbutin efficiently while minimizing tannin extraction.
Flavonoids
Flavonoids contribute mild diuretic and anti-inflammatory activity that complements the primary urinary antiseptic action of arbutin. The diuretic effect increases urine flow, which may enhance the flushing of bacteria from the urinary tract. Hyperoside is the principal flavonoid and is used as a supplementary quality marker in some analytical methods.
Triterpenes
Triterpenes provide ancillary anti-inflammatory activity. Ursolic acid has been extensively studied for its anti-inflammatory, anticancer, and hepatoprotective properties, though these effects are primarily documented in isolated compound studies rather than in the context of whole uva ursi extract at standard clinical doses.
Iridoid glycosides and other constituents
Minor constituents providing ancillary anti-inflammatory and mucosal-soothing effects. Allantoin may contribute to healing of irritated urinary tract mucosa. These constituents are not considered primary drivers of therapeutic activity.
Herbal Actions
The most established and clinically important action of uva ursi. Arbutin is metabolized to hydroquinone, which is excreted in the urine and exerts direct antimicrobial activity against common urinary pathogens (E. coli, Proteus spp., Klebsiella spp., Staphylococcus spp., Enterococcus faecalis). Commission E approved for 'inflammatory disorders of the lower urinary tract.' WHO monograph recognizes use as 'a mild urinary antiseptic.' EMA well-established use monograph approves for 'relief of symptoms of mild recurrent lower urinary tract infections.' Critical caveat: antimicrobial efficacy is pH-dependent and requires alkaline urine (pH > 7) for hydroquinone liberation from its conjugates.
[1, 2, 3, 5]Tightens and tones tissue, reduces secretions
The very high tannin content (6-20% gallotannins) makes uva ursi one of the most powerfully astringent herbs in the Western materia medica. Tannins precipitate surface proteins on inflamed urinary tract mucous membranes, forming a protective layer that reduces inflammation, bleeding, and excessive mucous discharge. BHP (1983) lists 'astringent' as a primary action. Hoffmann (2003) emphasizes the astringent action on the urinary tract lining as complementary to the antiseptic action. This dual astringent-antiseptic profile distinguishes uva ursi from purely antimicrobial urinary herbs.
[5, 6, 8]Anti-inflammatory activity specific to the urinary tract is recognized by multiple authorities. Commission E approved indication includes 'inflammatory disorders.' The anti-inflammatory effect is mediated by both the tannin fraction (mucosal protein precipitation reducing inflammation) and the hydroquinone metabolites (which demonstrate anti-inflammatory activity alongside their antimicrobial effects). Ursolic acid and flavonoids contribute additional anti-inflammatory activity.
[1, 2, 6]Mild diuretic activity attributed primarily to the flavonoid fraction (hyperoside, isoquercitrin) and the high concentration of arbutin itself. The diuretic action is considered complementary to the antiseptic action — increased urine flow assists mechanical flushing of bacteria from the urinary tract. The WHO monograph notes the diuretic effect. Hoffmann (2003) lists diuretic as a secondary action.
[2, 5, 8]Kills or inhibits the growth of microorganisms
Broader antimicrobial activity beyond the urinary-specific antiseptic action. In vitro studies demonstrate activity of arbutin and hydroquinone against multiple bacterial species and some fungi. However, the clinical relevance is limited to the urinary tract due to the pharmacokinetic route of arbutin metabolism (hepatic conjugation and renal excretion). Systemic antimicrobial activity at standard doses is not expected.
[2, 3]Therapeutic Indications
Urinary System
Uncomplicated lower urinary tract infections (cystitis)
The primary approved indication across all major regulatory bodies. Commission E: 'inflammatory disorders of the lower urinary tract.' WHO: 'mild urinary antiseptic in inflammatory conditions of the urinary tract and bladder, such as cystitis, urethritis.' EMA well-established use: 'traditionally used for relief of symptoms of mild recurrent lower urinary tract infections such as burning sensation during urination and/or frequent urination in women, after serious conditions have been excluded by a medical doctor.' The REGATTA trial (Wuethrich et al., 2021) demonstrated that uva ursi reduced antibiotic use by 63.6% compared to fosfomycin in uncomplicated UTI, though symptom burden was higher in the uva ursi group and non-inferiority was not met for symptom relief. Use is limited to uncomplicated infections; complicated UTI, pyelonephritis, and febrile UTI require antibiotic treatment.
[1, 2, 3, 10]Recurrent urinary tract infection (prophylaxis)
Larsson et al. (1993) conducted a double-blind trial in 57 women with recurrent cystitis: patients receiving a uva ursi-dandelion combination had zero recurrences over 12 months compared to 23% recurrence in the placebo group. This result is suggestive but the study was small and has not been replicated. Additionally, long-term prophylactic use is problematic due to the recommended duration limit of 1-2 weeks per course (maximum 5 times per year per EMA). The EMA monograph specifically states the product 'should not be used for longer than 1 week' and 'should not be used more than 5 times per year without medical advice.'
[3, 12]Dysuria (painful urination)
Commission E and WHO list dysuria among the symptom indications. The anti-inflammatory and astringent actions on the urinary tract mucosa provide symptomatic relief from burning and painful urination. EMA specifies 'burning sensation during urination' as a recognized symptom indication.
[1, 2, 3]Frequency and urgency of urination associated with UTI
EMA well-established use indication includes 'frequent urination' as a symptom. The astringent tannins tone the bladder mucosa and reduce irritability, while the antimicrobial action addresses the underlying infection driving urgency and frequency.
[3, 5]Chronic irritation of the bladder with catarrhal discharge
Traditional Eclectic and BHP indication. King's American Dispensatory (Felter & Lloyd, 1898): 'relaxation of the urinary membranes, with catarrhal discharge.' The high tannin content is particularly suited to conditions with excessive mucous discharge from atonic, relaxed bladder mucosa. BHP (1983) lists cystitis with catarrh as an indication.
[5, 8, 15]gastrointestinal
Chronic diarrhoea (as astringent)
Traditional use as a powerful astringent for chronic, non-infectious diarrhoea and dysentery. King's American Dispensatory (Felter & Lloyd, 1898) lists 'chronic diarrhoea and dysentery' among the indications. The exceptionally high tannin content provides strong astringent activity on intestinal mucosa. This is a secondary, lesser-known use; the primary clinical application is urinary. Not included in Commission E, WHO, or EMA approved indications.
[8, 15]Energetics
Temperature
cool
Moisture
dry
Taste
Tissue States
damp/stagnation, hot/excitation, lax/atony
Uva ursi is cooling and drying in Western energetic assessment. Its powerful astringency reflects the extremely high tannin content and is the dominant organoleptic quality of the leaf. The bitter taste is secondary, contributed by the phenol glycosides (arbutin) and triterpenes. Energetically indicated for hot, damp, lax tissue states in the urinary tract — conditions with inflammation (heat), excessive mucous discharge or infection (dampness), and relaxed, boggy mucous membranes (laxity/atony). Hoffmann (2003) describes it as having 'a specific antiseptic and astringent effect on the membranes of the urinary system,' which in energetic terms translates to cooling heat, drying dampness, and toning lax tissue. Contraindicated in dry, irritated, deficient tissue states where further astringency and cooling would be aggravating.
Traditional Uses
European traditional herbalism
- Urinary antiseptic for cystitis, urethritis, and dysuria
- Astringent for mucous discharge from the bladder
- Treatment of gravel and urinary calculi
- Astringent for chronic diarrhoea and dysentery
- External wash for wound cleansing (astringent)
"Hoffmann (2003): 'Bearberry has a specific antiseptic and astringent effect on the membranes of the urinary system and as such it generally soothes, tones, and strengthens them. It has a specific use where there is gravel or ulceration of the kidney or bladder... It is specifically indicated for cystitis, urethritis, dysuria, pyelitis, lithuria, and a range of other conditions affecting the urinary system.'"
[5]
German phytotherapy (Commission E / ESCOP)
- Inflammatory disorders of the lower urinary tract
- Mild urinary tract infections (cystitis, urethritis)
- Symptomatic relief of dysuria and urinary frequency
"Commission E approved indication: 'Inflammatory disorders of the lower urinary tract.' ESCOP: 'Uncomplicated infections of the lower urinary tract such as cystitis, when antibiotic treatment is not considered essential.' Both authorities specify limitation to short-term use (1-2 weeks maximum, not more than 5 times per year)."
Eclectic medicine (American)
- Chronic bladder irritation with relaxed membranes and catarrhal discharge
- Cystitis and urethritis
- Gonorrhoea (as urinary antiseptic adjunct)
- Chronic diarrhoea and dysentery (astringent)
- Menorrhagia (astringent)
- Diabetes with urinary symptoms
- Enuresis (bedwetting)
"Felter and Lloyd (King's American Dispensatory, 1898): 'Uva ursi is an excellent remedy in all cases of chronic irritation of the bladder, attended with pain, much mucous or bloody secretions... It has also been used in chronic diarrhoea and dysentery, menorrhagia, diabetes, enuresis.' Specific indications: 'Relaxation of the urinary tract, with pain and mucous or bloody secretions; feeling of weight and dragging in the loins and perineum.'"
[15]
Native American traditional medicine
- Treatment of urinary tract complaints
- Kinnikinnick — ceremonial and social smoking mixture (leaves mixed with tobacco, dogwood bark, or other herbs)
- Food use of berries (raw, cooked with meat, or dried)
- Preparation of yellow dye from plant material
"Multiple Native American peoples (including Blackfeet, Cheyenne, Thompson, Okanagan, and others) used bearberry medicinally for urinary ailments and as a key ingredient in kinnikinnick smoking mixtures. The Algonquin word 'kinnikinnick' literally means 'smoking mixture.' The Blackfeet used the berries as food, often mixed with meat and animal fat. Medicinal use centered on urinary complaints and was adopted by early European settlers and subsequently validated by pharmacological research."
[16]
British Herbal Pharmacopoeia (BHP)
- Cystitis
- Urethritis
- Dysuria
- Pyelitis
"BHP (1983) lists uva ursi with actions 'diuretic, urinary antiseptic, astringent' and indications 'cystitis, urethritis, dysuria, pyelitis, lithuria.' Specific indication: 'cystitis with alkaline urine and excess mucous secretion.'"
[8]
Modern Research
Antibiotic-sparing treatment for uncomplicated UTI (REGATTA trial)
Randomized controlled trial comparing uva ursi extract to fosfomycin for uncomplicated lower UTI in women in primary care (n=398).
Findings: Wuethrich et al. (2021) randomized 398 women with suspected uncomplicated UTI in 42 German general practices to uva ursi extract (105 mg, 3 x 2 tablets daily for 5 days) or fosfomycin (3 g single dose). Antibiotic courses were 63.6% lower in the uva ursi group. However, non-inferiority for symptom burden was not met (ratio 136.5%, exceeding the pre-specified non-inferiority margin). Eight women developed pyelonephritis in the uva ursi group versus two in the fosfomycin group. The authors concluded that while uva ursi reduced antibiotic use, it led to higher symptom burden and more safety-relevant complications compared to fosfomycin.
Limitations: Non-inferiority was not demonstrated for symptom relief. Higher rate of pyelonephritis in the uva ursi group is a significant safety concern. Study design as comparative effectiveness trial (not superiority or placebo-controlled). Clinical relevance of antibiotic reduction must be weighed against the risk of disease progression.
[10]
Prophylaxis of recurrent UTI
Double-blind placebo-controlled trial of uva ursi-dandelion combination for prevention of recurrent cystitis in women (n=57).
Findings: Larsson et al. (1993) treated 57 women with a history of recurrent cystitis with either UVA-E (a combination of uva ursi extract and dandelion leaf) or placebo for one month, then followed them for 12 months. Zero recurrences occurred in the 30 women receiving UVA-E, compared to 5 recurrences (23%) in the 27 women receiving placebo. The difference was statistically significant.
Limitations: Very small sample size (n=57). Combination product makes it impossible to attribute the effect to uva ursi alone. Single study not replicated. Prophylactic use contradicts the widely recommended duration limit of 1-2 weeks per course, raising safety questions about the clinical applicability of this finding.
[12]
Uva ursi and ibuprofen as alternative UTI treatments (ATAFUTI trial)
2x2 factorial randomized placebo-controlled trial evaluating uva ursi extract and ibuprofen as alternatives to antibiotics for uncomplicated UTI in women (n=382).
Findings: Moore et al. (2019) conducted a 2x2 factorial trial in 382 women with suspected lower UTI in primary care. Neither uva ursi (3600 mg daily for 3-5 days) nor ibuprofen showed significant benefit over placebo for UTI symptom severity. Uva ursi had no significant effect on urinary symptoms compared to placebo. Antibiotic use was not significantly reduced in either active treatment group.
Limitations: Factorial design may have reduced power for individual treatment comparisons. Symptom-based inclusion criteria (not all participants had bacteriologically confirmed UTI). High placebo response rate. The uva ursi dose used was relatively high.
[11]
Hydroquinone safety and risk assessment
Toxicological risk assessment of free hydroquinone derived from Arctostaphylos uva-ursi folium herbal preparations.
Findings: Garcia de Arriba et al. (2013) assessed the safety of hydroquinone exposure from standard uva ursi doses. At the recommended daily dose (420 mg hydroquinone derivatives as anhydrous arbutin), free hydroquinone exposure in urine was estimated at a maximum of 11 mcg/kg body weight/day. The established permitted daily exposure for negligible risk was 100 mcg/kg body weight/day — nearly 10-fold higher than the therapeutic exposure. The authors found no direct evidence that free hydroquinone from uva ursi causes convulsions, hepatotoxicity, nephrotoxicity, or tumor promotion in humans at recommended doses and durations.
Limitations: Review based on extrapolation from animal toxicity data and estimated human exposure models. Long-term human safety data beyond 12 months of use is limited. The safety margin may not apply to doses exceeding recommendations or in individuals with compromised hepatic or renal function.
[13]
Arbutin pharmacokinetics in humans
Randomized crossover study of arbutin urinary excretion and metabolism after oral administration of uva ursi extract in healthy volunteers (n=16).
Findings: Schindler et al. (2002) administered a single oral dose of bearberry leaf dry extract to 16 healthy volunteers as either film-coated tablets or aqueous solution in a randomized crossover design. Approximately 65% of the administered arbutin dose was excreted as hydroquinone equivalents in the urine (64.8% from tablets, 66.7% from solution). The principal urinary metabolites were hydroquinone glucuronide and hydroquinone sulfate. Free hydroquinone was detected in urine but at much lower concentrations than conjugated forms. The aqueous solution showed slightly earlier peak urinary excretion but no significant difference in total bioavailability (relative bioavailability of tablets vs. solution: 103.3%).
Limitations: Single-dose study. Healthy volunteers only. Did not assess the effect of urinary pH on free hydroquinone liberation. Did not include a clinical efficacy component.
[14]
Preparations & Dosage
cold maceration (preferred method)
Strength: 2.5-4 g dried leaf per 150-200 mL cold water
Soak 2.5-4 g of dried, cut or coarsely powdered uva ursi leaf in 150-200 mL of cold water for 6-12 hours (or overnight). Stir or agitate occasionally. Strain and warm slightly before drinking if desired. Cold maceration is the preferred method because it extracts arbutin efficiently while minimizing extraction of the irritant tannin fraction.
2.5-4 g dried leaf per 150 mL water, 3-4 times daily (equivalent to 400-840 mg hydroquinone derivatives calculated as anhydrous arbutin per day)
3-4 times daily
Maximum 1 week per course (EMA). Maximum 2 weeks per course (Commission E, WHO). Not more than 5 times per year without medical supervision (EMA). Not to be used for prolonged periods.
Not recommended for children or adolescents under 18 years (EMA, WHO)
Cold maceration is specifically recommended by the WHO monograph and multiple herbal authorities to reduce tannin-related gastrointestinal irritation. The cold water extraction method extracts approximately 50% of the arbutin content while extracting significantly less tannin compared to a hot infusion. Commission E, WHO, and EMA all specify this preparation method. Alkalinize the urine during treatment to maximize efficacy: avoid acidifying foods (meat, cranberries, citrus juices) and consider sodium bicarbonate (3-6 g/day in divided doses) or a vegetable-heavy diet to maintain urinary pH above 7.
Infusion (Tea)
Strength: 2.5-4 g dried leaf per 150-200 mL boiling water
Pour 150-200 mL boiling water over 2.5-4 g of dried uva ursi leaf. Cover and steep for 10-15 minutes. Strain. Note: hot infusion extracts more tannins than cold maceration and may cause greater gastrointestinal irritation.
2.5-4 g dried leaf per cup, 3-4 times daily (equivalent to 400-840 mg hydroquinone derivatives as anhydrous arbutin daily)
3-4 times daily
Maximum 1-2 weeks per course. Not more than 5 courses per year.
Not recommended for children under 18 years
Hot infusion is an acceptable but less preferred preparation method due to greater tannin extraction. Some patients report significant nausea and stomach upset with hot infusions — switching to cold maceration often resolves this. The WHO monograph lists both hot infusion and cold maceration as acceptable preparation methods, with cold maceration as preferred.
Tincture
Strength: 1:5 dried leaf in 25-45% ethanol
Macerate dried uva ursi leaf in 25-45% ethanol at a ratio of 1:5 for 2-4 weeks. Press and filter.
2-4 mL of 1:5 tincture (in 25-45% ethanol), 3 times daily
3 times daily
Maximum 1-2 weeks per course
Not recommended for children under 18 years
Tincture extracts both arbutin and tannins efficiently. The BHP (1983) specifies the tincture as an official preparation. Some practitioners prefer the tincture form for its convenience, though the cold maceration delivers arbutin with less gastrointestinal irritation from tannins. Tincture may be combined with demulcent herbs (marshmallow root, corn silk) to buffer the astringent effect.
powdered extract (tablets/capsules)
Strength: Standardized to 20% arbutin (typical); DER (drug-extract ratio) varies by manufacturer, commonly 3-6:1
Standardized dry extracts of uva ursi leaf, typically standardized to 20% arbutin content, taken as tablets or capsules.
Tablets/capsules containing equivalent of 400-840 mg hydroquinone derivatives calculated as anhydrous arbutin per day. The REGATTA trial used 105 mg uva ursi dry extract, 2 tablets 3 times daily for 5 days.
2-3 times daily, depending on product standardization
Maximum 1-2 weeks per course
Not recommended for children under 18 years
Standardized extracts provide more consistent arbutin dosing than crude plant preparations. This is the form used in most modern clinical trials (REGATTA, ATAFUTI). Products should be standardized based on hydroquinone derivative content expressed as anhydrous arbutin. The same duration and frequency-of-use restrictions apply as for other preparation forms.
Safety & Interactions
Class 2b
Not to be used during lactation (AHPA Botanical Safety Handbook)
Contraindications
AHPA Class 2b: not to be used during pregnancy. The WHO monograph contraindicates use during pregnancy. The EMA monograph states 'Use during pregnancy is not recommended.' Theoretical oxytocic risk has been cited historically, though the evidence base for this is limited. Additionally, hydroquinone metabolites cross the placenta, and fetal safety has not been established.
Not recommended during breastfeeding. Hydroquinone metabolites may be excreted in breast milk. Insufficient safety data to establish safe use during lactation. The EMA monograph states 'Use during breast-feeding is not recommended.'
EMA and WHO do not recommend use in children or adolescents under 18 due to insufficient safety data. Pediatric UTIs require medical evaluation and appropriate antibiotic treatment.
The WHO monograph contraindicates use in 'kidney disorders' because impaired renal function may alter the excretion of hydroquinone metabolites, potentially increasing systemic exposure and toxicity risk. Commission E also notes this contraindication.
Uva ursi is only appropriate for uncomplicated lower UTI (cystitis). Upper UTI (pyelonephritis), febrile UTI, or UTI with systemic symptoms requires prompt antibiotic treatment. The REGATTA trial documented a higher rate of pyelonephritis in the uva ursi group (8 cases) vs. fosfomycin group (2 cases), underscoring the importance of appropriate patient selection.
Drug Interactions
| Drug / Class | Severity | Mechanism |
|---|---|---|
| Lithium (Mood stabilizers) | theoretical | The mild diuretic activity of uva ursi may theoretically reduce renal lithium clearance, increasing lithium serum levels and toxicity risk. |
| Thiazide and loop diuretics (Diuretics) | theoretical | Additive diuretic effect may occur, potentially leading to excessive fluid and electrolyte loss. |
| Urinary acidifiers (ammonium chloride, ascorbic acid, cranberry juice) (Urinary pH modifiers) | moderate | Urinary acidifiers reduce urinary pH below 7, preventing the liberation of free hydroquinone from its glucuronide and sulfate conjugates. This directly antagonizes the antimicrobial mechanism of action of uva ursi. |
| NSAIDs and other gastric irritants (Non-steroidal anti-inflammatory drugs) | theoretical | The high tannin content of uva ursi may exacerbate gastric irritation when combined with NSAIDs or other gastric irritants. |
Pregnancy & Lactation
Pregnancy
unsafe
Lactation
unsafe
AHPA Class 2b: not to be used during pregnancy. WHO, Commission E, and EMA all contraindicate use during pregnancy. Hydroquinone metabolites cross the placenta and fetal safety is not established. Historical citations of oxytocic activity exist in traditional literature, though direct evidence is limited. During lactation, hydroquinone metabolites may be excreted in breast milk; the EMA states 'use during breast-feeding is not recommended' due to insufficient safety data. Both internal and external use should be avoided during pregnancy and breastfeeding.
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] World Health Organization. WHO Monographs on Selected Medicinal Plants, Volume 2 — Folium Uvae Ursi. World Health Organization (2002) . ISBN: 978-9241545372
- [3] Committee on Herbal Medicinal Products (HMPC). European Union herbal monograph on Arctostaphylos uva-ursi (L.) Spreng., folium (Revision 2). European Medicines Agency (2018)
- [4] ESCOP (European Scientific Cooperative on Phytotherapy). ESCOP Monographs: The Scientific Foundation for Herbal Medicinal Products — Uvae ursi folium. 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] Wuethrich, P., Bautista, B.F., Glinz, D., et al.. Herbal treatment with uva ursi extract versus fosfomycin in women with uncomplicated urinary tract infection in primary care: a randomized controlled trial. Clinical Microbiology and Infection (2021) ; 27 : 1441-1447 . DOI: 10.1016/j.cmi.2021.05.048 . PMID: 34111592
- [11] Moore, M., Trill, J., Simpson, C., et al.. Uva-ursi extract and ibuprofen as alternative treatments for uncomplicated urinary tract infection in women (ATAFUTI): a factorial randomized trial. Clinical Microbiology and Infection (2019) ; 25 : 643-649 . DOI: 10.1016/j.cmi.2019.01.011 . PMID: 30685500
- [12] Larsson, B., Jonasson, A., Fianu, S.. Prophylactic effect of UVA-E in women with recurrent cystitis: a preliminary report. Current Therapeutic Research (1993) ; 53 : 441-443
- [13] Garcia de Arriba, S., Naser, B., Nolte, K.U.. Risk assessment of free hydroquinone derived from Arctostaphylos uva-ursi folium herbal preparations. International Journal of Toxicology (2013) ; 32 : 442-453 . DOI: 10.1177/1091581813507721 . PMID: 24296864
- [14] Schindler, G., Patzak, U., Brinkhaus, B., et al.. Urinary excretion and metabolism of arbutin after oral administration of Arctostaphylos uvae ursi extract as film-coated tablets and aqueous solution in healthy humans. Journal of Clinical Pharmacology (2002) ; 42 : 920-927 . DOI: 10.1177/009127002401102740 . PMID: 12162475
Traditional Texts
- [15] Felter, H.W., Lloyd, J.U.. King's American Dispensatory (18th edition, 3rd revision). Ohio Valley Company (1898)
- [16] Moerman, D.E.. Native American Ethnobotany. Timber Press (1998) . ISBN: 978-0881924534
Pharmacopeias & Reviews
- [17] European Pharmacopoeia Commission. European Pharmacopoeia — Uvae ursi folium (Bearberry Leaf). Council of Europe / EDQM (2023)
Last updated: 2026-03-02 | Status: review
Unlock the Full Materia Medica
This monograph is part of our complete evidence-based herbal reference. Enter your email to get free, unlimited access to all of our monographs.
No spam, ever. Unsubscribe anytime.
You're In!
You now have full access to all of our herbal monographs.