The leaves and flower tops of the horehound have long been used in home remedies for the common cold. They are now used primarily as flavorings in liqueurs, candies, and cough drops. Extracts of the plant have also been used for treating intestinal parasites, as a diaphoretic, and as a diuretic.
The active ingredients are obtained from the leaves and flowers of M. vulgare. Horehound's active compound, marrubi in, stimulates secretions in the bronchioles and works as an expectorant. It also contains antiarrhythmic properties, but is of limited use for this purpose because large doses can also cause arrhythmias.
Marrubin acid, derived from marrubiin, stimulates bile secretion. An aqueous extract from horehound may have antagonistic activities toward serotonin. The horehound extract has hypoglycemic effects. Horehound is available as dried herb, liquid extract, lozenges, powder, syrup, and tea.
Reported uses
Horehound is used to treat acute or chronic bronchitis, whooping cough, and sore throat. It's used as an expectorant for treating nonproductive coughs and as a digestive aid. Horehound also may be used for its transient bile secretion stimulant properties.
Administration
Dried herbs: An infusion is prepared by pouring boiling water over 1 to 2 g of the herb and straining after 10 minutes. Dosage is 1 to 2 g by mouth, three times a day
Liquid extract (1:1 preparation in 20% alcohol): Dosage is 2 to 4 ml by mouth three times a day
Oral use: Average daily dose is 4.5 g of the drug, or 30 to 60 ml of the pressed juice.
Hazards
Horehound may cause diarrhea, hypoglycemia, and contact dermatitis. Antiarrhythmics, some antidepressants, antiemetics, and antimigraine drugs may potentiate the serotonergic effects when used with horehound. Enhanced hypoglycemic effects may be seen with antidiabetics and insulin.
Patients with arrhythmias or diabetes mellitus and patients who are pregnant or breast-feeding should avoid use. Patients with cardiovascular disease should use with caution.
Safety Risk High doses of horehound may be associated with cardiac arrhythmias.
Clinical considerations
Medicinal use is not recommended.
Horehound may interfere with the intended therapeutic effect of conventional drugs.
Monitor patient's serum glucose level, and heart rate and rhythm.
Monitor patient for changes in bowel habits.
Warn patient not to treat chronic cough and dyspepsia before seeking appropriate medical evaluation because doing so may delay diagnosis of a potentially serious medical condition.
Advise patients with diabetes or cardiac problems not to use horehound.
Advise patient to use less or to stop using horehound if upset stomach or diarrhea occur.
Advise patient to seek medical help if cough doesn't improve significantly in 2 weeks, or if a cough brings up brown, black, or bloody phlegm.
Advise patient to keep the herb away from children and pets.
Tell patient to notify pharmacist of any herbal or dietary supplement that he's taking when obtaining a new prescription.
Advise patient to consult his health care provider before using an herbal preparation because a conventional treatment with proven efficacy may be available.
Research summary
The FDA banned the use of horehound in the preparation of OTC cough remedies because of unconvincing evidence to support its effectiveness; however, horehound preparation is still available in sore throat products.
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