Written by Karen Pilkington and the CAM-Cancer Consortium.
Updated February 28, 2017

Artemisia absinthium

Is it safe?

Adverse events

Wormwood oil has been reported to cause nausea, vomiting and muscle aches.1 There have been very few anecdotal reports of the toxicity of Artemisia.2 Chronic ingestion of absinthe, an alcoholic drink containing wormwood, has been reported to be linked to a syndrome known as absinthism. This is said to consist of gastro-intestinal symptoms, insomnia and hallucinations.1 More severe adverse effects such as addiction, paralysis, epilepsy, brain damage, and psychiatric disorders and suicide have also been reported. However, the possible contribution of chronic alcohol intake has been also highlighted and the existence of a separate syndrome questioned.14 There has also been a suggestion that some symptoms may be due to adulteration with metals or toxic plants.1 One case of rhabdomyolysis leading to acute renal failure has been reported following accidental ingestion of 10ml of wormwood oil purchased on the internet.15 Artemisia absinthia is a member of the Asteraceae/Compositae (daisy, sunflower etc.) family and may cause allergic reactions in people who are allergic to other plants in this group.4

Contraindications

Wormwood has been assessed as likely unsafe for use in pregnancy if amounts larger than those found in food stuffs are ingested.1 Insufficient information is available to assess its safety in lactation. Thujone containing extracts have potentially toxic effects and therefore pose a particular risk with equivocal evidence on carcinogenicity from animal studies.16

Wormwood is contraindicated in obstruction of the bile duct, cholangitis and liver disease.4

Interactions

Thujone is metabolised via the cytochrome P450 enzyme system with involvement of the specific enzymes CYP2A6, CYP3A4 and CYP2B6.16 Therefore, there is a theoretical risk of interactions with drugs and other herbs metabolised via this system. There is also a risk if used with other thujone-containing herbs such as Salvia spp. (sage) or Thuja spp.

Due to its potential effects on the central nervous system, there is a potential for interaction with anti-convulsant (anti-epilepsy) drugs 1 and with drugs that act via GABA receptors.4

One case has been reported of a probable interaction between warfarin and Artemisia absinthium leading to gastrointestinal bleeding.18

Warnings

These relate particularly to thujone-containing extracts. The European Medicines Agency recommends caution in people with gall-bladder disease or other biliary disorders and that driving and operating machinery is avoided during treatment.4 Most forms of tinctures contain alcohol.

Citation

Karen Pilkington, CAM-Cancer Consortium. Artemisia absinthium [online document]. http://cam-cancer.org/The-Summaries/Herbal-products/Artemisia-absinthium. February 28, 2017.

Document history

Assessed as up to date in February 2017 by Barbara Wider.
Assessed as up to date in January 2015 by Barbara Wider.
First published in May 2014 authored by Karen Pilkington.

References

  1. Natural Medicines Comprehensive Database. Absinthium (wormwood). Available at  http://naturaldatabase.therapeuticresearch.com, accessed 28th February 2017.
  2. Lachenmeier DW. Wormwood (Artemisia absinthium L.)--a curious plant with both neurotoxic and neuroprotective properties? J Ethnopharmacol. 2010 Aug 19;131(1):224-7.
  3. Judþentienë A, Mockutë D. Chemical composition of essential oils of Artemisia absinthium L. (wormwood) growing wild in Vilnius. CHEMIJA. 2004. T. 15. Nr. 4. P. 64–68.
  4. Committee on Herbal Medicinal Products. EMEA/HMPC/234463/2008: Community Herbal Monograph on Artemisia Absinthium L., Herba. European Medicines Agency 2009.
  5. 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 Apr;17(5):305-9.
  6. Bora KS, Sharma A. Neuroprotective effect of Artemisia absinthium L. on focal ischemia and reperfusion-induced cerebral injury.  J Ethnopharmacol. 2010 Jun 16;129(3):403-9.
  7. Blagojevic P , Radulovic N , Palic R , Stojanovic G . Chemical composition of the essential oils of Serbian wild-growing Artemisia absinthium and Artemisia vulgaris. J Agric Food Chem . 2006 ; 54 (13); 4780-4789
  8. Lopes-Lutz D, Alviano DS, Alviano CS, Kolodziejczyk PP. Screening of chemical composition, antimicrobial and antioxidant activities of Artemisia essential oils. Phytochemistry. 2008 May;69(8):1732-8.
  9. 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 Apr;17(5):305-9.
  10. Krebs S, Omer B, Omer TN, Fliser D. Wormwood (Artemisia absinthium) for poorly responsive early-stage IgA nephropathy: a pilot uncontrolled trial. Am J Kidney Dis. 2010 Dec;56(6):1095-9.
  11. Shafi G, Hasan TN, Syed NA, Al-Hazzani AA, Alshatwi AA, Jyothi A, Munshi A. Artemisia absinthium (AA): a novel potential complementary and alternative medicine for breast cancer. Mol Biol Rep. 2012 Jul;39(7):7373-9.
  12. Wegiera M, Smolarz HD, Jedruch M, Korczak M, Koproń K. Cytotoxic effect of some medicinal plants from Asteraceae family on J-45.01 leukemic cell line--pilot study. Acta Pol Pharm. 2012 Mar-Apr;69(2):263-8.
  13. Food and Drug Administration. Dietary Supplements. Available at: https://www.fda.gov/Food/DietarySupplements/default.htm, accessed 28th February 2017. 
  14. Lachenmeier DW, Walch SG, Padosch SA, Kröner LU. Absinthe--a review. Crit Rev Food Sci Nutr. 2006;46(5):365-77.
  15. Weisbord, M.D., Jeremy B. Soule, M.D., and Paul L. Kimmel, M.D. Poison on Line — Acute Renal Failure Caused by Oil of Wormwood Purchased through the Internet. N Engl J Med 1997; 337:825-827
  16. Pelkonen O, Abass K, Wiesner J. Thujone and thujone-containing herbal medicinal and botanical products: toxicological assessment. Regul Toxicol Pharmacol. 2013 Feb;65(1):100-7.
  17. Açıkgöz SK, Açıkgöz E. Gastrointestinal bleeding secondary to interaction of Artemisia absinthium with warfarin. Drug Metabol Drug Interact. 2013;28(3):187-9.