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Source Active components of wormwood are extracted from the leaves and flowering tops of Artemisia absinthium, a shrubby perennial herb that is native to Europe, northern Africa, and western Asia. Chemical Components Extracts of A. absinthium contain the glucosides absinthin and anabsinthin, lactones (including santonin), and other compounds. The plant contains a sweet-smelling volatile oil consisting of terpenes, primarily thujone, with smaller amounts of phellandrene, pinene, and azulene. Actions Santonin has shown analgesic, anti-inflammatory, and antipyretic activity in mice. Thujone exerts narcotic-like analgesic effects it is believed to be responsible for causing the symptoms associated with absinthism. This syndrome is marked by digestive disorders, hallucinations, insomnia, loss of intellect, paralysis, paresthesia, psychosis, seizures, tremor, and, possibly, brain damage. Crude extracts of A. absinthium have also demonstrated preventive and curative effects on acetaminophen hepatotoxicity in mice. Reported Uses Common therapeutic claims for wormwood include its use as an anthelmintic, an antipyretic, and a sedative. Lay publications promote wormwood as an insect repellent. These sources encourage the planting of wormwood hedges or use of powders and infusions around gardens and other areas where insects may be a problem. Dosage No consensus exists. Adverse Reactions CNS: absinthism, seizures. GU: renal failure. EENT: xanthopsia. Metabolic: anion gap acidosis. Musculoskeletal: rhabdomyolysis. Skin: allergic reactions (with topical use in sensitized people). Other: porphyria. Interactions None reported. Contraindications and Precautions Avoid using wormwood in pregnant or breast-feeding patients; effects are unknown. Internal and long-term use is contraindicated. Special Considerations * Advise the patient to consult a health care provider before using herbal preparations because a treatment that has been clinically researched and proved effective may be available. * Inform the patient that wormwood should not be taken internally. Alert Absinthism may result from chronic intake of wormwood compounds. Monitor the patient who uses wormwood for symptoms of absinthism. Points of Interest * Wormwood, derived from A. absinthium, should not be confused with other substances termed wormwood. Sweet wormwood, or Chinese wormwood, derived from A. annua, has been used in China for almost 2,000 years for fever, and the active component, artemisinin, has received much attention as an antimalarial. * A thujone-free extract of wormwood is used as a flavoring agent for alcoholic beverages, such as vermouth. Commentary Wormwood shows some promise as an anthelmintic, an antipyretic, an anti-inflammatory, and a hepatoprotective agent, but more animal and human clinical data are needed. Because wormwood extract has been associated with potentially serious CNS toxicity, it cannot be recommended for internal use.
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