Butcher's Broom
Ruscus aculeatus
Evidence Rating
C Moderate
Confidence Level
Moderate
Medium -- Commission E approved, but the standalone clinical trial evidence is more limited than for horse chestnut. Most clinical data come from combination products.
Traditions
Western
Last Updated
2/9/2026
Summary
Butcher's Broom (Ruscus aculeatus) is Commission E-approved for supportive therapy of CVI and hemorrhoids. Its active compounds -- the steroidal saponins ruscogenin and neoruscogenin -- have vasoconstrictive and anti-inflammatory effects on venous tissue. The evidence base is smaller than for horse chestnut, with most clinical trials using combination products (ruscus + hesperidin methylchalcone + ascorbic acid). One key multi-center RCT demonstrated significant leg volume reduction. It is a second-line venoactive drug in European phytotherapy.
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Drug Interactions
This herb has significant drug interactions. Do not use if you are taking medications without consulting a healthcare provider first. See detailed interaction information below.
Regulatory Status
| Regulatory Body | Status |
|---|---|
| Commission E (Germany) | ✓ Approved |
| ESCOP (European) | ✓ Approved |
| EMA/HMPC (EU) | ✓ Approved |
Metadata
| Field | Details |
|---|---|
| Common Names | Butcher’s Broom, Mausedorn (German), Fragon (French), Pungitopo (Italian) |
| Botanical Name | Ruscus aculeatus L. |
| Plant Family | Asparagaceae (formerly Liliaceae/Ruscaceae) |
| Part Used | Rhizome (Rusci rhizoma) — underground stem/root |
| Evidence Quality Rating | LOW-MEDIUM — Commission E approved, but few standalone RCTs; most evidence from combination products |
Approved Indications
Commission E (Germany)
- Approved: Supportive therapy for discomforts of chronic venous insufficiency (CVI)
- Approved: Complaints of hemorrhoids
- Note: The Commission E approval for hemorrhoids was established before significant clinical studies had been performed [Source: drugs.com/npp/butcher-s-broom.html]
ESCOP Monograph
- Recommended daily intake: Rusci rhizoma corresponding to 7-11 mg ruscogenins
- Indication: Treatment of CVI symptoms
EMA/HMPC
- Assessment report: EMEA/HMPC/261939/2007 (September 2008)
- Traditional use registration for symptoms of venous insufficiency
- Acknowledges the traditional use in European countries
Agreement/Disagreement Between Bodies
- General agreement on CVI indication
- Commission E is more generous in also approving hemorrhoids
- EMA/HMPC takes a more conservative stance, reflecting the limited standalone clinical trial evidence
- The evidence gap between Commission E approval (which preceded robust trials) and current EMA standards highlights the evolving evidence requirements in European phytotherapy
Conditions Treated
Primary (evidence-based)
- Chronic venous insufficiency (CVI)
- Leg heaviness and fatigue
- Leg edema
- Calf cramps
- Varicose vein symptoms
Secondary (Commission E-approved, limited evidence)
- Hemorrhoids — itching, burning, discomfort
Traditional
- Circulatory disorders of the lower extremities
- Orthostatic hypotension (traditional use in some European countries)
Mechanism of Action
Venoconstrictive Activity
- Ruscogenin and neoruscogenin directly activate alpha-1 adrenergic receptors on venous smooth muscle
- This produces venoconstriction, improving venous return
- Unique among venoactive drugs in having a direct vasoconstrictive mechanism (horse chestnut and red vine leaf work primarily via anti-exudative mechanisms)
Anti-inflammatory
- Inhibition of vascular permeability
- Reduction of capillary fragility
- Anti-inflammatory effects mediated through complement inhibition and anti-elastase activity
Anti-edematous
- Reduction of capillary filtration
- Decreased transcapillary albumin leakage
- Lymphatic drainage enhancement (in some preclinical models)
Key Active Constituents
- Ruscogenin: Primary steroidal saponin (sapogenin); venoconstrictive
- Neoruscogenin: Secondary steroidal saponin; similar activity
- Total saponin content: Typically 3-6% in rhizome
- Often combined with:
- Hesperidin methylchalcone (HMC): A semi-synthetic flavonoid; enhances venotonic and anti-edematous effects
- Ascorbic acid (vitamin C): Supports collagen synthesis in venous walls; enhances flavonoid activity
Clinical Evidence Summary
Key Multi-Center RCT
Vanscheidt et al. 2002
- Design: Multi-center, double-blind, randomized, placebo-controlled
- Intervention: Ruscus extract vs placebo
- Outcomes: Significant differences favoring ruscus for:
- Leg volume reduction
- Changes in ankle and leg circumferences
- Subjective symptoms (heaviness, pain, tension)
- Overall efficacy assessment significantly better for ruscus vs placebo [Source: pubmed.ncbi.nlm.nih.gov/12040966/]
Combination Product Evidence (Ruscus + HMC + Vitamin C)
Cappelli et al. 2007
- Clinical and capillaroscopic evaluation
- Ruscus aculeatus + hesperidin methylchalcone + ascorbic acid
- Demonstrated improvement in microcirculation parameters
- Positive effects on CVI symptoms [Source: pubmed.ncbi.nlm.nih.gov/18091707/]
Multiple observational studies have documented the efficacy of the triple combination, particularly the Cyclo 3 Fort brand (widely used in France):
- Improvements in CVI symptoms
- Reduction in leg edema
- Generally well tolerated
Evidence Limitations
- Few standalone Ruscus RCTs exist — most trials use the combination product [CONTESTED]
- The Commission E approval was based partly on pharmacological plausibility and traditional use, not solely on RCT evidence
- Sample sizes in existing trials are modest compared to horse chestnut evidence (no Cochrane review)
- Head-to-head trials against horse chestnut or compression stockings are lacking
European vs US/Anglophone Consensus
| Aspect | European Position | US/Anglophone Position |
|---|---|---|
| Regulatory status | Registered phytomedicine in Germany, France | Dietary supplement; virtually unknown |
| Clinical use | Second-line venoactive drug for CVI; prescribed in France (Cyclo 3 Fort) | Not used clinically |
| Evidence perception | Accepted based on Commission E monograph + pharmacological rationale | Insufficient evidence for clinical recommendation |
| Market presence | Significant market share in French pharmacy (Cyclo 3 Fort is one of the most prescribed venoactive drugs in France) | Minimal presence even in supplement market |
Safety Profile
Contraindications
- Known hypersensitivity to Ruscus aculeatus
- No other specific contraindications identified
Drug Interactions
- No well-documented drug interactions reported [Source: drugs.com/npp/butcher-s-broom.html]
- Theoretical caution with:
- Antihypertensives (venoconstrictive effect could theoretically oppose hypotensive drugs, though this is unlikely at clinical doses)
- MAO inhibitors (theoretical, based on adrenergic receptor activity)
- Overall, the interaction profile appears to be very clean
Side Effects
- Generally well tolerated
- Occasional: mild GI discomfort (nausea, stomach upset)
- Rare: allergic skin reactions
- Very rare: contact dermatitis with topical application
Pregnancy and Lactation
- Insufficient data — not recommended
- Some European sources note traditional use during pregnancy for hemorrhoids, but safety data are inadequate
- The combination product Cyclo 3 Fort has been used in pregnancy in France (for pregnancy-related venous complaints), but controlled safety studies are lacking [NEEDS-RESEARCH]
Clinical Dosage
| Preparation | Dosage | Notes |
|---|---|---|
| Standardized rhizome extract | 7-11 mg ruscogenins daily | ESCOP recommendation |
| Root extract (typical product) | 150 mg twice daily | Often combined with 150 mg hesperidin methylchalcone + 100 mg ascorbic acid per dose |
| Cyclo 3 Fort (combination product) | 2-3 capsules daily | Each capsule: 150 mg Ruscus extract + 150 mg HMC + 100 mg vitamin C |
| Multi-ingredient products | 30-150 mg Ruscus per capsule | Varies widely by product |
| Duration | Minimum 4 weeks; typically 8-12 weeks | Long-term seasonal use common in European practice |
Sources
- German Commission E Monograph: Rusci rhizoma
- ESCOP Monograph: Rusci rhizoma
- EMA/HMPC Assessment Report on Ruscus aculeatus L., rhizoma (EMEA/HMPC/261939/2007)
- Vanscheidt W et al. Efficacy and safety of a Butcher’s broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency. Arzneimittelforschung. 2002;52(4):243-250. [PubMed: 12040966]
- Cappelli R et al. Clinical and capillaroscopic evaluation in the treatment of chronic venous insufficiency with Ruscus aculeatus, hesperidin methylchalcone and ascorbic acid. Minerva Cardioangiol. 2007;55(6):47-55. [PubMed: 18091707]
- Drugs.com. Butcher’s Broom Uses, Benefits & Dosage. drugs.com/npp/butcher-s-broom.html
- Memorial Sloan Kettering. Butcher’s Broom. mskcc.org
Connections
- Compare with Horse Chestnut — stronger evidence base for CVI; different mechanism (anti-exudative vs venoconstrictive)
- Compare with Red Vine Leaf — another CVI option with different mechanism