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Evening primrose oil
Overview
Evening primrose is a wildflower that grows throughout the U.S. Although Native Americans used the seeds for food and made poultices from the whole plant to heal bruises, evening primrose oil (EPO) has only recently been used as medicine. European settlers took the root back to England and Germany, where it was eaten as food.

Evening primrose oil is found in the plant's seeds and is high in the essential fatty acid gamma-linolenic acid (GLA). Essential fatty acids -- such as omega-6, found in EPO, and omega-3, found in fish oil -- are used as building blocks for a number of molecules in the body. Your body needs a balance of omega-6 and omega-3 fatty acids for good health. In addition to evening primrose oil, GLA is found in borage oil and black currant oil.

Today, EPO is used to relieve PMS symptoms and some arthritis-related conditions, although there is not a lot of scientific evidence about using EPO for those conditions. The strongest evidence for EPO is for treating eczema.


What is Evening Primrose Oil?
Evening primrose oil is the oil from the seed of the evening primrose plant. Evening primrose oil is used for skin disorders such as eczema, psoriasis, and acne. It is also used for rheumatoid arthritis, weak bones (osteoporosis), Raynaud’s syndrome, multiple sclerosis (MS), Sjogren’s syndrome, cancer, high cholesterol, heart disease, a movement disorder in children called dyspraxia, leg pain due to blocked blood vessels (intermittent claudication), alcoholism, Alzheimer’s disease, and schizophrenia.

Some people use evening primrose oil for chronic fatigue syndrome (CFS); asthma; nerve damage related to diabetes; an itching disorder called neurodermatitis; hyperactivity in children and attention deficit-hyperactivity disorder (ADHD); obesity and weight loss; whooping cough; and gastrointestinal disorders including ulcerative colitis, irritable bowel syndrome, and peptic ulcer disease.

Women use evening primrose oil in pregnancy for preventing high blood pressure (pre-eclampsia), shortening labor, starting labor, and preventing late deliveries. Women also use evening primrose oil for premenstrual syndrome (PMS), breast pain, endometriosis, and symptoms of menopause such as hot flashes.

In foods, evening primrose oil is used as a dietary source of essential fatty acids.
In manufacturing, evening primrose oil is used in soaps and cosmetics.

In Britain, evening primrose oil used to be approved for treating eczema and breast pain. However, the Medicines Control Agency (MCA), the British equivalent of the US Food and Drug Administration (FDA), withdrew the licenses for evening primrose oil products marketed as prescription drug products for these uses. The licenses were withdrawn because the agency concluded that there is not enough evidence that they are effective. The manufacturer disagrees, but it hasn’t published studies yet to prove the effectiveness of evening primrose for these uses.


How it is made
Evening primrose oil is extracted from the seeds of the evening primrose. The oil is usually put into capsules for use.

Benefits / uses
EPO is used mostly to relieve the itchiness causes by certain skin conditions, such as eczema and dermatitis. It is also used to ease breast tenderness from premenstrual syndrome (PMS) or other causes. Some of the uses for EPO include:

Eczema
Eczema symptoms include redness and scaling in addition to itching. More than 30 human studies report the benefits of EPO for eczema and dermatitis. A study of 1,207 patients found that EPO helped relieve symptoms from skin conditions, including itching, crusting, edema (fluid, swelling), and redness. EPO can be used in children and adults with skin conditions.

Premenstrual syndrome (PMS)
Many women throughout the world take EPO to reduce symptoms of PMS, although there isn' t any real scientific evidence that it works. In one review of 10 studies that used EPO to treat PMS, only two were well designed. Both of those studies found that EPO had no effect on PMS symptoms. Better studies are needed to know for sure.

Rheumatoid arthritis (RA)
Although a few studies have found that people with RA who took EPO felt better, the studies were hampered by poor design and high drop-out rates. Also, there wasn' t any evidence that taking EPO actually helped slow down the joint damage that happens with RA. Rheumatoid arthritis should be treated with conventional medications, to slow down or stop permanent joint damage.

Raynaud' s phenomenon
One small study suggests that taking EPO may help reduce symptoms in some people with Raynaud' s phenomenon. But the study found no difference in hand temperature between people who took EPO and those who took placebo. More studies are needed.

Diabetic peripheral neuropathy
Diabetic peripheral neuropathy is a nerve condition where people with diabetes have numbness, tingling, pain, burning, or lack of sensation in their feet and legs. Two studies have found that GLA may help reduce symptoms of diabetic neuropathy.

Breast pain
Although there is not a lot of scientific evidence, EPO is widely used to treat breast pain (mastalgia) in a number of European countries. A few studies have found that EPO seemed to help, but they have not been well-designed studies. Other studies show no benefit.

Menopausal symptoms
Although EPO has gotten popular for treating hot flashes, there is no scientific evidence that it actually helps.

Best Form For Human Consumption
EPO is available as an oil or in capsules. EPO products should be kept in the refrigerator and out of direct sunlight to prevent the oil from becoming rancid. Generally, high-quality oil will be certified as organic by a reputable third party, packaged in light-resistant containers, refrigerated, and marked with a freshness date. EPO should be standardized to contain 8% gamma-linolenic acid.
 
Doses
Pediatric: Ask your doctor before giving EPO to a child.
Adult: Take 2 - 8 grams of EPO daily, standardized to contain 8% GLA


Possible Side effects / Precautions / Possible Interactions:
Evening primrose oil is LIKELY SAFE for most people. It can sometimes cause mild side effects including upset stomach, nausea, diarrhea, and headache.

Special precautions & warnings:

Pregnancy and breast-feeding: Taking evening primrose oil is POSSIBLY UNSAFE during pregnancy. It might increase the chance of having complications. Don’t use it if you are pregnant.
It is POSSIBLY SAFE to take evening primrose oil during breast-feeding, but it’s best to check with your healthcare provider first.


Bleeding disorders: There is a concern that evening primrose oil might increase the chance of bruising and bleeding. Don’t use it if you have a bleeding disorder.

Epilepsy or another seizure disorder: There is a concern that taking evening primrose oil might make seizures more likely in some people. If you have a history of seizure, avoid using it.

Schizophrenia: Seizures have been reported in people with schizophrenia treated with phenothiazine drugs, GLA (a chemical found in evening primrose oil), and vitamin E. Get your healthcare provider’s opinion before starting evening primrose oil.

Surgery: Evening primrose oil might increase the chance of bleeding during or after surgery. Stop using it at least 2 weeks before a scheduled surgery.

Possible Interactions:
If you are currently being treated with any of the following medications, you should not use EPO without first talking to your health care provider.

Blood-thinning medications (anticoagulants) -- EPO may raise the risk of bleeding, especially if you take blood-thinners such as aspirin, warfarin (Coumadin), and clopidogrel (Plavix).

Blood pressure medications -- EPO may lower blood pressure in some people, although researchers aren' t sure. If you take medications to treat high blood pressure, ask your doctor before taking EPO.

Phenothizines -- People who take a class of medications called phenothiazines to treat schizophrenia should not take EPO because it may increase the risk of seizures.

Medications to control seizures -- EPO may lower the threshold for seizures, so people who are prone to seizures should not take it.

Antidepressants -- It' s possible, although researchers aren' t sure, that EPO may interact with some antidepressants, including selective serotonin uptake inhibitors such as:
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)


Research studies / References
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Wedig KE, Whitsett JA. Down the primrose path: petechiae in a neonate exposed to herbal remedy for parturition. J Pediatr 2008;152:140, 140.e1.
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Sinn N, Bryan J. Effect of Supplementation with Polyunsaturated Fatty Acids and Micronutrients on Learning and Behavior Problems Associated with Child ADHD. J Dev Behav Pediatr 2007;28:82-91.
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Verhoeven MO, van der Mooren MJ, van de Weijer PH, et al. CuraTrial Research Group. Effect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study. Menopause 2005;12:412-20.
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Furse RK, Rossetti RG, Seiler CM, Zurier RB. Oral administration of gammalinolenic acid, an unsaturated fatty acid with anti-inflammatory properties, modulates interleukin-1beta production by human monocytes. J Clin Immunol 2002;22:83-91.
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McKendry RJ. Treatment of Sjogren's syndrome with essential fatty acids, pyridoxine and vitamin C. Prostaglandins Leukot Med 1982;8:403-8.

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Oxholm P, Manthorpe R, Prause JU, Horrobin D. Patients with primary Sjogren's syndrome treated for two months with evening primrose oil. Scan J Rheumatol 1986;15:103-8.
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Belch JJ, Ansell D, Madhok R, et al. Effects of altering dietary essential fatty acids on requirements for non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis: A double blind placebo controlled study. Ann Rheum Dis 1988;47:96-104.
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Hansen TM, Lerche A, Kassis V, et al. Treatment of rheumatoid arthritis with prostaglandin E1 precursors cis-linoleic acid and gamma-linolenic acid. Scand J Rheumatol 1983;12:85-8.
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Das UN. The lipids that matter from infant nutrition to insulin resistance. Prostaglandins Leukot Essent Fatty Acids 2002;67:1-12.
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Menendez JA, Colomer R, Lupu R. Omega-6 polyunsaturated fatty acid gamma-linolenic acid (18:3n-6) is a selective estrogen-response modulator in human breast cancer cells: gamma-Linolenic acid antagonizes estrogen receptor-dependent transcriptional activity, transcriptionally represses estrogen receptor expression and synergistically enhances tamoxifen and ICI 182,780 (Faslodex) efficacy in human breast cancer cells. Int J Cancer 2004;10;109:949-54.