The root extract of A. officinalis has also been studied as a topical anti-inflammatory agent. In a study using rabbits with ultraviolet radiant irritation on the external ear, the root extract of A. officinalis was used alone and in combination with dexamethasone ointment.5 As a positive control, dexamethasone ointment was used alone.5 The root-only ointment reduced inflammation the least, with the dexamethasone ointment following next in efficacy. The ointment containing both compounds exerted the most substantial clearing effect, indicating a possible synergistic effect.5 Studies in human fibroblast cells confirm this anti-inflammatory action and that this action is due to an upregulation of genes related to stimulation of cell vitality without triggering hyperproliferation.6

Safety, interactions, side effects


A. officinalis has been classified as safe for consumption by the FDA.7 Other than possible allergic response, the potential for adverse reactions is negligible. Interactions with lithium and oral diabetes drugs have been noted, but few other interactions have been reported. These interactions are due to a potentiating effect that could increase the serum concentration of lithium and enhance the glucose-lowering action of oral agents for diabetes control.7


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No studies are available to verify safety in infants and young children. Use during pregnancy and lactation, however, are thought to be safe in moderation. 


Dose, how supplied, cost 


As with many medicinal agents, the dose is often dependent on the delivery method. A. officinalis root is available in powder-filled capsules, teas, and liquid extracts. It should be emphasized that the marshmallow sweet is not the same as the herbal supplement. 


As an antitussive or for relief of minor throat irritation, 1 teaspoon to 2 teaspoons of a liquid formulation is recommended.8 For more systemic ailments such as irritable bowel syndrome, powder-filled capsules are recommended at a dose of 2 g daily.8A. officinalis is often found in combination with other herbs that have a synergistic effect. The average cost of products that contain A. officinalis is relatively modest, ranging from $5 to $15 for a month’s supply. 


Summary


A. officinalis root compounds are generally safe, and, in some instances such as mild skin irritation, they may be useful. To date, however, no large-scale human clinical trials have clearly established efficacy. Consequently, providers should be cautious when considering recommending the routine use of supplements containing A. officinalis.


Sherril Sego, FNP-C, DNP, is a staff clinician at the VA Hospital in Kansas City, Mo., where she practices adult medicine and women’s health. She also teaches at the nursing schools of the University of Missouri and the University of Kansas.

References


  1. Marshmallow. University of Maryland Medical Center Web site. Available at umm.edu/health/medical/altmed/herb/marshmallow 

  2. Shah SMA, Akhtar N, Akram M, et al. Pharmacological activity of Althaea officinalis L. Journal of Medicinal Plants Research. 2011;5(24):5662-5666. Available at 
academicjournals.org/journal/JMPR/article-abstract/BD00EAD40178 

  3. Sutovska M, Nosalova G, Franova S, Kardosova A. The antitussive activity of polysaccharides from Althea officinalisL, var. Robusta, Arctium lappa L, var. Herkules, and Prunus persica L, Batsch. Bratisl Lek Listy. 2007;108(2):93-99. 

  4. Zarei B, Saifi T, Fazeli A, et al. Evaluation of 
antibacterial effects of marshmallow (Althaea 
officinalis) on four strains of bacteria. Intl J Agri Crop Sci. 2013;5(14):1571-1573. Available at ijagcs.com/wp-content/uploads/2013/08/1571-1573.pdf 

  5. Al-Snafi AE. The pharmaceutical importance of Althaea officinalis and Althaea rosea: A review. Int J Pharm Tech Res. 2013;5(3):1378-1385. Available at sphinxsai.com/2013/JulySept13/phPDF/PT=57(1378-1385)JS13.pdf 

  6. Deters A, Zippel J, Hellenbrand N, et al. Aqueous extracts and polysaccharides from marshmallow roots (Althea officinalis L): Cellular internalization and stimulation of cell physiology of human epithelial cells in vitro. 
J Ethnopharmacol. 2010;127(1):62-69. 

  7. Code of Federal Regulations. Title 21, Volume 3, Part 172—Food additives permitted for direct addition to food for human consumption. U.S. Food and Drug Administration Web site. Available at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=172.510

  8. Skidmore-Roth, L. Mosby’s Handbook of Herbs & Natural Supplements. 3rd ed. St. Louis: Mosby; 2006.


All electronic documents accessed August 15, 2015.