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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Comfrey - Drugs and Lactation Database (LactMed®) - NCBI Bookshelf</title>
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<meta name="citation_inbook_title" content="Drugs and Lactation Database (LactMed®) [Internet]">
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<meta name="citation_title" content="Comfrey">
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<meta name="citation_publisher" content="National Institute of Child Health and Human Development">
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<meta name="citation_date" content="2021/05/17">
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<meta name="citation_pmid" content="30000832">
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<meta name="citation_keywords" content="comfrey">
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<meta name="citation_keywords" content="Comfrey extract">
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<meta name="citation_keywords" content="Extract of comfrey">
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<meta name="citation_keywords" content="Symphytum officinale">
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<meta name="citation_keywords" content="Comfrey leaf extract">
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<meta name="citation_keywords" content="Extract of comfrey leaf">
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<meta name="citation_keywords" content="Symphytum officinalis L.">
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<meta name="citation_keywords" content="Symphytum officinalis extract">
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<meta name="citation_keywords" content="Symphytum officinalis leaf extract">
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<meta name="citation_keywords" content="Comfrey, Symphytum officinale, ext.">
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<meta name="DC.Title" content="Comfrey">
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<meta name="description" content="Comfrey (Symphytum officinalis) herb and leaf contains allantoin and rosmarinic acid; comfrey also contains pyrrolizidine alkaloids. Comfrey preparations have been used topically for pain following episiotomy and cracked, painful nipples, either as aqueous preparations or in creams and ointments.[1-7] Scientific evidence of effectiveness for these indications is minimal. The pyrrolizidine alkaloids in comfrey can cause severe liver damage, liver cancer, mutagenicity, and even death.[8,9] For this reason, the U.S. Food and Drug Administration has banned the sale of oral comfrey products in the United States. Furthermore, most sources consider topical use of comfrey during breastfeeding to be contraindicated.[1,10] If it is used on the skin, it should only be applied to intact skin away from the breast on the smallest area of skin possible, and for a limited duration. It is particularly important to ensure that the infant not come into direct contact with the areas of skin that have been treated, because ingestion may cause severe liver damage.">
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<meta name="og:description" content="Comfrey (Symphytum officinalis) herb and leaf contains allantoin and rosmarinic acid; comfrey also contains pyrrolizidine alkaloids. Comfrey preparations have been used topically for pain following episiotomy and cracked, painful nipples, either as aqueous preparations or in creams and ointments.[1-7] Scientific evidence of effectiveness for these indications is minimal. The pyrrolizidine alkaloids in comfrey can cause severe liver damage, liver cancer, mutagenicity, and even death.[8,9] For this reason, the U.S. Food and Drug Administration has banned the sale of oral comfrey products in the United States. Furthermore, most sources consider topical use of comfrey during breastfeeding to be contraindicated.[1,10] If it is used on the skin, it should only be applied to intact skin away from the breast on the smallest area of skin possible, and for a limited duration. It is particularly important to ensure that the infant not come into direct contact with the areas of skin that have been treated, because ingestion may cause severe liver damage.">
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class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK501773_"><span class="title" itemprop="name">Comfrey</span></h1><p class="fm-aai"><a href="#_NBK501773_pubdet_">Publication Details</a></p><p><em>Estimated reading time: 2 minutes</em></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><p>CASRN: 84696-05-9</p><div id="LM865.Drug_Levels_and_Effects"><h2 id="_LM865_Drug_Levels_and_Effects_">Drug Levels and Effects</h2><div id="LM865.Summary_of_Use_during_Lactation"><h3>Summary of Use during Lactation</h3><p>Comfrey (<i>Symphytum officinalis</i>) herb and leaf contains allantoin and rosmarinic acid; comfrey also contains pyrrolizidine alkaloids. Comfrey preparations have been used topically for pain following episiotomy and cracked, painful nipples, either as aqueous preparations or in creams and ointments.[<a class="bibr" href="#LM865.REF.1" rid="LM865.REF.1">1</a>-<a class="bibr" href="#LM865.REF.7" rid="LM865.REF.7">7</a>] Scientific evidence of effectiveness for these indications is minimal. The pyrrolizidine alkaloids in comfrey can cause severe liver damage, liver cancer, mutagenicity, and even death.[<a class="bibr" href="#LM865.REF.8" rid="LM865.REF.8">8</a>,<a class="bibr" href="#LM865.REF.9" rid="LM865.REF.9">9</a>] For this reason, the U.S. Food and Drug Administration has banned the sale of oral comfrey products in the United States. Furthermore, most sources consider topical use of comfrey during breastfeeding to be contraindicated.[<a class="bibr" href="#LM865.REF.1" rid="LM865.REF.1">1</a>,<a class="bibr" href="#LM865.REF.10" rid="LM865.REF.10">10</a>] If it is used on the skin, it should only be applied to intact skin away from the breast on the smallest area of skin possible, and for a limited duration. It is particularly important to ensure that the infant not come into direct contact with the areas of skin that have been treated, because ingestion may cause severe liver damage.</p><p>Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to <i>prove</i> the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does <i>not</i> certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information <a href="/books/n/lactmed/LactMedDietarySupps/?report=reader">about dietary supplements</a> is available elsewhere on the LactMed Web site.</p></div><div id="LM865.Drug_Levels"><h3>Drug Levels</h3><p><i>Maternal Levels.</i> Relevant published information was not found as of the revision date.</p><p><i>Infant Levels.</i> Relevant published information was not found as of the revision date.</p></div><div id="LM865.Effects_in_Breastfed_Infants"><h3>Effects in Breastfed Infants</h3><p>Relevant published information was not found as of the revision date.</p></div><div id="LM865.Effects_on_Lactation_and_Breastmil"><h3>Effects on Lactation and Breastmilk</h3><p>Relevant published information was not found as of the revision date.</p></div><div id="LM865.References"><h3>References</h3><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="LM865.REF.1">Low Dog T. The use of botanicals during pregnancy and lactation. <span><span class="ref-journal">Altern Ther Health Med. </span>2009;<span class="ref-vol">15</span>:54–8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19161049" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19161049</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="LM865.REF.2">Petrie KA, Peck MR. Alternative medicine in maternity care. <span><span class="ref-journal">Prim Care. </span>2000;<span class="ref-vol">27</span>:117–36.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10739460" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10739460</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="LM865.REF.3">Kopec K. Herbal medications and breastfeeding. <span><span class="ref-journal">J Hum Lact. </span>1999;<span class="ref-vol">15</span>:157–61.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10578793" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10578793</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="LM865.REF.4">Allaire AD, Moos MK, Wells SR. Complementary and alternative medicine in pregnancy: A survey of North Carolina certified nurse-midwives. <span><span class="ref-journal">Obstet Gynecol. </span>2000;<span class="ref-vol">95</span>:19–23.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10636495" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10636495</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="LM865.REF.5">Dennehy C, Tsourounis C, Bui L, et al. The use of herbs by California midwives. <span><span class="ref-journal">J Obstet Gynecol Neonatal Nurs. </span>2010;<span class="ref-vol">39</span>:684–93.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/21044150" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21044150</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="LM865.REF.6">Yarnell E. Botanical medicine in pregnancy and lactation. <span><span class="ref-journal">Altern Complement Ther. </span>1997;<span class="ref-vol">3</span>(April):93–100.</span></div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="LM865.REF.7">Fleiss P. Herbal remedies for the breastfeeding mother. Mothering 1988;Summer:68-71.</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="LM865.REF.8">Panter KE, James LF. Natural plant toxicants in milk: A review. <span><span class="ref-journal">J Anim Sci. </span>1990;<span class="ref-vol">68</span>:892–904.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/2180885" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2180885</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="LM865.REF.9">Winship KA. Toxicity of comfrey. <span><span class="ref-journal">Adverse Drug React Toxicol Rev. </span>1991;<span class="ref-vol">10</span>:47–59.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1878443" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1878443</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="LM865.REF.10">Howard CR, Lawrence RA. Drugs and breastfeeding. <span><span class="ref-journal">Clin Perinatol. </span>1999;<span class="ref-vol">26</span>:447–78.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10394496" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10394496</span></a>]</div></dd></dl></dl></div></div><div id="LM865.Substance_Identification"><h2 id="_LM865_Substance_Identification_">Substance Identification</h2><div id="LM865.Substance_Name"><h3>Substance Name</h3><p>Comfrey</p></div><div id="LM865.CAS_Registry_Number"><h3>CAS Registry Number</h3><p>84696-05-9</p></div><div id="LM865.Drug_Class"><h3>Drug Class</h3><p>Breast Feeding</p><p>Lactation</p><p>Anti-Inflammatory Agents</p><p>Complementary Therapies</p><p>Phytotherapy</p><p>Plants, Medicinal</p></div></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin"><p><b>Disclaimer: </b>Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.</p></p></div></dd></dl></dl></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK501773_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Revision: <span itemprop="dateModified">May 17, 2021</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a><p class="small"><b>Attribution Statement:</b> LactMed is a registered trademark of the U.S. Department of Health and Human Services.</p></div></div><h3>Publisher</h3><p><a href="https://www.nlm.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Child Health and Human Development</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Comfrey. [Updated 2021 May 17].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/lactmed/LM453/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/lactmed/conbercept/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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