Agrimony
RosaceaeAgrimonia eupatoria
Also known as: Church Steeples, Stickwort, Sticklewort
clinical_notes Clinical Summary
Agrimony (Agrimonia eupatoria) is a classic European hepatic and digestive astringent whose tannin-rich profile — particularly the ellagitannin agrimoniin — and flavonoids confer anti-inflammatory, antiviral, hepatoprotective, and wound-healing properties.
The EMA recognises its traditional use for mild diarrhoea, oral inflammation, and skin wound healing.
A double-blind RCT supports its hepatoprotective use in mild ALT elevation, and antiviral activity against hepatitis B has been demonstrated in vitro.
Pregnancy Safety
No reliable safety data for pregnancy or lactation. EMA states no data available for use in children under 12, pregnant or breastfeeding women. Avoid medicinal doses as precaution.
Lactation Safety
Insufficient data. Avoid medicinal doses during lactation.
warning Contraindications
- Pregnancy (caution)Theoretical
- Constipation (caution)Theoretical
vital_signs Clinical Profile
Primary Indications
- check_circle mild diarrhoea
- check_circle IBS
- check_circle sore throat
- check_circle oral inflammation
- check_circle mild liver dysfunction (elevated ALT)
- check_circle skin inflammation
- check_circle wound healing
- check_circle gallbladder disorders
- check_circle urinary tract conditions
- check_circle diabetes (adjunct)
Therapeutic Actions
System Affinities
- check_circle digestive
- check_circle hepatic
- check_circle urinary
- check_circle oral cavity
- check_circle skin
- check_circle immune
labs Active Constituents
tannins
flavonoids
triterpenoids
volatile oil
phenolic acids
polysaccharides
history_edu Traditional Use
No TCM data available for this herb yet.
Traditional Uses Across Healing Systems
While many herbs lack controlled clinical trials, centuries of traditional practice across cultures provide valuable insight into their therapeutic applications.
Digestive and hepatic tonic; used for diarrhoea, IBS, gallbladder disorders, liver support, sore throat (gargle), and wound healing (topical). Central to Western European herbal tradition.
One of the most versatile European herbs; the EMA recognises traditional use for diarrhoea, oral/throat inflammation, and skin wounds.
North American indigenous use of related Agrimonia species for gastrointestinal complaints and skin conditions
Multiple native species used by indigenous peoples of North America.
spa Parts Used
aerial parts
- diarrhoea
- oral inflammation
- liver support
- wound healing
- IBS
Dried flowering tops used for internal infusions and external compresses. Harvest when in full flower for highest tannin content.
shield Safety
Contraindications — Evidence Basis
Pregnancy
No data on use in pregnancy or breastfeeding (EMA 2015). Avoid medicinal doses during pregnancy as a precautionary measure.
Constipation
High tannin content may worsen constipation by increasing GI tone. Use cautiously in those with habitual constipation.
Monitoring Parameters
Monitor during use, especially with prolonged or high-dose therapy.
Liver enzymes (ALT, AST)
Baseline and at 8 weeks in liver support useRandomised controlled trial demonstrated significant reduction in ALT and serum triglycerides in subjects with mildly elevated ALT after 8 weeks of agrimony aqueous extract
flagThreshold: ALT normalisation or failure to improve: reassess treatment
Toxicity
No significant toxicity reported at standard doses. High tannin preparations may cause GI irritation.
Nausea, GI upset, constipation with excessive tannin intake
Reduce dose; increase hydration; discontinue if adverse effects persist
Adverse Effects
CYP Metabolism
No significant CYP interactions reported. Tannins may bind to drugs and reduce absorption if taken simultaneously; take at least 2 hours apart from medications.
swap_horiz Interactions
Antidiabetics (Insulin, Glimepiride, Metformin)
Class: Antidiabetic
Agrimonia eupatoria exhibits documented antidiabetic activity: aqueous extracts stimulate insulin secretion from BRIN-BD11 pancreatic B-cells, enhance glucose uptake in muscle tissue, and reduce hyperglycaemia in streptozotocin-diabetic mice. Additive hypoglycaemic effects with antidiabetic medications are expected and well-documented.
Patients on antidiabetic medications including insulin, sulfonylureas, or metformin should monitor blood glucose closely when using agrimony. Dose adjustment of antidiabetic medication may be required. Discontinue agrimony at least 2 weeks before any surgical procedure involving blood glucose management.
Iron Supplements / Iron-containing Medications
Class: Mineral Supplement
Agrimony contains high concentrations of tannins (ellagitannins, procyanidins) that form stable, insoluble complexes with iron ions in the gastrointestinal tract, significantly reducing iron absorption. This is particularly problematic for patients receiving oral iron therapy for anaemia.
Take oral iron supplements (ferrous sulphate, ferric gluconate, etc.) at least 2-3 hours before or after agrimony preparations to minimise tannin binding. Patients on iron therapy should notify their prescriber of agrimony use. Monitor haemoglobin and ferritin levels.
Oral Antibiotics (Tetracycline, Ciprofloxacin)
Class: Antibiotic
Agrimony tannins can chelate metal ions and bind to protein structures. Tetracyclines and fluoroquinolones (e.g., ciprofloxacin) bind strongly to polyvalent cations (Ca2+, Mg2+, Fe3+) and are known to be significantly reduced in absorption by tannin-containing preparations. Simultaneous administration may reduce antibiotic bioavailability below therapeutic levels.
Patients taking tetracycline or fluoroquinolone antibiotics should separate dosing from agrimony by at least 2-3 hours. This is especially important during acute infection treatment where therapeutic drug levels are critical. Advise prescribers if agrimony use is current.
Lithium
Class: Mood Stabilizer
Agrimony has diuretic properties, which may alter renal lithium clearance. Diuresis reduces renal tubular reabsorption of lithium, potentially lowering plasma lithium levels and reducing therapeutic efficacy. However, significant diuresis may also concentrate lithium if dehydration occurs. The net effect on lithium levels is unpredictable.
Patients on lithium therapy should avoid using agrimony as a regular diuretic. If used, monitor serum lithium levels more frequently. Ensure adequate hydration. Alert patients that herbal diuretics can unpredictably alter lithium clearance.
Thyroid Hormone (Levothyroxine)
Class: Thyroid Hormone
Tannins in agrimony can bind thyroid hormone preparations (levothyroxine, liothyronine) in the gastrointestinal tract, forming insoluble complexes that reduce absorption. This is the same mechanism by which calcium, iron, and soy products reduce levothyroxine absorption. Even modest reductions in thyroid hormone absorption can destabilise thyroid control.
Levothyroxine should be taken on an empty stomach at least 60 minutes before, or 3-4 hours after, agrimony preparations. Monitor TSH levels if agrimony use is initiated or discontinued in patients on thyroid hormone therapy. Dose adjustment may be needed.
hub Combinations
Synergistic pairings can enhance therapeutic outcomes, while knowing suitable substitutes helps when specific herbs are unavailable or contraindicated.
Synergistic Combinations
3Chamomile
Traditional UseGut-soothing combination; Agrimony provides astringent tannins to reduce diarrhoea while Chamomile provides antispasmodic and anti-inflammatory support for IBS.
Traditional European combination for IBS and gastroenteritis; complementary digestive actions.
Globe Artichoke
Moderate EvidenceCholagogue and hepatic combination; Artichoke increases bile production while Agrimony improves bile flow and protects hepatic tissue. Classic liver and gallbladder formula.
Complementary hepatic mechanisms; both herbs included in European liver support formulas.
Milk Thistle
Moderate EvidenceCombined for liver protection; Milk Thistle silymarin protects hepatocytes while Agrimony reduces ALT and triglycerides through complementary antioxidant and anti-inflammatory mechanisms.
Both herbs have RCT evidence for hepatoprotective effects; combined use recommended in naturopathic hepatology.
science Studies
Agrimonia eupatoria L. Aqueous Extract Improves Skin Wound Healing: An In Vitro Study in Fibroblasts and Keratinocytes and In Vivo Study in Rats
In VivoThis study combined in vitro experiments with fibroblasts and keratinocytes with in vivo wound healing experiments in rats to evaluate whether Agrimonia eupatoria aqueous extract (AE) could accelerate wound healing. In vitro, AE extract induced the myofibroblast-like phenotype in fibroblasts, enhanced extracellular matrix deposition, and stimulated keratinocyte proliferation and differentiation. In an animal wound model, AE significantly increased wound tensile strength (14 days post-surgery) and promoted wound contraction compared to controls. Histological and immunofluorescence analysis confirmed enhanced re-epithelialization and collagen deposition in AE-treated wounds. These findings suggest agrimony extract as a promising agent for topical wound care and skin repair applications.
Agrimonia eupatoria L.: An integrative perspective on ethnomedicinal use, phenolic composition and pharmacological activity
Systematic ReviewThis integrative review synthesized ethnomedicinal uses, phenolic composition, and pharmacological activities of Agrimonia eupatoria based on a systematic literature search. The plant has been traditionally used for gastrointestinal disorders (including diarrhea and colitis), liver and gallbladder disease, diabetes, and anti-inflammatory applications across multiple cultures. Phytochemical analysis identified tannins, flavonoids, phenolic acids, and triterpenoids as the primary bioactive components with antioxidant, immunomodulatory, and antimicrobial activities. Two clinical studies were identified: one demonstrating hepatoprotective properties and another showing anti-inflammatory and lipid-lowering effects. The review concluded that agrimony has genuine therapeutic potential for digestive, liver, cardiovascular, and metabolic conditions with a strong safety profile.
medication Dosing
tea
1.5-4 g dried herb per cup (250 mL)
2-3x daily
For diarrhoea: steep 1.5-4 g in 250 mL boiling water for 10 min. Consult healthcare provider if diarrhoea persists > 3 days.
tincture
1-4 mL (1:5, 25% ethanol)
3x daily
For liver support and digestive conditions; hepatoprotective effect demonstrated in 8-week RCT with aqueous extract at equivalent dose.
topical
3-10 g dried herb per 250 mL water as wash or compress
2x daily to affected area
For skin wounds, inflammation. Apply compress or wash; assess after 1 week. Gargle for sore throat.
Disclaimer: This information is largely AI-generated and reviewed by human experts at Evara Health. It is intended for educational and clinical reference purposes only and should not replace professional medical advice.
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