Wormwood
AsteraceaeArtemisia absinthium
Also known as: Absinthium, Common Wormwood, Green Ginger
clinical_notes Clinical Summary
Wormwood (Artemisia absinthium) is a bitter aromatic herb of Mediterranean origin whose thujone-containing essential oil is infamous as the active principle of absinthe.
Clinically, low-thujone preparations are used as bitter digestives, carminatives, and anthelmintics, with a notable 2007 double-blind RCT showing steroid-sparing effects in Crohn's disease.
Because of thujone's abortifacient, convulsant, and neurotoxic properties, it is absolutely contraindicated in pregnancy, lactation, and seizure disorders; aqueous extracts at controlled doses remain the safer clinical form.
Pregnancy Safety
Absolutely contraindicated in pregnancy. Thujone is a known abortifacient and neurotoxin. Australian TGA recalled Artemisia absinthium products over pregnancy risks in 2021.
Lactation Safety
Contraindicated during breastfeeding. Thujone is neurotoxic and transfers into breast milk.
warning Contraindications
- Pregnancy (contraindicated)Theoretical
- Breastfeeding (contraindicated)Theoretical
- Seizure disorder / Epilepsy (contraindicated)Theoretical
- Peptic ulcer disease / Gastric hyperacidity (avoid)Clinically Proven
- Asteraceae/Compositae allergy (avoid)Clinically Proven
vital_signs Clinical Profile
Primary Indications
- check_circle intestinal parasites
- check_circle dyspepsia
- check_circle loss of appetite
- check_circle Crohn's disease
- check_circle biliary insufficiency
- check_circle IgA nephropathy
Therapeutic Actions
System Affinities
- check_circle digestive system
- check_circle liver
- check_circle gallbladder
- check_circle intestines
labs Active Constituents
absinthin
anabsinthin
thujone
sesquiterpene lactones
chamazulene
phenolic acids
flavonoids
essential oil
history_edu Traditional Use
Traditional Chinese Medicine (TCM)
苦艾 (Ku Ai)
Nature: cool
- damp-heat dysentery
- food stagnation
- parasitic infestation
- summer-heat
Used in folk Chinese medicine (distinct from common mugwort Ai Ye / Artemisia argyi) — sometimes for bacillary dysentery externally.
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.
Bitter digestive tonic for dyspepsia, anorexia, biliary insufficiency; vermifuge for roundworms and pinworms.
Approved by German Commission E for loss of appetite and dyspeptic complaints.
Afsanteen — used for hepatic disorders, fever, and as anthelmintic.
Classified as hot and dry.
External poultice for tendon inflammation; fresh or dried application for acute bacillary dysentery.
Distinct from Ai Ye (Artemisia argyi) in mainstream TCM practice.
spa Parts Used
aerial parts
- dyspepsia
- anorexia
- parasites
- Crohn's disease
Aerial parts (leaves and flowering tops) harvested at flowering. Aqueous extracts (teas) have markedly lower thujone content than essential oil or alcoholic extracts.
shield Safety
Contraindications — Evidence Basis
Pregnancy
Thujone is an abortifacient and neurotoxic; Australian TGA recalled Artemisia absinthium products in 2021 over pregnancy risk.
Breastfeeding
Thujone passes into breast milk and is neurotoxic to infants.
Seizure disorder / Epilepsy
Thujone is a GABA-A receptor antagonist and can provoke seizures; 13-week rat study showed convulsions at 25 mg/kg/day thujone.
Peptic ulcer disease / Gastric hyperacidity
Bitter principles stimulate gastric acid secretion and may aggravate ulcer disease.
Asteraceae/Compositae allergy
Cross-reactivity with ragweed, mugwort; reports of rhinitis, dermatitis.
Monitoring Parameters
Monitor during use, especially with prolonged or high-dose therapy.
Liver enzymes (ALT, AST)
Baseline and every 4-6 weeks during therapeutic useThujone is hepatotoxic at high/chronic doses; essential oil particularly concerning
flagThreshold: ALT/AST >3x ULN: discontinue and reassess
Renal function (creatinine, BUN)
Baseline and every 4-6 weeksThujone-containing preparations have been associated with acute kidney injury
flagThreshold: Creatinine rise >30% from baseline: discontinue
Toxicity
Essential oil toxic at doses >15mL; thujone LD50 in rats ~120 mg/kg oral; convulsions seen at 25 mg/kg/day thujone chronically.
Absinthism syndrome: convulsions, hallucinations, tremors, insomnia, stupor, vomiting, diarrhea, urinary retention, renal injury, hepatotoxicity.
Discontinue immediately; benzodiazepines for seizures; supportive care; activated charcoal if recent ingestion; renal and hepatic monitoring.
Adverse Effects
CYP Metabolism
Thujones detoxified by CYP2A6, CYP2B6, and CYP3A4 to 7-hydroxythujone. Individuals with CYP2A6 polymorphisms may have prolonged thujone exposure. Avoid co-administration with CYP2A6/3A4 inhibitors.
swap_horiz Interactions
Phenobarbital
Class: Barbiturate anticonvulsant / GABA-A modulator
α-Thujone is a rapidly acting antagonist of the GABA-gated chloride channel, producing excitation and seizures; it pharmacodynamically opposes the GABA-enhancing action of barbiturates and benzodiazepines, potentially reducing seizure threshold.
Contraindicated in epilepsy and in patients taking GABAergic anticonvulsants (phenobarbital, primidone, clonazepam, diazepam). Use only thujone-free (<0.35 mg/kg) preparations in this population.
Itraconazole
Class: Azole antifungal (CYP3A4 inhibitor)
α-Thujone undergoes 7- and 4-hydroxylation primarily by CYP2A6 with CYP3A4 and CYP2B6 as minor pathways. Strong CYP3A4 inhibitors (itraconazole, ketoconazole, ritonavir, clarithromycin) slow thujone detoxification and increase neurotoxic exposure, particularly in CYP2A6 poor-metabolisers.
Avoid wormwood essential-oil and high-dose tincture preparations with strong CYP3A4 inhibitors. Thujone-free herbal preparations pose no such risk.
Methoxsalen (8-MOP)
Class: CYP2A6 inhibitor / photochemotherapy
CYP2A6 performs 70–80% of α-thujone 4- and 7-hydroxylation in human liver microsomes. Methoxsalen, a potent CYP2A6 inhibitor, blocks thujone detoxification, prolonging GABA-antagonist effect and raising seizure risk.
Avoid thujone-containing wormwood preparations with methoxsalen, pilocarpine, or other CYP2A6 inhibitors; recommend processed or thujone-limited (EMA <3 mg/day) preparations for ≤2 weeks only.
Warfarin
Class: Anticoagulant
Case report documented probable warfarin-wormwood interaction with elevated INR and gastrointestinal bleeding; flavonoids and sesquiterpenes may inhibit CYP2C9-mediated S-warfarin metabolism and/or hepatic clearance.
Avoid concurrent use. If wormwood is being used, check INR at day 3, 7, and 14 after initiation and watch for GI bleeding; dose-reduce warfarin if INR rises.
Valproic acid
Class: Anticonvulsant
Thujone-mediated GABA-A antagonism lowers seizure threshold and can precipitate convulsions despite therapeutic valproate levels; essential-oil wormwood preparations have caused tonic-clonic seizures in case reports.
Contraindicated in patients with seizure disorders on any anticonvulsant. Advise epilepsy patients that absinthe-style wormwood preparations must be avoided.
hub Combinations
Synergistic pairings can enhance therapeutic outcomes, while knowing suitable substitutes helps when specific herbs are unavailable or contraindicated.
Classical Formulas
2Black Walnut
Traditional UseClassic parasite cleanse triad with clove — broad-spectrum antiparasitic synergy targeting different life-cycle stages.
Traditional combination; limited formal RCT evidence.
Clove
Traditional UseEugenol in clove destroys parasite eggs while wormwood targets adult stages.
Traditional antiparasitic combination.
Possible Substitutes
1Mugwort
Traditional UseMugwort (Artemisia vulgaris) has gentler bitter and emmenagogue action — sometimes used as a milder substitute in digestive and menstrual formulas.
Traditional Western practice.
Synergistic Combinations
2Fennel
Traditional UseFennel's carminative action offsets wormwood's potential GI irritation while complementing digestive support.
Traditional European digestive formulation.
Gentian
Traditional UseBoth are potent bitters; synergistic stimulation of digestive secretions with complementary gentle and intense bitter profiles.
Traditional European bitter formulation (featured in Swedish Bitters).
science Studies
Topical Effects of Artemisia Absinthium Ointment and Liniment in Comparison with Piroxicam Gel in Patients with Knee Joint Osteoarthritis: A Randomized Double-Blind Controlled Trial
RCTThis randomised double-blind trial enrolled 90 patients (aged 30–70) with primary knee osteoarthritis and assigned them to topical Artemisia absinthium ointment 3% (AAO), A. absinthium liniment 3% (AAL), or piroxicam gel (PG) applied three times daily for 4 weeks. Both wormwood formulations produced meaningful reductions in pain and improved functional status. The AA ointment group showed beneficial effects comparable to piroxicam gel in relieving OA symptoms. These findings support the traditional use of A. absinthium as a topical anti-inflammatory agent for musculoskeletal pain.
Wormwood (Artemisia absinthium) for poorly responsive early-stage IgA nephropathy: a pilot uncontrolled trial
Case StudyThis pilot uncontrolled trial enrolled 10 patients with biopsy-proven IgA nephropathy who had proteinuria >500 mg/day despite at least 3 months of dual renin-angiotensin system (RAS) blockade. Patients received 1.8 g/day of thujone-free wormwood preparation for 6 months as a supplement, while continuing RAS blockade. Proteinuria decreased and kidney function parameters showed improvement in several patients. Given the known role of TNF-alpha in IgA nephropathy and wormwood's TNF-alpha-suppressing properties, the results suggest a potential role for A. absinthium as adjunctive therapy in this autoimmune kidney disease, warranting further controlled investigation.
medication Dosing
tea
1-1.5 g dried herb in 150 mL boiling water
TID before meals
Maximum 3g/day. Short-term use only (max 4 weeks). Aqueous extract has low thujone content.
tincture
1-4 mL (1:5 in 40% ethanol)
TID before meals
Short-term use; thujone content higher in alcoholic extract. Final product should contain <6 mg thujone/day.
capsule
500-1500 mg dried herb/day
divided TID
Steroid-sparing Crohn's study used SedaCrohn 3x500 mg/day with total daily thujone <6 mg.
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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