Osteoarthritis and White Willow

White willow can be used in the treatment for osteoarthritis as an alternative to aspirin.

Read more details about White Willow.

The herb white willow contains the aspirin-like substance salicin. A 2-week, double-blind, placebo-controlled trial of 78 individuals with arthritis found evidence that willow extracts can relieve osteoarthritis pain.⁶⁹ However, another double-blind study enrolling 127 people with osteoarthritis found white willow less effective than a standard anti-inflammatory drug and no more effective than placebo.¹⁴² Again, the likely explanation for these contradictory results is that white willow at usual doses provides relatively modest benefits.

Standardized willow bark extracts should provide 120 to 240 mg of salicin daily.

Safety Issues

Evidence suggests that willow, taken at standard doses, is the equivalent of 50 mg of aspirin, a very small dose. ¹ Willow doesn't impair blood coagulation to the same extent as aspirin, ² and also doesn't appear to significantly irritate the stomach. ³ Nonetheless, it seems reasonable to suppose that, if it is used over the long term or in high doses, willow could still cause the side effects associated with aspirin. All the risks of aspirin therapy potentially apply.

For this reason, white willow should not be given to children, due to the risk of Reye's syndrome. It should also not be used by people with aspirin allergies, bleeding disorders, or kidney disease. In addition, it may interact adversely with "blood thinners," other anti-inflammatory drugs, methotrexate, metoclopramide, phenytoin, probenecid, spironolactone, and valproate.

Safety in pregnant or nursing women, or those with severe liver or kidney disease, has not been established.

Interactions You Should Know About

Avoid combining white willow with the following medications:

Blood-thinning medications, such as:

• Warfarin (Coumadin)
• Heparin
• Clopidogrel (Plavix)
• Ticlopidine (Ticlid)
• Pentoxifylline (Trental)
• Aspirin
• Methotrexate
• Metoclopramide
• Phenytoin (Dilantin)
• Sulfonamide drugs
• Spironolactone and other potassium-sparing diuretics
• Valproic acid

Note: White willow should not be combined with standard anti-inflammatory drugs, such as ibuprofen. For more information, including dosage and safety issues, see the full White Willow article.

1. Chrubasik S, Eisenberg E, Balan E, Weinberger T, Luzzati R, Conradt C. Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. Am J Med. 109(1):9-14.
2. Krivoy N, Pavlotzky E, Chrubasik S, et al. Effect of Salicic cortex extract on human platelet aggregation. Planta Med. 2000;66:1-4.
3. European Scientific Cooperative on Phytotherapy. Salicis cortex. Exeter, UK: ESCOP; 1996-1997:2. Monographs on the Medicinal Uses of Plant Drugs, Fascicule 4.

4. Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. Am J Med. 2000;109:9-14.
8. Krivoy N, Pavlotzky E, Chrubasik S, et al. Effect of Salicic cortex extract on human platelet aggregation. Planta Med. 2000;66:1-4.
9. European Scientific Cooperative on Phytotherapy. Salicis cortex. Exeter, UK: ESCOP; 1996-1997:2. Monographs on the Medicinal Uses of Plant Drugs, Fascicule 4.
69. Schmid B, Ludtke R, Selbmann HK, et al. Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized, placebo-controlled, double blind clinical trial [translated from German]. Z Rheumatol. 2000;59:314-320.
142. Biegert C, Wagner I, Ludtke R, et al. Efficacy and safety of willow bark extract in the treatment of osteoarthritis and rheumatoid arthritis: results of 2 randomized double-blind controlled trials. J Rheumatol. 2004;31:2121-2130.