Benefits
Leg vein comfort: heaviness, tension and lower-leg volume
In a 12-week placebo-controlled trial in 166 women with chronic venous insufficiency, a Ruscus extract taken alone reduced lower-leg volume and ankle and lower-leg circumference and eased leg heaviness, tiredness and tension more than placebo. Pain, tingling and quality of life did not differ between groups, and European regulators rated the evidence from this one trial as low.
Vein comfort and ankle swelling with a Ruscus blend
Most Ruscus research used a blend with hesperidin methyl chalcone and vitamin C. A pooled analysis of 10 double-blind, placebo-controlled trials (719 patients with chronic venous disease) found less leg pain, heaviness, fatigue and feeling of swelling and smaller ankle circumference with the blend. An earlier pooled analysis found no significant change in ankle or calf circumference.
Traditional use for rectal itching and burning
The European Medicines Agency lists Ruscus rhizome as a traditional herbal medicine for itching and burning linked to hemorrhoids, once a doctor has ruled out serious causes. This listing rests on long-standing use only: the agency found no clinical data for Ruscus taken alone, and any rectal bleeding needs a medical check.
Arm swelling with a Ruscus and hesperidin methyl chalcone blend
In a 3-month double-blind trial in 57 patients with arm swelling after earlier breast cancer treatment, all also receiving manual lymphatic drainage, arm volume fell 12.9% more with a blend of Ruscus and hesperidin methyl chalcone than with placebo. This is one trial of a blend in one population.
Mechanism of action
Alpha-adrenergic tightening of veins
Lab and animal studies reviewed by the European Medicines Agency show Ruscus extract contracts veins by directly activating alpha-1 and alpha-2 adrenergic receptors and by releasing norepinephrine from nerve endings. The effect appeared stronger at higher temperatures. Small human plethysmography studies reviewed by the agency point the same way, but the agency could not judge their quality.
Lymphatic vessel contraction (animal data)
In anesthetized dogs, Ruscus extract given by injection contracted lymphatic vessels, and in a cat model of induced swelling it reduced fluid buildup. Ruscogenin was active, but other parts of the extract were needed for the full effect. These are animal findings, not evidence in people.
Capillary changes on skin capillaroscopy (uncontrolled)
In an open study of 124 adults taking a Ruscus, hesperidin methyl chalcone and vitamin C blend for 8 weeks, skin capillaroscopy showed less fluid between capillaries over time. The study had no control group, so these changes cannot be separated from time or other factors.
Clinical trials
Multicenter, double-blind, randomized, placebo-controlled trial of a Ruscus extract taken without other actives; funding not stated in the abstract (Vanscheidt et al. 2002, Arzneimittelforschung)
166 women with chronic venous insufficiency (CEAP 3 to 4) randomized; 148 aged 30 to 89 analyzed. 36 to 37.5 mg Ruscus dry extract (Fagorutin Ruscus Kapseln) or placebo twice daily for 12 weeks.
Lower-leg volume fell over 12 weeks with Ruscus and did not fall with placebo (primary endpoint AUB0-12, between-group difference 827 mL x day). Leg volume at 8 and 12 weeks (16.5 and 20.5 mL less than placebo), ankle and lower-leg circumference, and heaviness, tiredness and tension at week 12 also favored Ruscus. Pain, tingling and quality of life did not differ. Adverse events: 22 with Ruscus, 26 with placebo.
Open-label, randomized, multicenter trial over 90 days in chronic venous lymphatic insufficiency, with an active comparator (hydroxyethyl rutoside) and no placebo arm; the same trial was also published in Int Angiol in 1999 (Beltramino et al. 2000, Angiology)
80 adults aged 30 to 70 in Argentina with heavy, tired, swollen or painful legs, given a blend of Ruscus, hesperidin methyl chalcone and ascorbic acid (Cyclo 3 Fort) or hydroxyethyl rutoside.
The blend group reported faster and more complete symptom regression than the rutoside group (p<0.01). Limb size fell in both groups, but the reduction persisted at 90 days only in the blend group (p<0.01). Patients and physicians knew which product was given, which limits this comparison.
Double-blind, placebo-controlled trial over 3 months in patients with secondary lymphedema of the arm after breast cancer treatment; funding not stated in the abstract (Cluzan et al. 1996, Lymphology)
57 patients with arm swelling after earlier breast cancer treatment, all also receiving manual lymphatic drainage twice a week for at least 1 month; Cyclo 3 Fort blend (Ruscus plus hesperidin methyl chalcone) or placebo.
Arm volume fell 12.9% more with the blend than with placebo after 3 months (p=0.009), and the reduction tended to be larger in the forearm than in the upper arm. The authors reported minimal adverse reactions.
Randomized, double-blind, placebo-controlled trial of an oral blend (Phlebodril: Ruscus extract, trimethyl hesperidin chalcone and ascorbic acid) measuring venous tone in primary varicose veins; German-language paper (Weindorf et al. 1987, Z Hautkr)
50 patients with trunk or branch varicosis; blend or placebo by mouth for 2 weeks.
Plethysmography measures at rest and during exercise trended toward improvement with the blend, but only some changes reached significance. The authors suggested that 2 weeks may have been too short to see the full effect.
Non-randomized controlled study (consecutive allocation to three groups) using duplex ultrasound of leg vein diameter in women with chronic venous disease, CEAP C2 to C3 (Porto et al. 2009, Int Angiol)
52 women given a Cirkan blend (40 mg Ruscus root extract, 100 mg hesperidin methyl chalcone and 200 mg vitamin C per pill), elastic compression stockings, or no treatment.
Popliteal and great saphenous diameters decreased on both legs within the blend group, and clinical scores differed between the blend and no-treatment groups. Leg perimeter changed only with stockings, which the authors rated the most effective option tested.