Benefits
Traditional use as a digestive and bile-flow herb
Greater celandine has been used since the Middle Ages for bile and liver complaints. EU regulators declined to list it as a traditional remedy for indigestion, citing lacking efficacy evidence and many liver reports. They noted that safer herbal options exist.
Upper abdominal discomfort in a 60-person placebo-controlled trial
In a randomized double-blind trial in 60 people with functional upper abdominal complaints, 6 weeks of celandine extract tablets lowered symptom scores more than placebo, and physicians rated 18 of 30 vs 8 of 30 improved. The daily dose, 24 mg of alkaloids, is nearly ten times the later German ceiling, and the trial is not PubMed-indexed; its details come from the EMA assessment.
Right upper abdominal pain with a celandine and turmeric blend
In a 3-week placebo-controlled pilot trial in 76 people with cramp-like or dull right upper abdominal pain, a capsule of celandine plus turmeric root extract eased pain faster in the first week. The main outcome did not reach significance, and fullness, nausea and other complaints improved about equally on placebo. Celandine's own share cannot be separated.
Bile flow in isolated rat liver studies
Celandine is sold to promote bile flow, but this has not been measured in people. In an isolated rat liver, a whole ethanol extract of the herb increased bile flow, while its alkaloid and phenolic fractions on their own had only weak, non-significant effects. These are lab findings, not evidence of a digestive benefit.
Smooth muscle relaxing compounds in lab studies
The EU assessment summarizes lab and animal work in which coptisine, chelidonine and caffeoylmalic acid showed antispasmodic activity, a proposed basis for the traditional use against cramping. No study has shown that this action explains any effect in people, and the same alkaloids are under suspicion in the liver reports.
Mechanism of action
A mixture of potent isoquinoline alkaloids
The herb contains more than 20 alkaloids. Chelidonine, sanguinarine and chelerythrine (benzophenanthridines), berberine and coptisine (protoberberines) and protopine are the main groups. According to the EU assessment, sanguinarine is found mainly in the root rather than the aerial parts, and pharmacokinetic data are scarce but suggest the alkaloids are poorly absorbed or heavily metabolized.
Antispasmodic and bile-flow actions in lab models
In lab and animal models, several constituents showed antispasmodic activity, and a whole herb extract raised bile flow in an isolated rat liver. A total alkaloid extract did not show significant bile-flow activity, which suggests that any such effect depends on the full mix of compounds rather than the alkaloids alone.
How the liver injury may arise
Causality reviews describe celandine liver injury as an idiosyncratic reaction of the metabolic type, without immune-type features, and the culprit compound is unknown. In cultured rat liver cells, coptisine, chelerythrine and sanguinarine were the most toxic alkaloids, but rats and pigs fed celandine did not show similar harm, so animal tests have not reproduced the human reactions.
Clinical trials
Randomized, double-blind, placebo-controlled trial: two tablets of celandine dry extract (4 mg total alkaloids each) three times daily, 24 mg alkaloids a day, for 6 weeks. Not PubMed-indexed; details come from the EMA assessment report. (Ritter et al. 1993, as summarized by the European Medicines Agency)
60 patients with functional epigastric complaints; 30 per group.
The fall in symptom score on the Zerssen list was significantly greater with celandine than with placebo (p=0.003), and physicians rated 18 of 30 vs 8 of 30 patients improved or symptom-free. Restlessness or sleeplessness and dry mouth were reported in 3 patients on celandine and other complaints in 5 on placebo. The dose is far above the 2.5 mg a day later allowed in Germany.
Prospective multicenter randomized double-blind placebo-controlled pilot trial at 8 practices: one capsule three times daily for 3 weeks of a product combining celandine dry extract (standardized to 4 mg total alkaloids) and turmeric root extract (Niederau et al. 1999, Med Klin (Munich))
76 adults (61 women) with cramp-like or dull right upper abdominal pain attributed to functional biliary disorders; 39 on the blend and 37 on placebo, 73 analyzed for efficacy.
Pain eased faster on the blend in the first week, while improvement on placebo continued into weeks 2 and 3. Per the EMA summary, the primary outcome, frequency of cramp-like pain, did not differ significantly from placebo (p=0.069); dull pain and combined pain scores favored the blend. Fullness, nausea, flatulence and food intolerance changed similarly in both groups. No adverse events occurred on the blend. A two-herb product, so celandine's own effect is unknown.
Case series from a German university hospital, collected over 2 years (Benninger et al. 1999, Gastroenterology)
10 patients with acute hepatitis after taking greater celandine preparations, which the authors note are often prescribed for stomach and bile complaints.
Liver injury ranged from mild to severe, with marked cholestasis in 5 patients but no liver failure. Viral, autoimmune, hereditary, alcohol-related and biliary causes were excluded, and biopsies fitted drug-induced damage. All recovered after stopping, with liver enzymes normal in 2 to 6 months; one patient flared again after unintentional re-exposure.
Re-analysis of 22 spontaneous German reports of suspected celandine liver injury with the liver-specific CIOMS scale (Teschke et al. 2011, Regul Toxicol Pharmacol)
22 patients reported to German authorities after taking greater celandine.
Causality was highly probable in 2, probable in 6, possible in 10, unlikely in 1 and excluded in 3. Injury was mainly hepatocellular with a female majority; average age 56.4 years, treatment 36.4 days, and 35.6 days from the start of use to jaundice. The authors called it a distinct form of herb-induced liver injury but said poor data quality makes the link weaker than assumed.
Single case report from a US academic liver center (Power et al. 2024, ACG Case Rep J)
A 72-year-old man who had taken greater celandine pellets (about 6.6 mg of product a day by the authors' estimate; alkaloid content not reported) with two other remedies for 3 months for nausea and abdominal pain.
He presented with jaundice, ALT 974 U/L and bilirubin 12.3 mg/dL; biopsy showed hepatitis. All supplements were stopped and his liver tests were normal within 2 months and at 8 months. The authors note confounders, including a recently started diabetes drug and other medicines, so causality is not certain.
Two case reports plus a systematic PubMed literature review to March 2023 (Ciornolutchii et al. 2024, Am J Ther)
A 64-year-old woman who took celandine capsules for 1 month and a 66-year-old woman who drank celandine tea regularly; plus 38 published cases.
Both women had severe transaminase elevations (above 1000 IU/L in the first, who also had bile duct stones) that improved after stopping celandine and receiving intravenous amino acid and phospholipid therapy. The 38 published cases were mostly adult women aged 27 to 77, mostly reported from Germany, after 1 week to a year of use, with recovery generally after stopping.