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Oscillococcinum (Anas barbariae hepatis et cordis extractum 200CK HPUS) and Use for Influenza Infections

Summary:

  • The use of natural, herbal or homeopathic treatments thought to be active against swine-origin influenza A (H1N1) viral infections is likely to increase and are now being advocated by a number of non-medical sources found on the internet.  One such homeopathic medicine being recommended by some non-medical authorities is Oscillococcinum (Anas barbariae hepatis et cordis extractum 200CK HPUS).
  • A systematic review of 7 trials by the Cochrane Collaboration concluded that there is no evidence that Oscillococcinum prevents influenza illness.  In addition, the Cochran Collaboration and a group out of the United Kingdom concluded that participants who took Oscillococcinum experienced a reduction in duration of illness of 6 hours, with a range of 1 hour to 12 hours of benefit.
  • It is important to note that the trials used in these systematic reviews and data published to date, do not include any scientific evidence for use of Oscillococcinum for the prophylaxis or treatment of the current swine-origin influenza A (H1N1) flu.

Editor-in-Chief: Anthony J. Busti, MD, PharmD, FNLA, FAHA
Reviewers:
  Donald S. Nuzum, PharmD, BCACP, CDE
Last Reviewed: October 2015

Explanation

  • The emergence and global impact of the swine-origin influenza A (H1N1) virus several years ago along with the knowledge that available methods for prevention and treatment are limited has raised concerns about how we will be able to offer preventative therapies and/or treatment to those in need should the situation worsen.  While government agencies recommend oseltamivir (Tamiflu) and zanamivir (Relenza) as effective therapies, worldwide supply is not sufficient to offer prophylaxis or treatment to everyone.1,2  In addition, there are a number of people that will not take treatments that are not "natural" or that are known to be synthetic/prescription medications.  As such, the use of natural, herbal or homeopathic treatments thought to be active against influenza A viral infections are likely to used and advocated by non-medical sources found on the internet.  One such homeopathic medicine being recommended is Oscillococcinum (Anas barbariae hepatis et cordis extractum 200CK HPUS).3 

    Oscillococcinum is a patented homeopathic medicine that is in the form of granules and is manufactured primarily by Boiron Laboratories.3  Prior to the emergence of the swine-origin influenza A (H1N1) or avian influenza A (H5N1) viruses, Oscillococcinum was reported to be used by over 1,000 United Kingdom physicians, and 10,000 French and German homeopathic physicians for influenza infections (flu).4  

    Are there any efficacy data regarding the use of Oscillococcinum for the prevention or treatment of the flu?

    Two separate systematic reviews have been done and will help answer this question.  One was done by the Cochrane Collaboration specifically on Oscillococcinum and another by a group from the United Kingdom that included Oscillococcinum in its systematic analysis.4,5  Both groups came to similar findings.  The Cochrane Collaboration included a total of 7 trials in their review of which 3 were prevention trials representing 2,265 participants and 4 were treatment trials representing 1,194 participants.  Of these trials only 2 studies had sufficient information to complete the full data extraction.  They found that there was no evidence that Oscillococcinum can prevent influenza (relative risk, 0.64; 95% confidence interval (CI), 0.28 - 1.43).4  As it related to the treatment of the flu, Oscillococcinum reduced the length of the influenza illness by 0.28 days (95% CI, 0.5 - 0.6).4  This translates into participants taking Oscillococcinum experiencing an average reduction in duration of illness by only 6 hours, with a range of 1 hour to 12 hours of benefit.4  This conclusion was consistent among both systematic analyses and while it is statistically significant, this is of debatable clinical significance.4,5  This is especially true given the poor standards used by these trials in reporting data.4  In fact, several of the studies never made it to full publication and one was published in a general medical magazine versus a scientific journal.4  Fortunately, there are no known major side effects associated with its use. 

    Is Oscillococcinum regulated by the U.S. Food and Drug Administration? 
    Yes.  Homeopathic medicines meeting certain criteria are regulated by the FDA.6  However, it is important to note that the trials used in these systematic reviews and data published to date do not include any scientific evidence for use of Oscillococcinum for the prophylaxis or treatment of the current swine-origin influenza A (H1N1) flu.  In addition, the current CDC recommendations for prevention and treatment against the current strains of the H1N1 virus do not include Oscillococcinum as a recommended option.  As such, its use for the prevention or treatment of the current H1N1 strain cannot be recommended and should not be used in place of other standard treatments that have supporting scientific information.

    References:

    1. Busti AJ, Margolis DM, Herrington J, Nuzum DS, Daves BJ, McKeever GC.  How can the antiviral, oseltamivir (Tamiflu) work to treat swine-origin influenza A strain (H1N1) viral infection?
    2. Center for Disease Control and Prevention.  H1N1 Flu (Swine Flu) and You.  Accessed: May 12, 2009.
    3. Boiron. Oscillococcinum.  Newtown Square, PA.
    4. Vickers AJ, Smith C.  Homeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes.  Cochrane Database Syst Rev  2006;3:CD001957.
    5. Guo R, Pittler MH, Ernst E.  Complementary medicine for treating or preventing influenza or influenza-like illness.  Am J Med  2007;120:923-929.e3.
    6. U.S. Food and Drug Administration. Sec 400.400 Conditions Under Which Homeopathic Drugs May be Marketed (CPG 7132.15).

MESH Terms & Keywords

  • Oscillococcinum, Anas Barbariae Hepatis, Influenza viral Infection, Homeopathic Medicine