Horsetail dosage varies with the formulation. Large amounts may cause a toxic reaction.

The dried, powdered extract is more concentrated than stem alone.

Monitor patient's serum potassium level.

Assess patient for signs and symptoms of hypokalemia, including weakness, muscle flaccidity, and abnormal ECG results.

Horsetail shouldn't be used for extended periods because of the potential for toxic reaction and thiamine depletion.

Instruct patients to stop taking horsetail immediately if signs or symptoms of nicotine toxicity (muscle weakness, abnormal pulse rate, fever, ataxia, and cold extremities) or potassium depletion (muscle cramping, irritability, or weakness) occur.

If patient is pregnant or breast-feeding, advise her not to use horsetail.

Advise patients taking a potassium wasting diuretic, a cardiac glycoside (Lanoxin), a corticosteroid, or licorice not to use horsetail.

Tell patient to notify pharmacist of any herbal or dietary supplement that he's taking when obtaining a new prescription.

Advise patient to consult his health care provider before using an herbal preparation because a conventional treatment with proven efficacy may be available.

Safety Risk Horsetail should be kept out of reach of children because poisonings have been reported in those that used the stems as blowguns or whistles.

Research summary

The FDA lists horsetail on its undetermined safety list. Horsetail is still found in some over-the-counter herbal preparations. It has been shown to contain small amounts of nicotine and other active compounds, and is a marginally effective diuretic.

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