Borage Nataly Martini BPharm, MSc, PhD School of Pharmacy, The University of Auckland, PB 92019, Auckland, New Zealand. Email: n.martini@auckland.ac.nz J PRIM HEALTH CARE 2021;13(3):289–290. doi:10.1071/HC19564 Published 30 September 2021 B orage (Borago officinalis) is an annual herb traditionally cultivated for its culinary and medicinal purposes. Native to the Middle East, Mediterranean, and North Africa, borage leaves have been used in a variety of dishes in fresh or dried form. Flowers are edible and are commonly used as a garnish or decoration in cocktails and desserts. The plant is also commercially cultivated for borage oil extracted from the seeds. In tradi- tional medicine, borage products have been used in the treatment of gastrointestinal, respiratory, car- diovascular, and urinary disorders. Purported to be effective in the treatment of inflammatory skin disorders, rheumatoid arthritis, depression, diabe- tes, premenstrual syndrome, alcoholism, and attention-deficit hyperactivity disorder, borage oil has also been used to enhance breast milk produc- tion and added to infant formula to promote neu- rodevelopment in preterm infants. COMMON NAMES: Bee Plant, Beebread, Borage Oil, Borage Seed Oil, Borago, Common Borage, Cool Tankard, Ox’s Tongue, Starflower, Starflower Oil, Talewort. PREPARATIONS: Borage leaves and flowers are available as a herbal tea; borage seed oil is available as liquid drops, capsules, and softgels. Borage is also formulated into skincare products including essential oil, body lotion, hand, foot and eye cream, and soap. MEDICAL CLAIMS: Borage has been reputed to play a role in maintaining heart, skin, cell membrane and nerve health. Borage seed oil is claimed to have anti- inflammatory, antioxidant, anticancer, anti-atopic, and antioestrogenic effects with blood pressure lowering, antiplatelet and cardiovascular benefits. It is also touted as a restorative agent on the adrenal cortex. ACTIVE CONSTITUENTS: Borage is a source of gamma- linolenic acid (GLA), an omega-6 fatty acid. Borage seed oil contains between 18–26% GLA as well as Summary message Some evidence exists for the use of borage in inflammatory diseases such as rheumatoid arthritis. However, results are inconsistent due to variability in products, dosing and duration of use. Furthermore, individual genetic variation may influence the efficacy of GLA-containing seed oils. Supplementation should be discouraged in pregnancy and lactation due to limited evidence, and risk of hepatotoxicity in the mother due to harmful PA compounds. PAs may also be excreted through breast milk. Borage supplements are generally well tolerated with gastrointestinal effects most commonly reported. PAs may cause hepatotoxicity when used in high doses over a prolonged period of time and only PA-free products should be consumed orally. Borage may increase bleeding time if used concomitantly with anticoagulants and antiplatelet agents. Caution is advised with CYP3A4 inducers and hepatotoxic drugs. It is advised borage supplementation is stopped 2 weeks before surgery. Herbal medicines are a popular health care choice, but few have been tested to contemporary standards. POTION OR POISON? summarises the evidence for the potential benefits and possible harms of well-known herbal medicines. CONTINUING PROFESSIONAL DEVELOPMENT POTION OR POISON? 289 CSIRO Publishing Journal compilation Ó Royal New Zealand College of General Practitioners 2021 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License